Thai diabetes prevention education program: development and validation of the Thai physical activity questionnaire for at-risk people Abstract Aim This study aimed to develop and validate the Thai physical activity questionnaire (Thai-PAQ) for Thai people at risk for type 2 diabetes (T2D). Subjects and methods After development and validation of the questionnaire, 95 people at risk for T2D were recruited. The Thai-PAQ was developed based on the International-PAQ. The Thai-PAQ was evaluated by three experts to ensure content validity. The at-risk people were interviewed using the Thai-PAQ for the previous 7 days’ activities. Spearman’s correlation was used to compare the accelerometer and Thai-PAQ for concurrent validity. Interclass correlation was used to evaluate the reliability of the Thai-PAQ separated by 3 days. Chi-square test was used to represent significant differences (p < 0.05) in the proportion of participants meeting the current physical activity guidelines. Results The content validity of the Thai-PAQ was 0.91. The total physical activity from the Thai-PAQ (MET-min week−1), which included the part-time occupation domain and excluded the part-time occupation domain, was significantly correlated with the total physical activity (counts week−1) according to the ActiGraph accelerometer (r = 0.57 and 0.54, p < 0.01, respectively). The 3-day test-retest reliability of the total physical activity of the developed PAQ was 0.86 (p < 0.05) when including the part-time occupation domain and was 0.85 (p < 0.05) when excluding the part-time occupation domain. Conclusions The study showed that that concurrent validity had high correlation compared with the ActiGraph accelerometer. Reliability was also acceptable as high reliability. The Thai-PAQ is considered useful for communities as well as a means to ultimately promote physical activity in communities.

A survey to validate the traditional Siddha perception of diabetes mellitus Abstract Aim To investigate the influence of gender, marital status, specific food, and lifestyle habits that could possibly be the causative factor according to ancient medical texts. Exploring the alternative medicinal knowledge about diabetes mellitus (DM) and validating its authenticity by carrying out a modern-day study with a scientific perception in identifying the specific food and lifestyle causing DM. Subjects and methods Our study was conducted during the period 2015 to 2017 in Tamil Nadu and Kerala States, South India. Data was collected from 1206 individuals aged between 18 and 89 years through a predesigned questionnaire which included seven novel questions acquired from the traditional Indian texts of Siddha medicine. Results A questionnaire-based study conducted using which a total of 1206 subjects (men: 55.4%; women: 44.6%) were evaluated with a mean age of 42.88 ± 13.212 years. A higher number of males were affected than females. It is also evident that married people get more affected by Type 2 ,whereas unmarried subjects were found to be more affected by Type 1. There is a significant effect of gender and marital status, and also the influence of specific food and lifestyle habits listed is evident. Conclusions The antiquity of early descriptions of diabetes underscores the importance of the observation and recording of medical conditions as humans evolve; more similar studies should be conducted to validate the data in ancient medicinal texts and to prove their authenticity in the modern scientific era.

Contraceptive use and unmet need for family planning among women with at least one child in rural Uttar Pradesh: the role of wealth and gender composition of children Abstract Aim Family planning has long been recognised as an effective public health intervention to reduce fertility and unwanted births. This study examines the effect of household wealth and gender composition of children on contraceptive use and unmet need for family planning. Subject and methods Our study is based on primary data collected from 460 respondents in the rural areas of the Rae Bareli district of Uttar Pradesh between September 2016 and February 2017. The representative sample comprised 460 currently married women who had at least one living child below 10 years of age. Current use of contraception and an unmet need for family planning were the outcomes variables. Descriptive statistics, a concentration curve and index for inequality, and multivariate techniques were used to examine the association between predictor and outcome variables. Results Our study showed low prevalence and substantial socio-economic differentials in contraceptive use. An unmet need for family planning was concentrated among the poor and the use of contraception was found to be more frequent among affluent women. Household wealth and gender composition of children were significantly associated with contraceptive use and unmet need for family planning. Conclusion There are substantial differentials in contraceptive use and unmet need for family planning in rural Uttar Pradesh. In addition to promoting family planning, there is a need to create an atmosphere to reduce son preference, increase the acceptance of girl babies and remove economic inequalities.

Political, economic, and health system determinants of tuberculosis incidence Abstract Aim Although global tuberculosis (TB) rates have decreased, multidrug-resistant strains have become a concern. Traditionally, causes of infectious diseases are determined through health and health system factors, yet socioeconomic and political variables may influence a nation’s vulnerability and response to infectious disease control. This study explores relationships among political stability, economic stability, tuberculosis detection policies, health system constructs, and the incidence of tuberculosis. Subjects and methods A retrospective, cross-sectional, observational design was employed using open-source, secondary, 2014 country-level data from the World Bank and World Health Organization. A structural equation model examined the direct and indirect effects of economic, political, and other constructs on tuberculosis incidence rates. Results Political and economic stability, health system indicators, and detection policies all covaried. Political stability, health system indicators, and detection policies directly affected tuberculosis incidence rates, but economic stability did not. Political stability and health system indicators were negatively associated with tuberculosis incidence, while detection policies were positively associated. Conclusions Countries with greater political stability and better health systems experienced lower TB incidence, but countries with more detection policies in place had higher TB incidence rates. Economic stability did not directly affect TB incidence, but covaried positively with political stability, indicating strong links to political stability.

