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Abstract
Dyslipidemia is the most important atherosclerotic risk factor. Review of population based studies in India shows increasing mean total cholesterol levels. Recent studies have reported that high cholesterol is present in 25–30% of urban and 15–20% rural subjects. This prevalence is lower than high-income countries. The most common dyslipidemia in India are borderline high LDL cholesterol, low HDL cholesterol and high triglycerides. Studies have reported that over a 20-year period total cholesterol, LDL cholesterol and triglyceride levels have increased among urban populations. Case-control studies have reported that there is significant association of coronary events with raised apolipoproteinB, total cholesterol, LDL cholesterol and non-HDL cholesterol and inverse association with high apolipoproteinA and HDL cholesterol. Prevalence of suspected familial hypercholesterolemia in urban subjects varies from 1:125 to 1:450. Only limited studies exist regarding lipid abnormalities in children. There is low awareness, treatment and control of hypercholesterolemia in India.
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Affiliation(s)
- Rajeev Gupta
- Department of Preventive Cardiology and Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India.
| | - Ravinder S Rao
- Department of Preventive Cardiology and Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Anoop Misra
- Department of Metabolic Diseases, Fortis C-DOC Centre, Chiragh Enclave, New Delhi, India
| | - Samin K Sharma
- Department of Cardiology, Mount Sinai Hospital and Icahn School of Medicine, New York, USA
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102
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Johnson C, Mohan S, Rogers K, Shivashankar R, Thout SR, Gupta P, He FJ, MacGregor GA, Webster J, Krishnan A, Maulik PK, Reddy KS, Prabhakaran D, Neal B. The Association of Knowledge and Behaviours Related to Salt with 24-h Urinary Salt Excretion in a Population from North and South India. Nutrients 2017; 9:E144. [PMID: 28212309 PMCID: PMC5331575 DOI: 10.3390/nu9020144] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/24/2017] [Accepted: 02/03/2017] [Indexed: 11/16/2022] Open
Abstract
Consumer knowledge is understood to play a role in managing risk factors associated with cardiovascular disease and may be influenced by level of education. The association between population knowledge, behaviours and actual salt consumption was explored overall, and for more-educated compared to less-educated individuals. A cross-sectional survey was done in an age-and sex-stratified random sample of 1395 participants from urban and rural areas of North and South India. A single 24-h urine sample, participants' physical measurements and questionnaire data were collected. The mean age of participants was 40 years, 47% were women and mean 24-h urinary salt excretion was 9.27 (8.87-9.69) g/day. Many participants reported favourable knowledge and behaviours to minimise risks related to salt. Several of these behaviours were associated with reduced salt intake-less use of salt while cooking, avoidance of snacks, namkeens, and avoidance of pickles (all p < 0.003). Mean salt intake was comparable in more-educated (9.21, 8.55-9.87 g/day) versus less-educated (9.34, 8.57-10.12 g/day) individuals (p = 0.82). There was no substantively different pattern of knowledge and behaviours between more-versus less-educated groups and no clear evidence that level of education influenced salt intake. Several consumer behaviours related to use of salt during food preparation and consumption of salty products were related to actual salt consumption and therefore appear to offer an opportunity for intervention. These would be a reasonable focus for a government-led education campaign targeting salt.
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Affiliation(s)
- Claire Johnson
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
| | - Sailesh Mohan
- Public Health Foundation of India, New Delhi 110070, India.
| | - Kris Rogers
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
| | - Roopa Shivashankar
- Public Health Foundation of India, New Delhi 110070, India.
- Centre for Chronic Disease Control, New Delhi 122002, India.
| | | | - Priti Gupta
- Public Health Foundation of India, New Delhi 110070, India.
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Jacqui Webster
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
| | - Anand Krishnan
- All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Pallab K Maulik
- George Institute for Global Health, Hyderabad 500034, India.
- George Institute for Global Health, University of Oxford, Oxford OX1 3PA, UK.
| | | | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi 110070, India.
- Centre for Chronic Disease Control, New Delhi 122002, India.
| | - Bruce Neal
- The George Institute for Global Health, Box M201 Missenden Rd, Sydney 2006, Australia.
- School of Public Health, Department of Medicine, The University of Sydney, Sydney 2006, Australia.
- Charles Perkins Centre, University of Sydney, Sydney 2050, Australia.
- School of Public Health, Imperial College, London SW7 2AZ, UK.
- Royal Prince Alfred Hospital, Sydney 2050, Australia.
