Objective: To define a set of dietary components that are relevant determinants for health in Europe. The selected components are intended to serve as nutrition indicators for health in the European Health Monitoring Programme and, as such, must be limited in number, relevant to health in Europe and practical for all involved countries with respect to data gathering and comparability of data. Design: Major nutrition factors were determined by reviewing relevant epidemiological and clinical literature in nutrition and health as well as referring to reports from international expert groups, including the report from the project Nutrition and Diet for Healthy Lifestyles in Europe. The selection of factors was also based on the relative ease and cost involved for participating countries to obtain comparable and valid data. Results: The selected factors include foods or food groups as well as individual nutrients. Biomarkers are suggested for selected nutrients that pose the greatest difficulty in obtaining valid and comparable data from dietary studies. Conclusions:The following list of diet indicators for health monitoring in Europe was agreed upon by the EFCOSUM group in 2001, in order of priority: vegetables, fruit, bread, fish, saturated fatty acids as percentage of energy (%E), total fat as %E, and ethanol in grams per day. Biomarkers were suggested for the following nutrients: folate, vitamin D, iron, iodine and sodium. Energy has to be assessed in order to calculate %E from total fat and saturated fatty acids.

INTRODUCTIONOptimal birth spacing and birth control are issues that caught the attention of global reproductive health services. Multiple studies show that adverse maternal and perinatal outcome is related to closely spaced pregnancies. Approximately 27% births in India occur <24 months after a previous birth and another 34% between 24 -35 months.1 61% of births in India occur at intervals shorter than the recommended birth-to-birth interval of 36 months. The study shows that 65% of women in the first year postpartum have an unmet need for family planning. Postpartum period is a highly vulnerable period for unintended pregnancy as there are limited contraceptive options for breastfeeding mothers. Moreover return of ovulation is highly unpredictable in those not on exclusive breastfeeding. So immediate postpartum is the ideal time to begin contraception as women is strongly motivated at this time.Government of India has launched several programs which emphasizes on promotion of adequate birth spacing. In India where government is promoting institutional deliveries, also creates opportunities for ABSTRACTBackground: Immediate Postpartum Intrauterine Contraceptive device is a novel approach to contraception which integrates Maternal -Child health and family planning services. It is a postpartum method which provides long term reversible contraception to women before discharge from the delivery setting. More research is needed in the field of PPIUCD to enhance awareness and acceptance in the community. This study is designed to compare the safety and efficacy of PPIUCD inserted at cesarean versus vaginal delivery. Methods: This is a prospective study conducted at Sree Avittom Thirunal Hospital, Govt. Medical College, and Kerala -A tertiary care teaching institution. A total of 126 patients with cesarean or vaginal deliveries had PPIUCD insertions and they were followed up for a period of one year. The outcome measures analyzed were safety measures -menstrual irregularities, vaginal discharge, pelvic infection and perforation and efficacy measures -failure, expulsion and removal. Data are expressed in frequency and percentage. Chi square test was used for comparison and P value <0.05 was considered significant. Results: The study shows that PPIUCD is an effective intervention in both cesarean and vaginal delivery with no significant differences in safety and efficacy depending on the route of insertion. There was no case of perforation or failure and no significant risk of infection in either group. Spontaneous expulsion occurred in two cases inserted by vaginal route. Missing string incidence is high in the cesarean group compared to vaginal insertion. Conclusions: PPIUCD is a safe effective and convenient method of contraception and should be encouraged in both vaginal and cesarean deliveries.

Context:Chronic kidney disease is an upcoming public health problem characterized by premature mortality and expensive treatment in low resource settings where diabetes is highly prevalent.Aim:To find out the causes and comorbidities and to explore the community support systems for treatments availed.Settings and Design:Community based cross sectional design.Materials and Methods:Interview of known chronic kidney disease patients above 18 years registered under palliative clinics.Statistical Analysis Used:Mean, SD, proportions, and 95% Confidence interval, chi square test at significance level P = 0.05.Results:Majority of patients were males, below 60 years. Mean duration was 5.26 years and mean age at onset was 48.6 years and 62% were in advanced stages of disease. The commonest cause was diabetic nephropathy (44.6%) followed by hypertensive nephropathy (33.3%). The comorbidities included hypertension (61.4%), diabetes (47.3%), cardiovascular disease (30.6%), Chronic obstructive pulmonary disease (10%) malignancies (2.6%), and retinopathy (28%). Considering treatment status 60.6% were on dialysis 13.3% had undergone transplantation, mostly from private institutions with help of public donations and both at significant underutilization by women. Though 44.6% were protected by social security schemes, the median monthly cost of disease management amounted to Rs. 10,500 which was unaffordable for the majority who were below the poverty line.Conclusions:There is an impending need for strengthening management, high-risk screening among diabetic and hypertensive patients and provision for specialist care to delay the onset of end-stage renal disease. The social security support system should be improvised for our setting to facilitate dialysis and transplantation to minimize out of the pocket expenditure.

Kozhikode district of North Kerala, India witnessed an outbreak of Nipah virus (NiV) in the month of May 2018. Two adjacent districts were affected leaving 17 patients dead out of the 19 confirmed. United Nations and WHO lauded the expeditious response of the state’s health system in the diagnosis and containment of the outbreak which was unprecedented. The authors being in the contact tracing and surveillance operation district team, had kept a record of timeline of events and actions at the state level, compiled the news clippings and tracked events. In the absence of an end‑of‑epidemic report for reference, these records served as a valuable tool for the present review. We used the Management science for health frame work tool (MSH framework) to evaluate the district and state coordinated actions which helped in curbing the outbreak. Though NiV outbreak in South India (2018) had similar epidemiological features to previous disease outbreaks, it stands out as the one to be detected and contained in a short span of time. As health personnel working in the government medical college of an affected district and directly involved in contact tracing operations and containment measures, exploring and sharing, what worked and how, in the context of multidisciplinary response and recovery attempts of the outbreak in the state may be beneficial to public health personnel and policy makers. This management framework may be replicated in the national and international context, particularly in South East Asian region under threat of emerging viral infections like COVID-19, lacking specific epidemic management frameworks for outbreak response and containment.

Unicornuate uterus is the type 2 variety of mullerian duct anomaly resulting in unilateral agenesis or hypoplasia. The hypoplastic (Rudimentary) horn can be functioning or non-functioning and communicating or noncommunicating with the main uterine cavity. Pregnancy in the rudimentary horn is an extremely rare entity. It is often missed at ultrasound in the early trimester, presenting later with massive hemoperitoneum and shock from rupture of the horn.  A “high index of suspicion” is essential to derive at the correct diagnosis. Hence reporting this rare case for emphasizing the importance in early diagnosis and prompt management.