Periodontitis among poor rural Indian mothers increases the risk of low birth weight babies: a hospital-based case control study

Pulikottil Shaju Jacob,Sonia Nath 대한치주과학회 2014 Journal of Periodontal & Implant Science Vol.44 No.2

Purpose: Low birth weight (LBW) is one of the major public health problems in India. Hence, there is a need to identify risk factors that, when modified, will reduce the burden of unhealthy children on the healthcare system. The objective of this study was to determine whether periodontitis among mothers in the rural population of India is a risk factor for LBW babies. Methods: A hospital-based case control study was conducted among 340 postpartum mothers. The cases consisted of 170 women who had given birth to babies weighing <2,500 g, while the control group consisted of 170 women who had given birth to babies weighing ≥2,500 g. Details of the mothers were taken from the hospital records and through a personal interview, and a full-mouth periodontal examination was performed postpartum, which included probing depth, clinical attachment level, and bleeding on probing on six sites per tooth. Results: LBW cases had a significantly worse periodontal status than the controls, having an odds ratio (OR) of 2.94 (P=0.01). The multivariate logistic regression model demonstrated that periodontal disease is a significant independent risk factor with an adjusted odds ratio (aOR) of 2.85 for the LBW group (95% confidence interval [CI], 1.62–5.5). Other factors showing significant associations with LBW were pre-eclampsia (aOR, 4.49; 95% CI, 1.4–14.7), preterm labor (aOR, 5.5; 95% CI, 3.2–9.9), and vaginal type of delivery (aOR, 2.74; 95% CI, 1.4–5.2). Conclusions: Periodontitis represents a strong, independent, and clinically significant risk factor for LBW. Periodontal therapy should form a part of the antenatal preventive care among rural women in India.

Evaluation of interleukin-$1{\beta}$ and 8 in gutka chewers with periodontitis among a rural Indian population

Jacob, Pulikottil Shaju,Nath, Sonia,Patel, Ritu Prabha Korean Academy of Periodontology 2014 Journal of Periodontal & Implant Science Vol.44 No.3

Purpose: Smokeless tobacco-based oral-use products like gutka are popular in India. Gutka usage leads to increased periodontal destruction and inflammation; however, the relevant mechanism remains unknown. This study aimed to elucidate the role of gutka in periodontitis by examining its effect on the levels of interleukin (IL) $1{\beta}$ and IL-8 from the gingival crevicular fluid (GCF). Methods: A total of 45 patients were enrolled in this study. Thirty patients with periodontitis (15 gutka chewers [GCP] and 15 nongutka chewers [NGC]) and 15 periodontally healthy controls (HC) were selected. The full-mouth plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and recession (RC) were recorded. The IL-$1{\beta}$ and IL-8 levels in the GCF of all subjects were assessed through an enzyme-linked immunosorbent assay (Quantikine). Results: The IL-$1{\beta}$ and IL-8 levels were not significantly higher in the GCP group (IL-$1{\beta}$, $369.01{\pm}273.44{\mu}L$; IL-8, $205.97{\pm}196.78{\mu}L$) as compared to those in the NGC group (IL-$1{\beta}$, $195.57{\pm}96.85{\mu}L$; IL-8, $178.61{\pm}149.35{\mu}L$). More gingival RC and loss of attachment was seen among the GCP group (RC: $2.02{\pm}0.31$, P=0.013; CAL: $4.60{\pm}0.56$, P<0.001) than among the NGC group (RC, $1.21{\pm}1.15$; CAL, $3.70{\pm}0.32$); however, PD was deeper among the NGC subjects (P=0.002). PI and GI were significantly higher for the periodontitis group (P<0.001) when compared to the HC, but there was no difference among gutka chewers and non-chewers (P=0.22 and P=0.89). A positive correlation was found between the IL-8 levels and the duration of gutka chewing (r=-0.64, P<0.01). Conclusions: Gutka chewing leads to increased gingival RC and clinical loss of attachment. There was no effect seen in the proinflammatory cytokine levels in the GCF of gutka users.