Sociodemographic disparities in the consumption of ultra-processed food and drink products in Southern Brazil: a population-based study Abstract Purpose This study aims to describe the distribution of ultra-processed food and drink products (UPP) consumption according to sociodemographic characteristics in adults from southern Brazil, and to investigate which are the most-consumed UPP subtypes in the different social strata. Methods Cross-sectional analysis of the second wave of a population-based cohort of 1720 adults. The usual caloric intake and the caloric contribution of UPP to total energy intake (%CTEI) were estimated by the application of two 24-h dietary recalls (adjusted by intra- and inter-individual variability). Data were analyzed according to gender, age, marital status, schooling, and family income. Linear regression models were used to estimate the adjusted means. Results Consumption data were obtained from 1206 adults (70.1% of the original cohort). Mean UPP consumption was higher in males than females (829.6 kcal vs 694.3 kcal, p value < 0.001), but the %CTEI from UPP increased in females (34.7% vs 39.3%, p value < 0.001), even after adjusting for sociodemographic variables. In the full model, which included all sociodemographic variables, %CTEI from UPP was inversely associated with age (difference between extreme categories 7.1 pp., 95 CI% 7.7–6.5) and directly associated with schooling (difference between extreme categories 6.3 pp., 95 CI% 5.5–7.1). The subtypes of UPP that contributed most to the observed differences were processed breads, fast food, and ultra-processed pies and sweets. Conclusions UPP account for a third of the calories normally consumed, with women, young people, and better educated individuals being the most vulnerable groups. These results can help when planning public policies to reduce UPP consumption.

Utilization of short message service (SMS) in non-pharmacological management of hypertension. A pilot study in an URBAN public hospital of Multan, Pakistan Abstract Objective To investigate the effectiveness of short message service (SMS) in promotion of non-pharmacological treatment approach in hypertension patients. Subjects and methods A prospective, randomized control study to measure the effect of short message service in improving self-management of hypertension by educating patients. One hundred and twenty hypertensive patients who had manual sphygmomanometers were selected, and were divided into two groups, i.e., an intervention group and a control group. But only the intervention group had mobile numbers of related health care professionals for SMS assistance. All of them were briefed on how they can improve HTN control by achieving a healthy life style, proper diet, and exercise (non-pharmacological approach in addition to pharmacological therapy). Patients were educated about the non-pharmacological approach for managing hypertension at each clinic visit, and were sent regular text messages about healthy diet, exercise, and adherence. Apart from educational text messages, reminder SMSs were also sent to them twice daily to remind them about taking their medicines. Patients’ feedback was collected to assess improvement in adherence and reduction in blood pressure. Results At the end of the study, the intervention group showed better hypertension control, with systolic blood pressure (SBP) declining by 8 mmHg to 141.15 ± 5.73 mmHg, and diastolic blood pressure (DBP) declining by 6 mmHg to 88 ± 3.97 mmHg. The control group showed a 2 mmHg and 3 mmHg decline in SBP and DBP respectively. Conclusion SMS proved to be very useful to enhance adherence to non-pharmacological treatment of HTN (hypertension). It also improved patient compliance.

Feasibility and organization of a population-based screening for pre-symptomatic type 1 diabetes in children — evaluation of the Fr1da study Abstract Aim Type 1 diabetes is the most common chronic metabolic disease in childhood. Often diagnosis comes with acutely life-threatening ketoacidosis and requires hospitalization. To avoid this, early detection of children at a pre-symptomatic stage is worthwhile. This task is met by a population-based screening in Bavaria, Germany – the Fr1da study. Here, we aim to evaluate the study concept, feasibility and medical evidence of the Fr1da study. Methods 308 pediatricians, 16 diabetes care centers and participating families were asked to evaluate the Fr1da study by completing questionnaires assessing study concept and feasibility, educational program and study organization. The assessment was done anonymously. In order to evaluate the effectiveness of the training the parents had to answer questionnaires to assess their knowledge about diabetes. Results 48% of pediatricians and 56% of pediatric diabetes care centers filled out the questionnaire. The majority positively judged the collaboration with the Fr1da coordinating center and the feasibility to integrate the project into daily routine. Medical evidence of the screening was recognized and most of the respondents endorsed the screening to be permanently integrated into standard care-program. The majority of parents would recommend the study to other parents with young children since they were satisfied with the collaboration with pediatricians, diabetes care centers and the coordinating center. Quality control of the educational program revealed good understanding of the teaching content. Conclusion The Fr1da study received high acceptance and recognition by both, health care providers and participating families, and demonstrated sustainable success with the developed educational program.

