Mb Soudarssanane

Community-based Randomized Controlled Trial of Non-pharmacological Interventions in Prevention and Control of Hypertension among Young Adults

Context: Hypertension is a major chronic lifestyle disease. Several non-pharmacological interventions are effective in bringing down the blood pressure (BP). This study focuses on the effectiveness of such interventions among young adults. Aims: To measure the efficacy of physical exercise, reduction in salt intake, and yoga, in lowering BP among young (20-25) pre-hypertensives and hypertensives, and to compare their relative efficacies. Settings and Design: The study was done in the urban service area of JIPMER. Pre-hypertensives and hypertensives, identified from previous studies, constituted the universe. The participants were randomized into one control and three interventional groups. Materials and Methods: A total of 113 subjects: 30, 28, 28 and 27 in four groups respectively participated for eight weeks: control (I), physical exercise (II) - brisk walking for 50-60 minutes, four days/week, salt intake reduction (III) - to at least half of their previous intake, and practice of yoga (IV) - for 30-45 minutes/day on at least five days/week. Statistical Analysis Used: Efficacy was assessed using paired t test and ANOVA with Games Howell post hoc test. An intention to treat analysis was also performed. Results: A total of 102 participants (29, 27, 25 and 21 in groups I, II, III and IV) completed the study. All three intervention groups showed a significant reduction in BP (SBP/DBP: 5.3/6.0 in group II, 2.6/3.7 in III, and 2.0/2.6 mm Hg in IV respectively). There was no significant change (SBP/DBP: 0.2/0.5 mmHg) of BP in control group (I). Physical exercise was most effective (considered individually); salt intake reduction and yoga were also effective. Conclusions: Physical exercise, salt intake reduction, and yoga are effective non-pharmacological interventions in significantly reducing BP among young hypertensives and pre-hypertensives. These can therefore be positively recommended for hypertensives. There is also a case to deploy these interventions in the general population.

Tracking of Blood Pressure Among Adolescents and Young Adults in an Urban Slum of Puducherry

Background: Early diagnosis of hypertension (HT) is an important strategy in its control. Tracking of blood pressure (BP) has been found useful in identifying persons with potential HT, particularly in youngsters. A cohort of 756 subjects (with baseline information as a cross-sectional study in 2002) was followed up in 2006 to comment on the distribution of BP and its attributes. Objectives: To track BP distribution in a cohort of adolescents and young adults, and assess the persistence of high/low normotensives; to measure the incidence of HT and study the relationship of BP with age, sex, socioeconomic status, BMI, physical exercise, salt intake, smoking and alcohol consumption. Materials and Methods: The baseline study cohort (2002) of 756 subjects (19-24 years) in urban field area of Department of Preventive and Social Medicine, JIPMER, was followed up between May and November 2006 by house visits for measurement of sociodemographic variables, anthropometry, salt intake, physical activity and BP. Results: A total of 555 subjects from the 2002 cohort were contacted (73.4%), in that 54.5% subjects who were below 5th percentile, 93.6% subjects between 5th and 95th percentiles and 72% of those above 95th percentile previously persisted in the same cut-offs for systolic blood pressure (SBP). The corresponding figures for diastolic blood pressure (DBP) were 46.2, 92.2 and 74.1%, respectively. Shift from one cut-off to another was not significant for both SBP and DBP, proving the tracking phenomenon. Annual incidence of HT was 9.8/1000. Baseline BP was the significant predictor of current BP for the entire cohort; BMI and salt intake were significant predictors only in certain sections of the study cohort. Conclusions: Early diagnosis of hypertension even among adolescents/young adults is an important preventive measure, as tracking exists in the population.

Unnecessary injections given to children under five years

Adults accompanying 64 children attending a hospital out-patient clinic were questioned about treatment and injections given for illnesses in the previous month. Half the children had received injections, almost all given by private doctors: we consider most of these injections to have been unnecessary. Three girls were paralysed by aggravation poliomyelitis after unnecessary injections. Adults approved of injections although they did not know what was injected.