Demon Possession and Psychopathology

Paulson Pulikottil 한세대학교 영산신학연구소 2017 영산신학저널 Vol.0 No.41

This paper is an inquiry into demon-possession, exorcism and psychopathology. In the history of the belief in demon possession and the practice of exorcism, belief in demons, evil and good spirits, possession, etc have always been part of human belief systems. Many church fathers testify that exorcism was practised in the various periods of Church History. The Catholic Church and the various Orthodox traditions advocate exorcism. However, it is the rationalism and the emergence of the scientific view of the world that questioned the belief in the demonic. However, the 20th and 21st century has seen a resurgence of these beliefs and practices particularly among Christians. Since exorcism played an important role in the ministry of Jesus and his disciples, it should have an integral part in the ministry of the Christian Church as well. The paper presents some tentative guidelines as to how the reality that there are two distinct conditions must be incorporated into the pastoral ministry and the missional approach of the contemporary church. Discernment and diagnosis is important in cross-cultural mission situations.

Periodontitis among poor rural Indian mothers increases the risk of low birth weight babies: a hospital-based case control study

Jacob, Pulikottil Shaju,Nath, Sonia Korean Academy of Periodontology 2014 Journal of Periodontal & Implant Science Vol.44 No.2

Purpose: Low birth weight (LBW) is one of the major public health problems in India. Hence, there is a need to identify risk factors that, when modified, will reduce the burden of unhealthy children on the healthcare system. The objective of this study was to determine whether periodontitis among mothers in the rural population of India is a risk factor for LBW babies. Methods: A hospital-based case control study was conducted among 340 postpartum mothers. The cases consisted of 170 women who had given birth to babies weighing <2,500 g, while the control group consisted of 170 women who had given birth to babies weighing ${\geq}2,500g$. Details of the mothers were taken from the hospital records and through a personal interview, and a full-mouth periodontal examination was performed postpartum, which included probing depth, clinical attachment level, and bleeding on probing on six sites per tooth. Results: LBW cases had a significantly worse periodontal status than the controls, having an odds ratio (OR) of 2.94 (P=0.01). The multivariate logistic regression model demonstrated that periodontal disease is a significant independent risk factor with an adjusted odds ratio (aOR) of 2.85 for the LBW group (95% confidence interval [CI], 1.62-5.5). Other factors showing significant associations with LBW were pre-eclampsia (aOR, 4.49; 95% CI, 1.4-14.7), preterm labor (aOR, 5.5; 95% CI, 3.2-9.9), and vaginal type of delivery (aOR, 2.74; 95% CI, 1.4-5.2). Conclusions: Periodontitis represents a strong, independent, and clinically significant risk factor for LBW. Periodontal therapy should form a part of the antenatal preventive care among rural women in India.

Socio Demographic and Reproductive Risk Factors for Cervical Cancer - a Large Prospective Cohort Study from Rural India

Thulaseedharan, Jissa V.,Malila, Nea,Hakama, Matti,Esmy, Pulikottil O.,Cheriyan, Mary,Swaminathan, Rajaraman,Muwonge, Richard,Sankaranarayanan, Rengaswami Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.6

Background: India shows some of the highest rates of cervical cancer worldwide, and more than 70% of the population is living in rural villages. Prospective cohort studies to determine the risk factors for cervical cancer are very rare from low and medium resource countries. The aim of this study was to quantify the effect of risk factors related to cervical cancer in a rural setting in South India. Material and methods: Sociodemographic and reproductive potential risk factors for cervical cancer were studied using the data from a cohort of 30,958 women who constituted the unscreened control group in a randomised screening trial in Dindigul district, Tamilnadu, India. The analysis was accomplished with the Cox proportional hazard regression model. Results: Women of increasing age (HR=2.4; 95% CI: 1.6, 3.8 in 50-59 vs 30-39), having many pregnancies (HR=7.1; 1.0, 52 in 4+ vs 0) and no education (HR=0.6; 0.2, 0.7 in high vs none) were found to be at significantly increased risk of cervical cancer. Conclusion: This cohort study gives very strong evidence to say that education is the fundamental factor among the sociodemographic and reproductive determinants of cervical cancer in low resource settings. Public awareness through education and improvements in living standards can play an important role in reducing the high incidence of cervical cancer in India. These findings further stress the importance of formulating public health policies aimed at increasing awareness and implementation of cervical cancer screening programmes.

