Urban Pune Research Articles

Cultural Aspects of Type-2 Diabetes-related Social Stigma: A Cultural Epidemiological Study among General Community Members in Urban Pune, India

There is growing evidence from developed countries that type 2 diabetes stigma has been prevalent. However, whether or not type 2 diabetes has a social stigma in India has not been explored. Against this background, a study was attempted to clarify type-2 diabetes-related stigma among general community members. A cross-sectional community-based survey using a locally adapted Explanatory Module Interview Catalog was conducted among 100 randomly selected general community members who did not have diabetes from slum pockets of Pune city. The stigma index was computed based on the responses of stigma indicators and the internal consistency assessed. In addition, based on the mean prominence values, socio-cultural group characteristics were analyzed across stigma indicators. Further, multivariate logistic regression assessed the relationship between socio-demographic characteristics as predictors and stigma indicators as outcome variables. General community members reported widespread awareness regarding type-2 diabetes. More than half of the respondents perceived that diabetes would be a fatal disease without any outside treatment. The resultant stigma index was 7.22 (Cronbach’s alpha = 0.75). The milder stigma for type-2 diabetes was revealed through the preference to hide, problems in arranging marriages, difficulties in ongoing marriages, and discrimination instances at the workplace. Adjusted logistic regression (AOR) across stigma indicators showed a tendency to hide diabetes across marital status (AOR = 8.39) and difficulty forming marriage alliances across religions (AOR = 3.10). Documented socio-cultural features of stigma should be considered priorities for action to mitigate its negative influence on the physical health and emotional well-being of persons who have diabetes.

Knowledge, attitudes, awareness and factors associated with the uptake of influenza vaccine among pregnant women in urban Pune

: This cross-sectional study was aimed to assess the knowledge, attitudes, awareness, facilitators, and barriers associated with the uptake of influenza vaccination during pregnancy in the urban area of Pune. : The study was conducted with 500 participants: 62 pregnant women and 438 postpartum women (total 524 were approached) attending Obstetrics and Gynaecology outpatient department (OPD) in a tertiary-care municipal hospital in Pune. The study-questionnaire collected data regarding socio-demographics general knowledge about influenza, attitude towards influenza vaccination, vaccine risk awareness, and its potential risk and benefits during pregnancy. The log-binomial regression models were used to examine the factors associated with influenza vaccination. : A good uptake of the vaccine (223/500, 44.6%) was found during current pregnancy of the participant; however, only 2.7% of study-participants vaccinated with influenza vaccine in their previous pregnancies. Also, there was poor awareness among all the participants regarding the safety of the seasonal influenza vaccine during pregnancy (19%, n=95/500). 11.2% (n=31/277) study-participants were found to be against the maternal influenza vaccination. Women receiving the vaccine against influenza were more likely to be previously informed of the recommendations from health-care providers about maternal influenza vaccination with odds ratio of 0.18 (95% CI, 0.04 to 0.8; p<0.00001), received the influenza vaccine in the past OR 8.27 (95% CI, 0.94 to 72.0), Z 1.09, p=0.05 and of having knowledge on influenza and its complications has more impact on influenza vaccination during pregnancy OR 14.4 (95% CI, 5.68 to 36.53), Z 5.6, p<0.0001 respectively.: This study concludes the vital causative factors for non-vaccination were provision of incomplete information or poor awareness about influenza vaccination (68.6%). There was poor knowledge among the pregnant women regarding the safety of maternal influenza vaccines. The recommendation from healthcare professionals is the major facilitators of decision-making by pregnant women for influenza vaccination during pregnancy.

A post-COVID-19 assessment of resilience of nurses and paramedical workers in municipal hospitals of urban Pune, India.