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103
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Jacoby SF, Winston FK, Richmond TS. Road safety perspectives among employees of a multinational corporation in urban India: local context for global injury prevention. Int J Inj Contr Saf Promot 2017; 24:493-500. [PMID: 28118760 DOI: 10.1080/17457300.2016.1278235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In rapidly developing economies, like urban India, where road traffic injury rates are among the world's highest, the corporate workplace offers a non-traditional venue for road safety interventions. In partnership with a major multinational corporation (MNC) with a large Indian workforce, this study aimed to elicit local employee perspectives on road safety to inform a global corporate health platform. The safety attitudes and behaviours of 75 employees were collected through self-report survey and focus groups in the MNC offices in Bangalore and Pune. Analysis of these data uncovered incongruity between employee knowledge of safety strategies and their enacted safety behaviours and identified local preference for interventions and policy-level actions. The methods modelled by this study offer a straightforward approach for eliciting employee perspective for local road safety interventions that fit within a global strategy to improve employee health. Study findings suggest that MNCs can employ a range of strategies to improve the road traffic safety of their employees in settings like urban India including: implementing corporate traffic safety policy, making local infrastructure changes to improve road and traffic conditions, advocating for road safety with government partners and providing employees with education and access to safety equipment and safe transportation options.
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Affiliation(s)
- Sara F Jacoby
- a Department of Biobehavioral Health Sciences and the Penn Injury Science Center , University of Pennsylvania School of Nursing , Philadelphia , PA , USA
| | - Flaura K Winston
- b The Children's Hospital of Philadelphia , Center for Injury Research and Prevention , Philadelphia , PA , USA
| | - Therese S Richmond
- a Department of Biobehavioral Health Sciences and the Penn Injury Science Center , University of Pennsylvania School of Nursing , Philadelphia , PA , USA
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104
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Johnson C, Mohan S, Rogers K, Shivashankar R, Thout SR, Gupta P, He FJ, MacGregor GA, Webster J, Krishnan A, Maulik PK, Reddy KS, Prabhakaran D, Neal B. Mean Dietary Salt Intake in Urban and Rural Areas in India: A Population Survey of 1395 Persons. J Am Heart Assoc 2017; 6:e004547. [PMID: 28062480 PMCID: PMC5523637 DOI: 10.1161/jaha.116.004547] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/02/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The scientific evidence base in support of population-wide salt reduction is strong, but current high-quality data about salt intake levels in India are mostly absent. This project sought to estimate daily salt consumption levels in selected communities of Delhi and Haryana in north India and Andhra Pradesh in south India. METHODS AND RESULTS In this study, 24-hour urine samples were collected using an age- and sex-stratified sampling strategy in rural, urban, and slum areas. Salt intake estimates were made for the overall population of each region and for major subgroups by weighting the survey data for the populations of Delhi and Haryana, and Andhra Pradesh. Complete 24-hour urine samples were available for 637 participants from Delhi and Haryana and 758 from Andhra Pradesh (65% and 68% response rates, respectively). Weighted mean population 24-hour urine excretion of salt was 8.59 g/day (95% CI 7.68-9.51) in Delhi and Haryana and 9.46 g/day (95% CI 9.06-9.85) in Andhra Pradesh (P=0.097). Estimates inflated to account for the minimum likely nonurinary losses of sodium provided corresponding estimates of daily salt intake of 9.45 g/day (95% CI 8.45-10.46) and 10.41 g/day (95% CI 9.97-10.84), respectively. CONCLUSIONS Salt consumption in India is high, with mean population intake well above the World Health Organization recommended maximum of 5 g/day. A national salt reduction program would likely avert much premature death and disability.