Effect of Screening on the Risk Estimates of Socio Demographic Factors on Cervical Cancer - A Large Cohort Study from Rural India

Thulaseedharan, Jissa Vinoda,Malila, Nea,Hakama, Matti,Esmy, Pulikottil Okuru,Cherian, Mary,Swaminathan, Rajaraman,Muwonge, Richard,Sankaranarayanan, Rengaswami Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.1

Background: Prospective cohort studies to determine cofactors with oncogenic HPV-infections for cervical cancer are very rare from developing countries and such data are limited to the few screening trials. Large screening trials provide such data as a by product. Some of the cases are prevented by screening and do not surface as invasive cancers at all. Also, pre-invasive lesions are detected almost entirely by screening. Screening causes selection bias if attendance in or effectiveness of screening is correlated with the risk factors. The aim of this study was to quantify the influence of screening on risk factors for cervical cancer. Materials and Methods: Our material stems from a rural cohort of 80,000 women subjected to a randomised screening trial. The effect of screening on the incidence of cervix cancer was estimated with reference to socio-demographic and reproductive risk factors of cervical cancer. We compared these risks with the incidence of cancer in the randomised control population by the same determinants of risk. Results: The results in the screening arm compared to the control arm showed that the women of low SES and young age were benefitting more than those of high SES and old age. The relative risk by age (30-39 vs 50-59) was 0.33 in the control arm and 0.24 in the screening arm. The relative risk by education (not educated vs educated) was 2.8 in the control arm and 1.8 in the screening arm. The previously married women did not benefit (incidence 113 and 115 per 100,000 women years in control vs screening arms) whereas the effect was substantial in those married (86 vs 54). Conclusions: The results in controls were consistent with the general evidence, but results in attenders and nonattenders of the screening arm showed that screening itself and self-selection in attendance and effectiveness can influence the effect estimates of risk factors. The effect of cervical cancer screening programmes on the estimates of incidence of cervical cancer causes bias in the studies on etiology and, therefore, they should be interpreted with caution.

Effect of Screening on Variation in Cervical Cancer Survival by Socioeconomic Determinants - a Study from Rural South India

Thulaseedharan, Jissa Vinoda,Malila, Nea,Swaminathan, Rajaraman,Esmy, Pulikottil Okuru,Cherian, Mary,Hakama, Matti,Muwonge, Richard,Sankaranarayanan, Rengaswamy Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.13

Background: Socioeconomic factors are associated with screening in terms of reducing the risk of cervical cancer. This study aimed to clearly establish the effect of screening on variation in socio-economic factor-specific survival estimates. Materials and Methods: Survival estimates were calculated using the life table method for 165 women from the routine care control arm and 67 from the visual inspection with acetic acid screening arm diagnosed with cervical cancer during 2000-2006 in rural south India. Kaplan-Meier survival curves were plotted to compare the variation in survival by socioeconomic factors. Results: Whereas there was a significant variation in survival estimates of the different categories of age at diagnosis among the screen-detected cancers with women aged<50 years having an improved survival, no significant variation was noted among women diagnosed with cervical cancer from the control arm. Compared to the variation among the cancer cases detected in the unscreened control group, screening widened the variation in survival estimates by age and type of house, and reduced the variation by education. The direction of the magnitude of the survival estimates was reversed within the different categories of occupation, marital status and household income in the screen-detected cancer cases compared to control group cancer cases. Also, women diagnosed with stage 1 disease had a very good survival. Conclusions: Screening changed the pattern of survival by socio-economic factors. We found improved survival rates in screened women aged <50 years, with no formal education, manual workers and married women.