Consumption of fallen umbilical cord stump as a treatment for infertility: A case study from Puducherry

Infertility is a stigma. The high cost and inaccessibility to treatment turn infertile couples to faith-based alternatives or practices that have been passed down from generation to generation. This report describes a case in which a woman consumed the umbilical cord stump to treat infertility. Initially, this incidence was reported in March 2006 by undergraduate students from the Kurusukuppam area of the Urban Health Centre of the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). This lower-middle class family consisted of RK, his wife G, his mother T and daughters of RK and G. RK was 37 years old, semi-literate and a painter; G was a housewife and educated up to the eighth standard. Six months after their marriage, G became pregnant, but had an abortion in the third month of pregnancy. Thereafter, the couple waited for four years, but G could not conceive. She consulted private allopathic doctors, who prescribed her some medicines without carrying out any investigation/follow-up. Meanwhile, T advised G to consume the umbilical cord stump. In January 2003, G visited Chennai in order to assist her sister-in-laws delivery. Other women present there also advised her to consume the neonates cord stump as a remedy for her infertility. After a simple ceremony on the eighth day, G consumed a 1-cm-long dried umbilical cord stump embedded in a banana. She conceived the next month. G opined that this sequence of events (pregnancy immediately following the consumption of stump) suggests the curative role of the cord stump. T recalled that 15 years ago, her neighbor had demonstrated the pro-fertility potential of the umbilical cord stump. Both T and her neighbor believed that the stomach (errai pai) is connected to the uterus (garppa pai), and that the cord had entered the uterus via the stomach, thus inducing pregnancy. In July 2006, during the community posting for undergraduates, a similar practice was reported in Pullichappallam, Tamil Nadu. A local remedy for infertility in this area was consuming the fallen cord stump. In a focus group discussion (FGD), P (a 40-year-old lady) commented, “If conception does not occur within five months of marriage, we wait for an opportunity to give a fallen cord stump to the ‘infertile’ woman. This practiceis common in our family and has been successful on all occasions.” She had recommended this to three of her relatives, one of whom was infertile for five years. In all instances, conception occurred within a few months. None of them took allopathic treatment. The FGD revealed the belief that the cord ‘donor’ can become infertile; hence, the infertile women should consume it without making the donor aware of it. Similar practice exists in Kattupalayam and Vannur areas of Tamil Nadu. A newspaper has reported the practice of consuming the products of the third-stage labor for curing infertility in the villages of Thirumangalam taluk of Madurai district, Tamil Nadu.(1) This practice has been documented in the Chenchu tribes of Nallamalai Hills in Andhra Pradesh.(2) They believed that the umbilical cord produces special fertility juice in the infertile woman. Elsewhere, a similar practice has been reported from primitive cultures of Australia, Africa and Hawaii.(3) This case report brings to light the fact that this practice is not restricted to few families. Reportedly, all known cases have resulted in pregnancy. While we may not share this belief, it highlights the common mans concept about the process of reproduction. Hence, the first step in infertility treatment should be creating awareness about human sexual function and clarify myths associated with infertility since they restrict the afflicted couples from seeking appropriate medical treatment. Peoples faith in modern medicine should actually improve when infertility treatments become more accessible and affordable. However, if a series of cases such as the abovementioned incidents occur, it may then become necessary to epidemiologically study such interventions.

Teaching epidemiology of acute diarrheal diseases to medical undergraduates—A new approach

A total of 165 students of first clinical year were taught the epidemiology of acute diarrheal diseases, during three successive years using a detailed lesson plan. The usual didactic lecture was minimised and supplemented by slide shows, and transparencies based on the contents of a handout on the subject distributed to all students a day prior to the class. This was followed by participatory discussions by the students on the diagnosis and management of some case examples presented. A video clip summarising the entire lesson was screened for reinforcement. Feed-back from the students showed that the teaching methodology was rated very good by 41%, and satisfactory by 59%. While 73% of the students mentioned videoclips as a factor favouring their learning, 69% cited the handouts and 49% felt that case discussions were helpful. Objective evaluation on the performance in the sessional test showed that out of 158 students who attended the test, 75% scored above 50% marks, 21% below 50% and the remaining 4% did not attempt that question.

Biased goiter prevalence estimate

Sir, There are some basic queries related to the article ‘Prevalence of Goiter in Rural Area of Belgaum District, Karnataka’(1). In the introduction the authors should have made some mention of the magnitude of the problem in Karnataka from earlier studies or should have informed that no such study is available. Under materials and methods mention has been made as community based cross sectional study; a cross sectional study by nature is community based. In this study 950 subjects were contacted; 334 males and 616 females. The sex ratio is highly skewed and is not representative of any of the sex ratio across the country. The higher prevalence among females is represented in the higher overall prevalence which is a gross overestimate. Therefore, subsequent sub-analysis and multiple logistic regressions are unreliable. Though in the results 950 subjects are accounted for, yet a limitation is mentioned that those who were not available could not be examined which depicts serious uncertainty since the whole population of the two villages are not mentioned and the percentage unaccounted persons can not be assessed.