A Narrative Review of the Role of Blood Biomarkers in the Risk Prediction of Cardiovascular Diseases

Cardiovascular disease (CVD) is a global health crisis and a leading cause of morbidities and mortalities. Biomarkers whose evaluation would allow the detection of CVD at an early stage of development are actively sought. Biomarkers are objectively measured as indicators of health, disease, or response to an exposure or intervention, including therapeutic interventions. Hence, this review aims to identify biomarkers that can help predict CVD risk in the healthy population. This helps with risk prediction and is crucial for advancing preventive cardiology and improving clinical outcomes in a wide range of patient populations. Biomarkers such as atherogenic lipoproteins, fibrinogen, homocysteine, and thyroid-stimulating hormone (TSH) have been linked to CVD risk factors, including dyslipidemia, hypertension, diabetes, and obesity. When combined with conventional biomarkers, inflammatory markers such as C-reactive protein (CRP) can enhance risk prediction. However, biomarkers such as high-sensitivity troponin T (hsTnT) and N-terminal proBNP (NT-proBNP) are widely used as diagnostic biomarkers for heart failure (HF) and cardiac dysfunction, as they are released only after one to two hours of cardiovascular event occurrence. Myeloperoxidase (MPO) and procalcitonin (PCT) have developed into promising new biomarkers for the early detection of systemic bacterial infections as inflammatory markers, which are better diagnostic tools than screening. Combining biomarkers can improve test accuracy, but the best combinations for diagnosis or prognosis must be identified.

Smoked tobacco dependence and its correlates among participants attending life skills training and counselling services programme across Karnataka (2017-2022)

Introduction

Indian National Mental Health Survey reports an alarming prevalence of 20.9% for tobacco dependence in India. Dependence on smoked tobacco can be prevented by thorough knowledge of the risk factors associated with it.

Objectives

To estimate the prevalence and identify the factors associated with smoked tobacco dependence among participants attending the life skills training and counselling services programme (LSTCSP) across Karnataka from 2017 to 2022.

Materials and Methods

Pretraining data of 3104 participants from training programmes between 2017 and 2022 were utilised. Univariate and multivariable logistic regression analysis was performed based on a conceptual framework with various hypothesised exposure variables and smoked tobacco dependence as outcome.

Results

The overall prevalence of smoked tobacco dependence among LSTCSP participants who used smoked tobacco products was 59.4%. Ever use of smokeless tobacco products (Adjusted odds ratio (AOR) =2.05, 95% CI: 1.11-3.78) and screening positive for symptoms of generalised anxiety (AOR = 2.53, 95% CI: 1.32-4.84) significantly increased the odds of smoked tobacco dependence, whereas making decisions collectively in the family (AOR = 0.35, 95% CI: 0.18-0.66) and individuals with increased score for neurotic personality traits (AOR = 0.64, 95% CI: 0.44-0.93) were the factors associated with reduced odds of smoked tobacco dependence.

Conclusion

The identified risk factors associated with smoked tobacco dependence are important to develop tobacco control programmes as well as in preventing its onset. With the risk factors for smoked tobacco dependence identified, the results of this study have implications for health promotion and prevention programmes as well as cessation programmes related to smoked tobacco dependence, within India and similar countries.

Assessing Quality of Sensitization Programs of State-Wide Youth Mental Health Promotion Program - An Indian Example

Background

Sensitization plays a pivotal role in raising awareness about critical youth issues and encouraging them to access support services, contributing to the success of programs like Yuva Spandana, a youth-centric mental health promotion initiative in Karnataka, India. For youth to access support within YSKs, the quality and effectiveness of sensitization programs (SPs) are crucial. A standard quality assessment through indicators for SPs is required to provide recommendations for improvement. To enlist quality indicators and assess the quality of SP conducted under Yuva Spandana (YS) program across Karnataka.

Material and Methods

We performed secondary data analysis (utilizing data available within the computerized management information system over 5 years; 2017-2022) and direct/in-person observation of SPs (by the researcher and the core team of YS between June and July 2022 using a specifically developed checklist). Quality indicators were developed using a process of consensus building. Each attribute within the checklist was scored, and a composite mean score and mean percentage scores for quality were calculated.

Results

Overall, 33257 SP reports and 31 in-person SPs were assessed. A total of 36 quality indicators (10 quality indicators based on SP reports and 26 based on in-person observation) were developed. The average quality score of report-based SPs was 10.93 (±2.59; range 1-20) and in-person assessment was 63.06 (±6.61; range 50-73).

Conclusion

The study emphasizes the importance of addressing all youth issues, including sensitive topics like gender, sex, and sexuality, to ensure a holistic approach to youth mental health. Challenges faced during program execution and the distribution of Information, Education, and Communication (IEC) materials also contribute to program quality. This research offers valuable insights for improving the conduct of SPs, enhancing youth access to services, and guiding future community-based health promotion initiatives.

Assessment of Stroke Case-fatality, Disability, Perceived Needs and Barriers for Care among First-ever Stroke Patients Attending a Tertiary Care Neuro-specialty Center in India: A Cross-sectional Study

Background

Stroke is a major public health and clinical challenge that results in significant mortality and disability. Stroke survivors require care and support, particularly during the crucial 3 months post-stroke when 95% of functional neurological recovery occurs. To estimate case-fatality and extent of disability, assess perceived needs, barriers, and unmet needs for care, and ascertain pathways to care post-discharge (at 3 months) among first-ever stroke patients attending a tertiary care neuro-specialty center in India.

Material and Methods

A cross-sectional descriptive study was conducted among patients receiving care within [NIMHANS]. Patients with confirmed computed tomography (CT) scans experiencing their first-ever stroke between September 1 and October 31, 2022, were contacted between November 1, 2022, and March 31, 2023. A pre-tested semi-structured questionnaire was used to collect information. Descriptive statistics were performed using STATA version 16.

Results

Stroke fatality among study subjects was 13.8%. Almost half (49.09%) had some form of disability, with 40% having moderate to severe disability. The majority perceived the need for follow-up visits (87%) and compliance with stroke medication (84%). Distance and transportation (60%) were cited as the main barriers to care. After discharge, the majority preferred healthcare facilities close to their homes (60%).

Conclusions

This study emphasizes the need for stroke survivors to have follow-up and compliance with medication, along with various unmet needs such as de-addiction services, vocational training, and emotional support. A network-based multi-disciplinary approach, along with a comprehensive hub and spoke model of stroke management services, could help address these challenges and improve patient outcomes.