To assess the resilience of primary healthcare workers (HCWs) by determining the factors associated with developing resilience post-coronavirus disease 2019 (COVID-19). A cross-sectional study in selected municipal hospitals. Connor-Davidson Resilience Scale was used to assess the resilience of the 245 HCWs, including the nurses and paramedics working in Pune Municipal Corporation (PMC) hospitals in Pune City. Data were analysed using the Chi-square test, one-way analysis of variance (ANOVA), independent-samples t-test and correlational analysis using the Statistical Package for the Social Sciences (SPSS) version 28. The mean resilience score of the HCWs in PMC hospitals post-COVID-19 was 75.09 (±9.25). The score for hardiness, optimism, resourcefulness and purpose was 20.15 (±3.87), 21.22 (±3.39), 17.24 (±2.76) and 16.40 (±2.17), respectively. Seven factors were significantly associated with the resilience of nurses and paramedics, namely age (P < 0.001), work experience (P < 0.001), monthly income (P < 0.001), having faced financial problems during COVID-19 (P < 0.001), hospital setting (P < 0.05), marital status (P < 0.01) and professional category (P < 0.001). In addition, 60% of the participants reported mental health issues due to routine workloads such as irritation/anger, frustration and tension/worry, fatigue and work-related stress, and sadness and anxiety. Suggestions for improvement were mainly increasing human resources, proper management, skilled staff, improved facilities and funding, and cooperation among staff. The resilience of primary HCWs in Pune post-COVID-19 was higher than HCWs in other countries assessed during COVID-19. Further, resilience was found more among nurses than paramedics. Modifiable factors affecting resilience must be addressed to improve the resilience of HCWs to build everyday resilience and strengthen health systems for public health emergencies.

The Epidemiology of Rheumatic Diseases in India

Epidemiological studies, referred to as the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) studies, have been conducted under the aegis of the International League against Rheumatism and the World Health Organization to evaluate the epidemiology of rheumatic and musculoskeletal (RMSK) diseases in India. These COPCORD studies conducted in rural Bhigwan and urban Pune in Maharashtra, rural Calicut and rural Trivandrum in Kerala and rural and urban Lucknow in Uttar Pradesh, along with data from the Global Burden of Diseases study have helped to understand the burden of rheumatic diseases in the community. Based on these studies, RMSK diseases, which are amongst the top 25 causes of disability in the Indian population, are prevalent in nearly 25%–30% of the Indian population. The common rheumatic diseases in the community are soft tissue rheumatism, neck and back pain, fibromyalgia and unspecified pains and osteoarthritis (most commonly affecting the knee). These diseases most commonly affect young persons between the third to the fifth decade of life, more often affect females, are prevalent in both rural and urban populations, and account for considerable disability in up to one-fifth of individuals leading to loss of livelihood and dependence on others for self-care. Community-based national healthcare programs to manage RMSK diseases at the community level are urgently needed. There also remains an unmet need to train more doctors to diagnose and manage rheumatic diseases at the primary, secondary and tertiary levels of care.

Awareness and Practices of Biomaterials in Solid Waste Management in Urban Pune

Awareness and Practices of Biomaterials in Solid Waste Management in Urban Pune

A Pilot Study to Assess and Compare Acceptability of an Energy-Dense Nutrient Supplement Among Moderate Underweight Children in Rural and Urban Settings of Pune, Maharashtra

ABSTRACT We developed and tested the reliability of a digital tool to facilitate sensory evaluation (SE) of an energy-dense nutrient supplement among children and elicit their mothers’ perceptions in Phase-I. In Phase-II, SE and two-week acceptability were assessed in children from government preschools in rural and urban Pune (India). Cronbach’s alpha values of 8 and 6.8 indicated good and fairly acceptable reliability for mother and child questions, respectively. “Very-good” rating was obtained from >75% and >60% for appearance and smell, respectively. The acceptability test showed a significantly higher intake among the rural (mean = 102.0 ± 19 gm) compared to the urban children (71.14 ± 13 gm) (p < .05).

A STUDY OF PATIENTS PRESENTING WITH SUICIDAL ATTEMPT TO A TERTIARY CARE PSYCHIATRY DEPARTMENT DURING LOCKDOWN DUE TO COVID 19 PANDEMIC

Aim: To study cases presenting with suicidal attempt to Psychiatry set up of a tertiary care hospital to assess psychopathology and impact of the Covid pandemic, in precipitating suicidal attempts. Settings: Patients admitted with suicidality during lockdown in 2021,in department of Psychiatry of our tertiary care hospital. This hospital in urban Pune has a 30 bedded Psychiatry ward and outpatient psychiatry services. Methods And Material: Medical record-based study of the admitted patients in the stipulated period of time. Results: 71%(5) cases were new onset psychiatric illness with suicidal attempt precipitated due to various psychosocial, nancial or other unique factors secondary to pandemic situation or pre-morbid personality problems or interpersonal adjustment. Most common mode of suicide was consumption of easily available poisonous substance or medicines, followed by hanging. Conclusions: Vigilant suicidal ideation assessment, individual/family counselling would be important in management. Further larger studies are needed to assess harmful mental health effects of nationwide lockdown in the pandemic situation are necessary.