Accuracy of self-reported weight compared to measured BMI among rural middle school students in Michigan Abstract Aim Measured body mass index (BMI) is recommended for field-based assessments of overweight and obesity in all population groups. However, self-reported perception of body weight is frequently used in surveys targeting overweight and obese individuals. This study’s purpose was to examine the accuracy of self-reported weight compared to measured BMI among rural middle school students in Michigan. Subject and methods A sample of 1995 students aged 11 and 12 were recruited over 5 years from six rural school districts in mid-Michigan. Data were collected using an interviewer-administered questionnaire with questions from the Youth Risk Behavior Survey. Height and weight were measured by research assistants and BMI calculated. Results Although only 3.5% of the students considered themselves very overweight, 26.4% were in the obese category of BMI. Almost a quarter (23.7%) reported they were slightly overweight, but these were all obese by BMI standards. Conversely, while 18.5% reported they were underweight, only 0.9% were truly underweight by BMI standards. A statistically significant difference (P < 0.001) was found in weight perception across BMI categories. Significant gender differences in perception were also found across all perceived weight categories. Conclusion It is imperative that children accurately perceive their body weight because this is the first step toward lasting behavior changes to achieve the optimal weight for their age and gender. However, when intervention programs use measured BMI rather than self-reports to define weight status among children and adolescents, it is more likely that overweight and obese children will be accurately targeted for intervention.

Gaps in nutrition knowledge and barriers to eating healthy among low-income, school-going adolescent girls in Delhi Abstract Aim This study assessed the nutrition awareness, attitude and practices of adolescent girls in Delhi and focussed on identifying gaps in knowledge and barriers to healthy eating. Subject and method A total of 250 adolescent girls (13–15 years old) belonging to low-income families were selected from four government-run schools in four districts of Delhi in 2016–2017. The cross-sectional study involved assessing the girl’s nutrition knowledge, attitude and practices and frequency of food consumption using a pretested questionnaire. Focus group discussions held with teachers, parents and the girls themselves helped to shed light on reasons for not adopting healthy food choices. Results Nearly three quarters (72%) of girls skipped one or more meals every day. About 34% of girls stated it was not necessary to consume fruit and vegetables on a daily basis. Around 51% of girls had not consumed green leafy vegetables in the past week. Only 40% ate fruit daily and 58% substituted meals with snacks on a regular basis. ‘Not feeling hungry’ and ‘disliking the taste of healthy foods’ were identified as major barriers to eating a healthy diet. Only 18% of girls knew that a lack of iron in the diet could cause anaemia. A significant but weak correlation between nutrition knowledge and attitude was observed (r = 0.258; p < 0.05). There was no significant relationship between nutrition knowledge and practices (p > 0.05). Teachers were of the opinion that the school curriculum provided enough background about health and nutrition. However, the low scores of the girls (6.892 ± 3.24) did not reflect this. Parents believed their children did not have healthy eating habits and expected schools to provide the necessary information. Conclusion Innovative behaviour change strategies are needed to inculcate healthy eating habits with the engagement of parents and teachers. School curriculums need to be modified to impart not only appropriate nutrition knowledge but also motivation for behaviour change.

Age and socioeconomic gradients in frailty among older adults in India Abstract Background Although individuals with frailty and lower socioeconomic status (SES) are vulnerable to morbidity and early mortality, few studies have investigated this association. We intend to fill this gap with a study using older adults aged ≥ 50 years from the SAGE WAVE I 2007 in India. Objective The two objectives of the study are to examine the association of frailty with SES and how this association varies across different age groups. Methods A modified Fried phenotype approach with five frailty indicators was used to categorize 6560 older adults as frail, pre-frail or robust who had more than two, one or zero indicators, respectively: grip strength, exhaustion, weight loss, walking speed and physical activity. Multinomial logistic regression estimated the likelihood of being pre-frail and frail for various levels of SES, controlling and not controlling for confounders. This study also shows the overall socioeconomic gradients and age patterns of socioeconomic gradients of frailty indicators using predicted probabilities. Results Approximately 26%, 55% and 20% participants were robust, pre-frail and frail, respectively. The number of frailty indicators was positively associated with lower income and education levels in the case of controlling and not controlling for confounders. Also, among the higher age groups, individuals with low SES had higher chances of being frail. Conclusion Overall, the results in this article indicated a negative low SES and frailty association as found in previous studies worldwide. This highlights the need for comprehensive and centered public health interventions for older adults with low SES.