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   Table of Contents - Current issue
Coverpage
July-September 2020
Volume 5 | Issue 3
Page Nos. 99-154

Online since Wednesday, September 30, 2020

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EDITORIAL  

Diabetes mellitus and COVID-19: The ominous duo p. 99
Sanjay Kumar Bhadada, Rimesh Pal
DOI:10.4103/jncd.jncd_65_20  
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ORIGINAL ARTICLES Top

Determinants of cervical cancer screening uptake among women attending selected family planning clinics in Ibadan, Oyo state, Nigeria p. 102
Chizoma Millicent Ndikom, Abiola B Ajibade, Timothy A Oluwasola
DOI:10.4103/jncd.jncd_10_20  
Background: Cervical cancer screening (CCS) continuously has low awareness and is poorly utilized in developing countries despite higher incidence of cervical cancer (CC). Increasing incidence of CC has been associated with late reporting of symptoms, ignorance about the disease, and its preventive measures. This study was conducted to further investigate the determinants of CCS uptake among women attending selected family planning clinics in Ibadan, Nigeria. Materials and Methods: Adopting a cross-sectional design, 205 consenting respondents attending family planning clinics were interviewed using an interviewer-administered questionnaire. The data collected were analyzed using Statistical Package for the Social Sciences version 21. The hypotheses were tested using Chi-square, odds ratio, and logistic regression at P < 0.05. Results: The mean age of the respondents was 33 ± 8 years; 176 (85.9%) were married and 72 (35.1%) had tertiary education. Although 71% of the respondents were aware of CC, only 37.1% had good knowledge and 16.1% had previously utilized CCS. About two-thirds (68.8%) of the respondents were willing to uptake CCS, except for perceived barriers such as lack of understanding of the disease and inadequate information about the services coupled with limited availability of the CCS services. There was a significant association between uptake of CCS and knowledge (χ2 = 17.944, P < 0.001), education (χ2 = 7.724, P < 0.024), and income (χ2 = 32.22, P < 0.001). On logistic regression, the uptake CCS remained influenced mainly by income of >40,000 Naira (OR = 5.355, CI = 1.678–17.083) and knowledge (OR = 3.112, CI = 1.247–7.768). Conclusion: Family planning clinics are readily available centers for increasing the knowledge base of the women on the need for regular CCS. This needs to be duly incorporated into our routine services.
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A school-based program for diabetes prevention and management in India – project KiDS and diabetes in schools p. 107
Tina Rawal, Radhika Shrivastav, Gaurang P Nazar, Nikhil Tandon, Monika Arora
DOI:10.4103/jncd.jncd_31_19  
Background: The purpose of this study is to describe the conceptualization and implementation of project KiDS and diabetes in schools (KiDS) in Delhi, India. Objective: Project KiDS was implemented to foster a supportive school environment for optimal management and care of children with type 1 diabetes (T1D) and the prevention of type 2 diabetes (T2D) through the adoption of healthy lifestyles. Methods: Project KiDS was initiated with a feasibility study (Phase-1); including a situational analysis through desk review of preexisting epidemiological data, national policies/existing projects focused on diabetes prevention and management for Indian school settings and in-depth Interviews with multiple stakeholders. In Phase-2, the international diabetes federation's global school diabetes information pack was culturally and contextually adapted, pretested and finalized for use in India and implemented in eight private and seven government (public) schools (Grades 1–9) of Delhi, India. Components included: training of school staff, follow-up educational activities with students, and engaging parents through social media. Results: In Phase-1, nine interviews were conducted with representatives from the Government and nongovernment organizations. Almost all respondents and literature emphasized the need to develop a comprehensive awareness program for the management of T1D and the prevention of T2D in schools. 1149 teachers were trained. Follow-up activities were conducted with 27,937 children. Over 80% of teachers were satisfied with the trainings. Conclusion: Positive feedback from trainings and implementation of project KiDS has important implications to feed into future programmatic and policy interventions for robust school-based diabetes management and prevention.
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A cross-national, cross-cultural comparison of predictors of academic performance among Canadian and Malaysian university students p. 114
Tricia L da Silva, Fatimah Shahruddin, Lai Fong Chan, Marhani Midin, Arun V Ravindran
DOI:10.4103/jncd.jncd_32_19  