Gains in body mass and body water in pregnancy and relationships to birth weight of offspring in rural and urban Pune, India.

Maternal size, weight gain in pregnancy, fetal gender, environment and gestational age are known determinants of birth weight. It is not clear which component of maternal weight or gained weight during pregnancy influences birth weight. We evaluated the association of maternal total body water measured by the deuterium dilution technique (TBW-D2O) at 17 and 34 weeks of gestation with birth weight. A secondary aim was to examine the utility of bioimpedance spectroscopy (BIS) to determine total body water (TBW-BIS) in pregnancy. At 17 and 34 weeks of pregnancy, ninety-nine women (fifty-one rural and forty-eight urban) from Pune, India had measurements of body weight, TBW-D2O, TBW-BIS and offspring birth weight. At 17 weeks of gestation, average weights for rural and urban women were 45⋅5 ± 4⋅8 (sd) and 50⋅7 ± 7⋅8 kg (P < 0⋅0001), respectively. Maternal weight gains over the subsequent 17 weeks for rural and urban women were 6⋅0 ± 2⋅2 and 7⋅5 ± 2⋅8 kg (P = 0⋅003) and water gains were 4⋅0 ± 2⋅4 and 4⋅8 ± 2⋅8 kg (P = 0⋅092), respectively. In both rural and urban women, birth weight was positively, and independently, associated with gestation and parity. Only for rural women, between 17 and 34 weeks, was an increase in dry mass (weight minus TBW-D2O) or a decrease in TBW-D2O as a percentage of total weight associated with a higher birth weight. At both 17 and 34 weeks, TBW-BIS increasingly underestimated TBW-D2O as the water space increased. Differences in body composition during pregnancy between rural and urban environments and possible impacts of nutrition transition on maternal body composition and fetal growth were demonstrated.

Mortality risk attributable to high and low ambient temperature in Pune city, India: A time series analysis from 2004 to 2012

BackgroundExposure to high and low ambient temperatures is associated with morbidity and mortality across the globe. Most of these studies assessing the effects of non-optimum temperatures on health and have been conducted in the developed world, whereas in India, the limited evidence on ambient temperature and health risks and has focused mostly on the effects of heat waves. Here we quantify short term association between all temperatures and mortality in urban Pune, India. MethodsWe applied a time series regression model to derive temperature-mortality associations based on daily mean temperature and all-cause mortality records of Pune city from year January 2004 to December 2012. We estimated high and low temperature-mortality relationships by using standard time series quasi-Poisson regression in conjunction with a distributed lag non-linear model (DLNM). We calculated temperature attributable mortality fractions for total heat and total cold. FindingsThe analysis provides estimates of the total mortality burden attributable to ambient temperature. Overall, 6∙5% [95%CI 1.76–11∙43] of deaths registered in the observational period were attributed to non-optimal temperatures, cold effect was greater 5.72% [95%CI 0∙70–10∙06] than heat 0∙84% [0∙35–1∙34]. The gender stratified analysis revealed that the highest burden among men both for heat and cold. ConclusionNon-optimal temperatures are associated with a substantial mortality burden. Our findings could benefit national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately due to climate change.

Risk-factors of non-communicable diseases in urban adolescents in Western India

Adolescents, who were once considered to be the healthiest individuals, are now seeing a rise in NCDs amongst them. This is a Short Term Studentship (STS) Indian Council of Medical Research (ICMR) selected research project of undergraduate medical student. It was done after institutional ethical clearance and permission from School Principal, assent from students and consent from their parents. This is a school based, cross- sectional study of total 200 school-going adolescents of 15 to 17 years age (100 students, each from private and government coed schools) in Urban Pune. A predefined, pretested AACCI lifestyle questionnaire was explained and given to the students followed by physical examination. The overweight and obese students were advised for further investigations for metabolic syndrome. In private school, the mean BMI was 21.16 for boys and 21.13 for girls while in government school, it was 19.62 for boys and 19.58 for girls. In private school, 3% students were overweight (Girls: 2.22%, Boys: 3.64%), 11% obese (Girls: 6.67%, Boys: 14.55%) and 4% underweight. In government school, 5% were overweight (Girls: 6.12%, Boys: 3.92%), 3% obese (Boys: 5.88%, no girls) and 17% underweight. In Private School, hypertension was in 5.45% boys and 2.17% girls. In government school, hypertension was in 3.64% boys and 2.17% girls. The prevalence of risk factors like overweight and obesity was higher in adolescents from private school than government school. It was more in boys in both schools. A significant correlation was found between lifestyle habits like eating fast food, sedentary lifestyle and non-communicable diseases in adolescents. This is due to change in lifestyle habits.

