Objective: To study the prevalence of hypertension and variation in blood pressure (BP) level among school children in rural India. Design: A cross-sectional study was conducted during the period from April 2010 to March 2012. Setting: Participants comprised of 958 school children (in the age group of 6-16 years) from 83 schools covered by three randomly selected primary health centers. Materials and Methods: After obtaining informed consent from the school principal, a pretested questionnaire was administered and anthropometric measurements were taken. Hypertension was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥95 ^th percentile for age, gender, and height measured on three distinct occasions. Results: Overall, prevalence of hypertension and was found to be 29 (3.0%). The proportion of hypertension among males was 13 (2.8%) against 16 (3.2%) in females. Overall mean SBP level was 97.2 mmHg and DBP level was 62.1 mmHg. Conclusion: SBP and DBP found to be correlated with the body mass index, waist circumference, which identifies the need of proper dietary changes at individual and family level. Constructed nomogram for study participants show lesser SBP and DBP values for 90 ^th and 95 ^th percentiles among Indian children when compared to NHLBP guidelines. This suggests lesser BP cut-off needed to identify maximum hypertensive population among Indian children.

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The present study was aimed to find out the prevalence of overweight and obesity and its associated factors among Bengalee children and adolescents in the Kolkata, India. A total of 1061 Bengalee school children and adolescents (610 boys and 451 girls) participated and were divided into three age groups: Group I = 8-11 years; Group II = 12-15 years and Group III = 16-18 years. Overweight and obesity were defined as: Overweight (between ≥85 ^th and <95 ^th percentile) and obesity (≥95 ^th percentile). Multivariate regression analyses (adjusted for age and sex) of body mass index (BMI) revealed that about 18% (R² = 0.185) of total variance of BMI could be explained by monthly family income, participants think obese, consumption of too much junk foodstuffs, breakfast skip, extra consumption of salt, and computer hours. Sedentary lifestyles, including increasing fast food preferences may be responsible for increasing occurrence of pediatric and adolescent obesity in this population.

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It was a qualitative enquiry conducted amongst Gujjar population of Shimla district, Himachal Pradesh (HP). The study was carried out to link various lifestyle factors of the Gujjar population with the 2002 outbreak of plague in HP. Focus Group discussions guide was prepared beforehand which had information about education, livelihood, dietary pattern, relationships, personal hygiene and habits and health care utilization. It was emerged out of the study that the population has poor literacy levels, poor personal hygiene, overcrowding in hutments, closely-knit social structure, lack of awareness about common diseases, and frequent visits to forests and living in caves during their visits. Further, government health care facilities are not routinely utilized by the Gujjar community. These factors might lead to increased proximity and exposure to wild rats among Gujjar population, thus increasing their susceptibility to plague. They are, therefore a potential link between any source of infection in forests and in native population of HP and other states. The government agencies should take various measures to increase health care access of such vulnerable population through outreach health care programs.

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Background: Coronary heart disease is multi-factorial in origin and its burden is expected to rise in developing countries, including India. Evidence suggests that the inflammation caused by infection is associated with the development of atherosclerosis and heart disease. An increasing number of clinical and experimental studies point to a contribution of various infectious organisms to the development of atherosclerosis in humans. Acute myocardial infarction (AMI) is associated with atherosclerosis. Objectives: The objective of the following study is to study the association between Helicobacter pylori, Chlamydia pneumoniae and C-reactive protein (CRP) with AMI. Materials and Methods: This group-matched case-control study was carried out in Government Medical College, Nagpur, Maharashtra, India. The study compared the risk of occurrence of AMI (outcome) if subjects were ever-infected with H. pylori or C. pneumoniae; and their CRP positivity (exposure). Incident cases of myocardial infarctions in a tertiary care hospital were included as cases. Results: The study recruited 265 cases and 265 controls and detected an odds ratio (OR) of 2.50 (95% confidence interval [CI]: 1.69-3.70) and an OR of 2.50 (95% CI: 1.71-3.65) for C. pneumoniae and H. pylori, respectively. Raised CRP levels had an OR of 3.85 (95% CI: 2.54-5.87). Conclusion: Although our study indicates the role of infections in the etiology of AMI in study population, the relative public health impact of these agents in the overall prevalence of AMI needs urgent research attention.

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Objectives: Growth curves are the most important tools for the assessment of growth of children, which could further helps to develop preventive interventions. Geographical and physical differences necessitate using national growth curves. This study aims to construct growth curves using anthropometric measurements namely weight and height for Indian children using cross-sectional data from National Family and Health Surveys. Materials and Methods: Box-Cox power exponential, a flexible distribution, was used that offers to adjust kurtosis and improves the estimation of extreme percentiles. LMS-methods that fit skewed data adequately and generate fitted curves that follow closely the empirical data, with maximum penalized likelihood, Akaike information criteria (AIC) and generalized AIC with penalty 3 were used to construct the growth curves. Before fittings this model factors which influence the nutritional status of children were examined, similar to World Health Organization (WHO) (2006) factors, namely standard infant feeding practices, sanitation, non-smoking mothers additionally poverty (household consumable assets based). Results: Model fitted in LMS-model and standard based on height and weight for children aged 0-60 months was obtained after iteration for degrees of freedom for the parameters. Growth curves for mean Z-scores and percentiles were constructed for both sexes and significant lower values were noticeably found to be set as growth-standard compared to WHO-standards. Conclusion: Study showed the prospect of constructing regional/national growth curve and their need for the assessment of children's growth, which could help to identify undernourished-children at national level. There is an urgent need to collect longitudinal data of children to fit the growth curve of children in India.