Background: Poor academic outcomes among postsecondary students are a concern to academic institutions globally. Several sociodemographic, psychosocial, and academic functioning factors are proposed as contributory. As most literature is from Western countries, global generalizability is limited. The aim of this 1-year study was to conduct a prospective cross-cultural comparison of factors impacting academic performance among university students from Canada and Malaysia. Methods: First-year undergraduate students were recruited from University of Toronto Scarborough and Universiti Kebangsaan Malaysia at the start of their academic year. Participants completed a comprehensive range of self-report measures on relevant factors. Information on their year 1 academic performance was obtained from the universities. The data were assessed using Chi-square, analyses of variance, and multiple linear regressions. Results: For Canadian students (n = 224), parents' educational levels, self-reported stress, coping, mental health knowledge, and physical activity were predictors of year 1 academic performance. For Malaysian students (n = 139), gender, ethnicity, academic amotivation, and peer engagement were predictors of year 1 academic performance. Attrition over the year was higher among Canadians (6%) than Malaysians (0%), but numbers were insufficient to determine likely predictors of dropout. Conclusions: The differences in predictors of academic performance between the Canadian and Malaysian students suggest that cultural factors may play an important role in academic outcomes. Intervention and prevention strategies customized to the local context are supported.
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Biomonitoring of biomarkers among pesticide sprayers and nonsprayers across cropping seasons in Punjab, India p. 123
JS Thakur, Soundappan Kathirvel, Samir Malhotra, Nusrat Shafiq, Jatinder Paul Singh Gill, Kulbhushan Tikoo, Shyam Biswal
DOI:10.4103/jncd.jncd_49_20  
Introduction: Pesticide exposure causes acute and chronic adverse health effects on humans affecting the Kelch ECH-associated protein (Keap1)- nuclear factor erythroid 2-related factor 2 (Nrf2) and other oxidative pathways. We assessed the Keap1-Nrf2 pathway and other oxidative stress biomarker levels among a cohort of agricultural pesticide sprayers (SP) and nonspraying (NSP) farmers of a rural community during the cotton and wheat cropping seasons in India. Methodology: We randomly selected eight villages from the four blocks of Bathinda district, Punjab. Using a cohort study design, we collected the socio-demographic characteristics and biological samples (blood and urine) from 68 SP and 71 NSP at baseline, during the flowering seasons of cotton and wheat crops at scheduled time points. The United States Environment Protection Agency methods and standards were used to detect pesticide residues. Standard and validated enzyme-linked immunosorbent assay-based kits and colorimetric method-based kits were used to detect the biomarkers of Keap1-Nrf2 and oxidative stress pathways. Results: In Keap1-Nrf2 pathway, cotton season glutathione peroxidase (P = 0.004) and baseline heme oxygenase-1 (P < 0.001) levels were significantly different between SP and NSP. However, glutathione reductase and glutathione s-transferase levels were not significantly different. Among oxidative stress and inflammatory biomarkers, a significant difference (P < 0.05) was observed between the groups during the cotton season in malondialdehyde, isoprostane, protein carbonyl, C-reactive protein, and interleukin-6. Conclusion: The Keap1-Nrf2 and other oxidative stress biomarker levels between the group were not consistently different all times across the seasons. The biomarker levels of SP and NSP need to be compared with the nonagricultural population.
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Poor awareness of diabetes self-care among diabetics: Cross-sectional study from an urban poor settlement in Delhi p. 131
Gurkirat Kaur, Shomik Ray, Niveditha Devasenapathy
DOI:10.4103/jncd.jncd_13_20  
Introduction: Lack of awareness about self-care and misconceptions about diabetes could have a negative impact on diabetes management. We aimed to assess the knowledge, attitude, and practices about diabetes self-care among diabetic individuals. Subject and Methods: We undertook a community-based quantitative survey in an urban poor colony of West Delhi. Using structured questionnaires, we collected the information on sociodemographic profile, knowledge, and perception regarding diabetes self-care and related expenses, from all consenting self-reported diabetic individuals. Results: Out of 198 individuals with diabetes from 543 households, 106 completed the interview. The mean age was 53 years, with a median of 5 years since the diagnosis. Equal numbers sought care from the private and government facilities with median expenses on diabetes care being INR 855 (INR 0-3900) per month. Many (28.7%) availed blood glucose tests from nearby government sponsored Mohalla clinic and none had tested hemoglobin A1C. Most (86.7%) were aware of eye complications due to diabetes and least (8.5%) about neuropathic and vascular complications. We found misconceptions regarding medications and physical activity. Perceived ability of following prescribed medications were better than hypoglycemia management and foot-care. Higher perception score was independently associated with the duration of diabetes, higher socioeconomic status, literacy, and those availing government facilities. Most clinic visits involved the prescription of medications and diagnostics without much emphasis on the lifestyle modifications. Conclusion: Diabetics living in the urban poor settlements have accessibility to medicines and diagnostics. However, there exists misperception regarding diabetes self-care that needs to be addressed through counseling during outpatient clinic visits and effective use of mass media.
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REVIEW ARTICLE Top