Antenatal influenza vaccination in urban Pune, India: clinician and community stakeholders’ awareness, priorities, and practices

ABSTRACT The World Health Organization (WHO) recommends antenatal influenza vaccination (AIV) for pregnant women at any stage of pregnancy. This study assessed fundamental aspects of AIV acceptance and demand among key stakeholders in urban Pune, India. Semi-structured interviews for rapid ethnographic assessment of AIV-related awareness, priorities, and practices were used to study clinicians and their communities of practice. A qualitative survey was conducted among 16 private clinicians providing antenatal care (ANC) in slum and middle-class areas of Pune. Following the survey, clinicians were informed about authoritative AIV recommendations. A qualitative community survey was also conducted with 60 women aged 20–35 years and 30 spouses from the same slum and middle-class practice areas of the ANC providers. Subsequently, a second clinician survey was conducted to assess changes in clinicians’ awareness, priority, and vaccination practice. After this interview, clinicians were informed of community survey findings. Most community respondents were unaware of AIV, in contrast with well-known and widely used antenatal tetanus vaccination. They expressed confidence in vaccines and trust in the clinicians. Clinicians’ advice was reportedly the most important determinant of community vaccine acceptance. Clinicians were confident of the safety of AIV and they anticipated patients’ acceptance if recommended. The second clinician interview showed increased awareness of AIV policy, but clinicians were more skeptical about the severity of maternal influenza in their practice. Our findings indicate community acceptance though not demand for AIV. We recommend five essential elements for vaccination program strategies to improve coverage with AIV and other ANC vaccines.

Study to Assess the Effect of Childbirth Education on Intrapartum Coping behaviours of Primiparous Women in a Selected Maternity Center of a Tertiary Level Hospital in Pune

Introduction: Child birth is a normal physiological process, yet gaining confidence by enhancing knowledge about childbirth can be considered an important factor influencing a parturient’s birthing experience. Method: A prospective quasi-experimental study conducted on 60 registered primigravidae attending the ANC OPD of a hospital at Pune. 30 included in the intervention group, received 3 sessions of CBE. The effect of this measured intranatally by a self-developed Intrapartum Behavioural Observation Checklist. The coping behaviours of the intervention group measured and compared against 30 primigravidae women who received conventional antenatal education. Results: Primigravidae were poorly informed about childbirth preparedness and not prepared for the experience of childbirth. Majority had no concept regarding the severity of pain, duration of labour and coping measures stress of labour. Significant reduction in episiotomy rates, use of analgesics and improvement in coping behaviours found among the experimental group. Hence the research hypothesis was accepted, level of significance = 0.001. Discussion: Gaps identified in the knowledge and practice of childbirth preparedness among primigravidae in urban Pune. Also analyzed the positive effects of childbirth education on intrapartum coping behaviours of primiparous women. Episiotomy rates and use of intrapartum analgesics were less in the Intervention group. Intrapartum behavioural compliance and exhibition of positive self-care, intra partum coping behaviours were also significantly high. Conclusion: The findings of this study indicate that the short term; need based childbirth educational intervention demonstrated a highly significant impact on the intrapartum coping behaviours of primiparous women.

Assessment for Hypertension Risk Score in Pune Urban Population

Introduction: The World health statistics 2012 report highlight on the growing problem of the noncommunicable diseases burden due to urbanisation and change in the life styles. According to the WHO report, one in three adults worldwide, has hypertension a condition that causes around half of all deaths from stroke and heart disease.In this study, we are using the common modifiable risk factors like obesity and exercise status to evaluate risk of hypertension in later life. So the present study is planned to calculate the risk score for the development of hypertension. Material & Method: It was a cross sectional study. Study was conducted on about 521 individuals between the age group of 18-50 yrs in Pune urban population. Risk factors like obesity,physical activity .family history and depression were used to assess score Results: In our study total 521 participants were included out of which 27%,58% and 15 % have mild, moderate and high risk of developing hypertension respectively in future. Conclusion: The study concludes that majority of urban Pune population have moderate risk of hypertension. This highlights need of preventable measures like counselling sessions, regular follow up, life style modification in form of increased physical activity and healthy diet.