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Obesity has reached epidemic proportions globally and the prevention of adult obesity will require prevention and management of childhood obesity. A study was conducted to determine the prevalence and behavioral determinants of overweight and obesity in school going adolescents. A total of 660 adolescents from affluent and nonaffluent schools were taken. Overweight and obesity was defined as per World Health Organization 2007 growth reference. Prevalence of overweight and obesity was 9.8% and 4.8%, respectively. Prevalence of both overweight and obesity was higher among males. Statistically significant difference was found in prevalence of overweight and obesity among affluent schools (14.8% and 8.2%) and nonaffluent schools (4.8% and 1.5%). Important determinants of overweight and obesity were increased consumption of fast food, low physical activity level and watching television for more than 2 h/day. The prevalence of obesity is high even in small cities. Dietary behavior and physical activity significantly affect weight of adolescent children.

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Background: The feasibility of using mobile health clinics (MHCs) to deliver health services in urban poor areas has to be explored as the health needs of the residents are not sufficiently addressed by the existing primary health care delivery system in India. Objective: To estimate the cost of providing primary health care services and the out of pocket expenditure (OOPE) incurred, while utilizing these services provided through the MHC based Urban Health Program of a Medical College in North India for the year 2008-2009. Materials and Methods: A cross-sectional study to estimate OOPE was conducted among 330 subjects selected from patients attending the mobile health care facility. For estimation of provider cost, 5 steps process involving identification of cost centres, measurement of inputs, valuing of inputs, assigning of inputs to cost centers, and estimation of unit cost were carried out. Results: Total annual cost of providing services under Urban Health Program in the year 2008-2009 was Rs. 7,691,943 Unit cost of providing outpatient curative care, antenatal care, and immunization were Rs. 107.74/visit, Rs. 388/visit and Rs. 66.14 per immunization, respectively. The mean OOPE incurred was Rs. 29.50/visit, while utilizing outpatient curative services and Rs. 88.70/visit for antenatal services. Conclusion: The MHC can be considered as a viable option to provide services to urban poor.

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Literature reveals theories explaining low birth weight (LBW) babies' unplanned catch-up growth is related to several non-communicable diseases (NCDs) in adult-life. Is the current growth chart as per World Health Organization child growth standards of healthy breast feed infants and young child is applicable for even LBW or small for gestational age babies? There are high chances that these LBW babies who are growing "in their centiles" will be diagnosed as mild or moderate protein energy malnutrition (PEM) in clinical settings as the current diagnostic criteria for PEM do not include birth weight as an indicator. Besides they are encouraged for home based extra caloric food to gain weight and thereby encouraging them to "crossing the percentile" in the growth curve. Do these managements really benefit the baby or are we inadvertently exposing them to increased future risk of adult diseases must be considered seriously. Thus, we may require revision to make a separate standardized growth chart for LBW babies indicating how they should grow.

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Background: It is hypothesized that exposure to transportation noise is associated with an increased risk of cardiovascular disease among adult population. The present study further explores this association in the light of new findings. The objective of this study was to perform a meta-analysis of studies reported during the last 3 decades on the association of transportation noise exposure with cardiovascular disease endpoints among adult population in cross-sectional studies. Materials and Methods: Relative risks were pooled from 12 studies by using an inverse-variance weighted fixed-effects model. The cardiovascular health outcomes included ischemic heart disease, myocardial infraction, angina pectoris, electrocardiogram-ischemia and cardiovascular medication. Results: The pooled risk estimate (95% confidence interval) of 1.04 (0.96-1.12), shows a positive but nonsignificant association. The sensitivity analysis, conducted by excluding studies one by one, resulted in a positive and significant risk estimate. Contrary to the earlier meta-analysis, this study observed heterogeneity among subgroups and produced significant positive results to show that there exists an association between air traffic noise exposure and cardiovascular disease. It was also observed that the risk of cardiovascular disease due to exposure to transportation noise has increase to significant levels over the last 30 years. Conclusion: It can be concluded that though the association between transportation noise exposure and cardiovascular disease is evident, but not at a significant level. This study although provides evidence that air traffic noise is a serious cause of concern.

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National iodine deficiency disorders control program needs to be continuously monitored. Hence, a cross-sectional study was conducted during the period from April-May 2011 to assess the prevalence of goiter, status of urinary iodine excretion (UIE) level and to estimate iodine content of salts at the household level in Darjeeling district, West Bengal. Study subjects were 2400 school children, aged 8-10 years selected through "30 cluster" sampling methodology. Goiter was assessed by standard palpation technique, UIE was estimated by wet digestion method and salt samples were tested by spot iodine testing kit. Overall goiter prevalence rate was 8.7% (95% confidence intervals = 7.6-9.8) and goiter prevalence was significantly different with respect to gender. Median UIE level was 15.6 mcg/dL (normal range: 10-20 mcg/dL). About 92.6% of the salt samples tested had adequate iodine content of ≥15 ppm. Findings of the present study indicate that the district is in a transition phase from iodine-deficiency to iodine sufficiency.

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A cross-sectional study was conducted to estimate and to compare immunization coverage and to understand reasons of partial/non-immunization among children of seasonal migrant sugarcane harvesting laborers and nonmigrating children. Caretakers of a total of 420 children between 12 and 23 months age were interviewed in 30 clusters consisting 14 children from each cluster (seven from each group) by expanded program on immunization cluster survey method. Statistical analysis was performed with proportions, their 95% confidence intervals (CI), Chi-square test, and binary logistic regression. Full immunization coverage rate was 89.5% (95% CI: 86.5-92.5) for children in nonmigrating group and 70.5% (95% CI: 66.0-74.9) for migrant group. Reasons cited for unimmunized/partially immunized were, place or time of vaccination not known, unavailability of immunization services at site, inconvenient time of sessions, unaware of need for vaccination etc. Thus full immunization coverage rate was significantly lower among children of seasonal migrant sugarcane harvesting laborers.

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