A “Bottom-up approach” to introduce ban on tobacco products to prevent spitting during COVID-19: An early review of progress made and challenges p. 138
Pranay Lal, Deepak Mishra, Rana Jugdeep Singh
DOI:10.4103/jncd.jncd_17_20  
On March 11, 2020, WHO announced that a novel coronavirus disease 2019 (COVID-19) had transformed into pandemic. Since then, it has challenged health systems and tested the governance of every country. In India, national and sub-national governments have responded by proposing new policies to stop the advance COVID-19 through a slew of measures. Among these was prohibiting smoking and spitting, especially that induced by the use of smokeless tobacco in public places, which could potentially spread the infection further. States and districts were first to propose strict orders, which was followed by advisories and orders at the national level, which supported sub-national implementation. It is premature to estimate the impact of restricting tobacco trade, sale, and use on COVID-19 transmission; however, this early review assesses efforts made which national and sub-national commitment (or lack of it) towards tobacco control.
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RESEARCH PROTOCOL Top

Effectiveness of interventions by nurse practitioners for prevention and control of noncommunicable diseases in low- and middle-income countries: A systematic review protocol p. 143
Kavita Kavita, JS Thakur, Sandhya Ghai, Tarun Narang
DOI:10.4103/jncd.jncd_24_20  
Introduction: Low- and middle-income countries (LMICs) face numerous challenges in the implementation of noncommunicable disease (NCD) prevention programs due to a shortage of health manpower. Task shifting to nurses is a viable and effective solution to address the health-care human resource crisis. The major advantage of involving nurses is that they are the largest, skilled, and already established workforce in any health-care institution. Despite the effectiveness of NCD interventions by nurse practitioners (NPs), there is a relative lack of evidence from LMICs which prevents the scale-up of the NPs model for better health outcomes. We, therefore, intend to assess the existing evidence on the effectiveness of interventions by NPs for the management of chronic NCDs in LMICs. Methods and Analysis: Electronic databases, i.e., PubMed, Excerpta Medica Database (EMBASE), CINAHL, Cochrane Central Register of Controlled Trials, and clinical registries of different LMICs in the English language shall be searched between 2004 and 2019 (last 15 years). Research designs to be included are randomized controlled trials, before–after studies, and Quasi-experimental studies. The primary outcome includes the change in behavioral risk factors, physiological risk factors, and clinical parameters. Subgroup and sensitivity analysis will be performed. Ethics and Dissemination: Ethical approval has been obtained from the institute ethics committee. Results will be disseminated through peer-reviewed scientific journals and presentation at national and international conferences. Study Design: Systematic review. PROSPERO registration number CRD42019118430
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Study of modifiable risk factors for instituting evidence-based preventive strategy for carcinoma esophagus in Punjab: A study protocol p. 149
Harmanjeet Kaur, JS Thakur, Usha Dutta, Savita Attri, Nalini Gupta, Mini P Singh, Kim Vaiphei, JP S Gill, Rajesh Dikshit
DOI:10.4103/jncd.jncd_33_19  
Background: In Punjab, esophageal carcinoma has been reported as leading cancer in rural population. Reason for this high incidence of esophageal carcinoma in this region is unknown. The life style of people in Punjab is different from those of other areas in India. Therefore, the risk factors contributing to esophageal carcinoma in Punjab may also be different than the other parts of India. There are no previous studies on risk factors for high incidence of esophageal carcinoma in this region. Use of pesticides is much higher in Punjab state. Also there is no evidence available for association of use of pesticides/fumigants in occurrence of esophageal carcinoma. Hence this study is planned to identify the risk factors, especially the role of chemical toxicity (Pesticides/fumigants/heavy metals) associated with development of esophageal carcinoma among inhibitants of Punjab. Methods: A case-control design will be used to identify potential risk factors associated with development of carcinoma esophagus in Punjab. Cases will be recruited from PGIMER, Chandigarh, Population based cancer registry Mansa, Sangrur, SAS Nagar and Punjab Cancer control cell. For each esophageal cancer case 2 controls will be selected after matching for gender, age and area of residence. A pre designed questionnaire, including demographic characteristics, family cancer history, personal medical history, height, weight, life-style (habits such as smoking, tobacco chewing, alcohol drinking, etc.), dietary habits, fumigants and pesticide usage and practices etc, will be used. Urine samples will be taken for the analysis of pesticide metabolites. Heavy metals analysis will be done in water samples. Oral health will be examined for mucosal changes as well as for oral hygiene. Discussion: This study will results in identification of risk factors for high occurrence of esophagus carcinoma in Punjab, so that measures for early detection, prevention and control of esophagus carcinoma could be initiated.
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