Influenza vaccination of pregnant women: Engaging clinicians to reduce missed opportunities for vaccination

BackgroundAntenatal influenza vaccination (AIV) is an effective intervention for protecting pregnant women and their newborns against influenza. Although the World Health Organization recommends AIV at any stage of pregnancy, in low- and middle-income countries, including India, it is rarely provided. Research suggests that antenatal care (ANC) provider practices explain much of this limited coverage. Our study in urban Pune, India, assessed the feasibility of a two-stage clinician-engagement strategy to reduce missed opportunities for AIV in urban private-practice ANC clinics. MethodsClinicians were randomized to intervention and control groups in slum and middle-class study sites. Intervention-group clinicians (active clinicians) were assessed on vaccination-related views and practices, and were presented with authoritative AIV recommendations from global, academic and professional medical organizations. In a second meeting after a community survey, findings concerning vaccination-related views and experiences were explained to active clinicians. Assessments of community vaccination views were not provided to control-group clinicians. Both groups maintained logs of ANC clinic visit vaccination status throughout the 11-month study period to enable identification of missed and taken opportunities for vaccination. Analyses were restricted to visits of women in their third trimester without previous AIV in the current pregnancy. ResultsOverall, 30 clinicians participated. After first and second interactions, active clinicians in middle-class communities vaccinated at 12.2% and 37.8%, respectively. Middle-class control clinicians vaccinated at <0.2% throughout the study. This difference in AIV taken opportunities between middle-class active and control clinics was statistically significant (p < 0.05) after first and second interactions. In slum-community sites, active clinicians’ AIV activity was minimal throughout. ConclusionsOur approach for engaging clinicians effectively reduced missed opportunities for AIV in urban middle-class settings of Pune. It may also improve maternal vaccination for other conditions. The absence of any similar effect in slum-based clinics likely reflects critical limitations of vaccine access.

Meteorological Parameters and Mosquito Abundance in Pashan Area of Pune, India during South West Monsoon and Post-Monsoon Seasons in 2016

The resurgence of vector borne diseases over the last decade has raised concerns about the role of climatic factors. Rapid urbanization due to expansion of Indian cities like Pune over the last decade has altered local land-use and environment. The present study was undertaken to investigate the composition and seasonal abundance of mosquito population in Pashan area of urban Pune, which was urbanized rapidly during 2001-2005. Mosquitoes were trapped and identified to determine the species composition and abundance. Association of meteorological parameters like temperature, humidity and rainfall with mosquito abundance was also analyzed from June to November 2016. Raw meteorological data was obtained and analyzed mathematically to determine derived parameters like diurnal temperatures and fortnightly averages of all parameters. A total of 21 species of mosquitoes were observed across four genera viz. Aedes , Anopheles , Culex and Armigerus . Mosquito abundance (M) peaked during South West (SW) Monsoon and correlated positively with maximum and minimum relative humidity and rainfall. In post-monsoon season mosquito abundance decreased alongwith relative humidity. Interestingly, the mosquito abundance is modulated by diurnal temperature range (DTR). During SW monsoon, low DTR corresponded to high mosquito abundance. The trend was reversed in the post-monsoon season as DTR increased by ~4 folds in comparison to SW monsoon and mosquito abundance decreased sharply. Mosquito population in the study area showed diversity and seasonal variability, influenced by meteorological parameters. DTR seemed to be the major factor affecting seasonal variability in mosquito abundance.

Clinical value of the cultural formulation interview in Pune, India.

Context:Development of the cultural formulation interview (CFI) in DSM-5 required validation for cross-cultural and global use.Aims:To assess the overall value (OV) of CFI in the domains of feasibility, acceptability, and utility from the vantage points of clinician-interviewers, patients and accompanying relatives.Settings and Design:We conducted cross-sectional semi-structured debriefing interviews in a psychiatric outpatient clinic of a general hospital.Materials and Methods:We debriefed 36 patients, 12 relatives and eight interviewing clinicians following the audio-recorded CFI. We transformed their Likert scale responses into ordinal values – positive for agreement and negative for disagreement (range +2 to −2).Statistical Analysis:We compared mean ratings of patients, relatives and clinician-interviewers using nonparametric tests. Clinician-wise grouping of patients enabled assessment of clinician effects, inasmuch as patients were randomly interviewed by eight clinicians. We assessed the influence of the presence of relatives, clinical diagnosis and interview characteristics by comparing means. Patient and clinician background characteristics were also compared.Results:Patients, relatives and clinicians rated the CFI positively with few differences among them. Patients with serious mental disorders gave lower ratings. Rating of OV was lower for patients and clinicians when relatives were present. Clinician effects were minimal. Clinicians experienced with culturally diverse patients rated the CFI more positively. Narratives clarified the rationale for ratings.Conclusions:Though developed for the American DSM-5, the CFI was valued by clinicians, patients and relatives in out-patient psychiatric assessment in urban Pune, India. Though relatives may add information and other value, their presence in the interview may impose additional demands on clinicians. Our findings contribute to cross-cultural evaluation of the CFI.

2608 – Screening for depression in elderly urban population

Introduction žDepression is a treatable medical condition and one of the most frequent causes of emotional distress in older adults žUntreated depression can delay recovery or worsen the outcome of other medical illnesses via increased morbidity or mortality žDepression is NOT a part of normal aging. Objectives žTo determine the prevalence of depression among the elderly population žTo identify the risk factors with respect to depression in elderly. Material and methods žStudy design: Cross sectional study žStudy setting: Community based žSample size: 216 žStudy area: Southern part of urban Pune city žInclusion criteria: Age more than 60 yrs of age žStudy tool: Predesigned Questionnaire including WHO 5 Well being index and Mastering depression in Primary care version 2.2 was administered. Results The prevalence of ndepression was 21.2% in the geriatric population. Widowed stae, financial dependancy,living in nuclear family and medical illnesses were the major stressors. Conclusion The present study found that widowed state,retirement,medical illness and residing in a nuclear family system are strong predictors of depression in the elderly. Recommendation žSocial support programs for the elderly must be developed to ensure their well-being. Awareness about risk factors would help in designing appropriate strategies for prevention of depressive disorders in geriatric population.

Cultural epidemiology of neurasthenia spectrum disorders in four general hospital outpatient clinics of urban Pune, India

Disorders emphasizing symptoms of fatigue and/or weakness, collectively termed Neurasthenia Spectrum Disorders (NSDs), typically emphasize a biological basis in the West and social origins in East Asia. In India, explanatory concepts are diverse. To clarify, 352 outpatients in Psychiatry, Medicine, Dermatology, and Ayurved clinics of an urban hospital were interviewed with a version of the Explanatory Model Interview Catalogue. Comparisons of categories and narratives of illness experience and meaning across clinics indicated both shared and distinctive features. Explanatory models of NSDs highlighted social distress, ''tensions,'' and both general and clinic-specific physical, psychological, and cultural ideas. Findings indicate the importance of social contexts and cultural meaning in explanatory models of neurasthenia, as well as the potential clinical relevance of the construct of Neurasthenia Spectrum Disorder.

Pandemic Influenza (H1N1) 2009 Is Associated with Severe Disease in India

BackgroundPandemic influenza A (H1N1) 2009 has posed a serious public health challenge world-wide. In absence of reliable information on severity of the disease, the nations are unable to decide on the appropriate response against this disease.MethodsBased on the results of laboratory investigations, attendance in outpatient department, hospital admissions and mortality from the cases of influenza like illness from 1 August to 31 October 2009 in Pune urban agglomeration, risk of hospitalization and case fatality ratio were assessed to determine the severity of pandemic H1N1 and seasonal influenza-A infections.ResultsPrevalence of pandemic H1N1 as well as seasonal-A cases were high in Pune urban agglomeration during the study period. The cases positive for pandemic H1N1 virus had significantly higher risk of hospitalization than those positive for seasonal influenza-A viruses (OR: 1.7). Of 93 influenza related deaths, 57 and 8 deaths from Pune (urban) and 27 and 1 death from Pune (rural) were from pandemic H1N1 positive and seasonal-A positive cases respectively. The case fatality ratio 0.86% for pandemic H1N1 was significantly higher than that of seasonal-A (0.13%) and it was in category 3 of the pandemic severity index of CDC, USA. The data on the cumulative fatality of rural and urban Pune revealed that with time the epidemic is spreading to rural areas.ConclusionsThe severity of the H1N1 influenza pandemic is less than that reported for ‘Spanish flu 1918’ but higher than other pandemics of the 20th century. Thus, pandemic influenza should be considered as serious health threat and unprecedented global response seems justified.

O48 HLADRB1* alleles in rheumatoid arthritis (RA): results from COPCORD population (Urban Pune and Village Bhigwan) and referral clinic (KEM Hospital, Mumbai) based cohorts

O48 HLADRB1* alleles in rheumatoid arthritis (RA): results from COPCORD population (Urban Pune and Village Bhigwan) and referral clinic (KEM Hospital, Mumbai) based cohorts