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Affiliation(s)
- Claire Johnson
- The George Institute for Global Health, Sydney, Australia
- The University of Sydney, Australia
| | | | - Kris Rogers
- The George Institute for Global Health, Sydney, Australia
- The University of Sydney, Australia
| | - Roopa Shivashankar
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
| | | | - Priti Gupta
- Public Health Foundation of India, New Delhi, India
| | - Feng J He
- Wolfson Institute of Preventive Medicine Queen Mary University of London, United Kingdom
- Barts and the London School of Medicine & Dentistry Queen Mary University of London, United Kingdom
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine Queen Mary University of London, United Kingdom
- Barts and the London School of Medicine & Dentistry Queen Mary University of London, United Kingdom
| | - Jacqui Webster
- The George Institute for Global Health, Sydney, Australia
- The University of Sydney, Australia
| | - Anand Krishnan
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Bruce Neal
- The George Institute for Global Health, Sydney, Australia
- The University of Sydney, Australia
- Charles Perkins Centre, University of Sydney, Australia
- Imperial College, London, United Kingdom
- Royal Prince Alfred Hospital, Sydney, Australia
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105
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Tarun S, Arora M, Rawal T, Benjamin Neelon SE. An evaluation of outdoor school environments to promote physical activity in Delhi, India. BMC Public Health 2017; 17:11. [PMID: 28056908 PMCID: PMC5217605 DOI: 10.1186/s12889-016-3987-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 12/22/2016] [Indexed: 12/04/2022] Open
Abstract
Background Increasing physical activity in children is an important public health goal in India. Schools may be a target for physical activity promotion, but little is known about outdoor school environments. The purpose of this study was to describe characteristics of the surrounding outdoor school environments that may promote children’s physical activity in Delhi, India. Methods For this cross-sectional study, we conducted a structured observation of outdoor school environments in a random sample of 16 private schools in Delhi, India using the Sport, Physical activity and Eating behavior: Environmental Determinants in Young people (SPEEDY) audit tool. The SPEEDY school audit measured six categories, including (1) access to the school; (2) surrounding area; (3) school grounds; (4) aesthetics; (5) usage; and (6) overall environment. Six trained data collectors conducted the audit independently in the summer of 2012 while schools were in session. Results Of the 16 schools, one had cycle lanes separated from the road while two schools had cycle lanes on the road. Two schools had pavement on both sides of the road for pedestrians. One school had marked pedestrian crossings. No schools had school warning signs, road safety signs, or route signs for cyclists that would help calm vehicular traffic. Fifteen schools had playground equipment and nine had courts, an assault course (a sequence of equipment designed to be used together), and a quadrangle (an enclosed or semi-enclosed courtyard) for outdoor physical activity. The majority of schools were shielded from the surrounding area by hedges, trees, or fences (n = 13) and were well maintained (n = 10). One school had evidence of vandalism. Two schools had graffiti, seven had litter, and 15 had murals or art. Conclusions The majority of schools did not have infrastructure to support physical activity, such as cycle lanes, marked pedestrian crossings, or traffic calming mechanisms such as school warning signs. However, most had playground equipment, courts, and outdoor play areas. Nearly all were free from vandalism and many had murals or art. These results provide preliminary data for future work examining outdoor school environments, active transport to school, and children’s physical activity in India. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3987-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samiksha Tarun
- Saint Louis University School of Medicine, 1402 South Grand Boulevard, St Louis, MO, 63104, USA
| | - Monika Arora
- Health Promotion and Tobacco Control, Public Health Foundation of India, Plot No. 47, Sector-44, Gurgaon, 122002, India
| | - Tina Rawal
- Public Health Foundation of India, Plot No. 47, Sector-44, Gurgaon, 122002, India
| | - Sara E Benjamin Neelon
- Department of Health, Behavior and Society, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, USA.
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106
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Thakur JS, Jaswal N, Grover A. Is Focus on Prevention Missing in National Health Programs? A Situation Analysis of IEC/BCC/Health Promotion Activities in a District Setting of Punjab and Haryana. Indian J Community Med 2017; 42:30-36. [PMID: 28331251 PMCID: PMC5349000 DOI: 10.4103/0970-0218.199795] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Context: Health promotion (HP) has been an integral part of all national programs although it has been a low priority in India, which has resulted in a failure to achieve the desired results. Settings and Design: Situation analysis of information education communication (IEC)/behavior change communication (BCC)/HP activities within the existing national health programs was undertaken in the district of Hoshiarpur in Punjab and the district of Ambala in Haryana during 2013-14. Materials and Methods: Facility-based assessments were done by conducting in-depth interviews with stakeholders, program officers, medical officers, health workers, and counselors. Household survey (332 individuals) and exit interview (102 interviews) were conducted to assess the knowledge of the community regarding key risk factors. Results: There was a high vacancy in the mass media division with 40% (2 out of 5) and 89% (8 out of 9) of the sanctioned positions vacant in Hoshiarpur and Ambala, respectively, with low capacity of staff and budget. There was no annual calendar, logbook of activities with poor recording of IEC material received and disseminated. The knowledge of community members regarding key risk factors such as tobacco use, salt intake, blood pressure level, anemia, and tuberculosis was 77.3%, 26.4%, 16.4%, 32.7%, and 91.8%, respectively, in the district of Ambala as compared to 77.5%, 37.5%, 33.3%, 25.8%, and 88.3%, respectively, in the district of Hoshiarpur. The village health and sanitation committee (VHSC) in the district of Hoshiarpur and village level core committee (VLCC) in the district of Ambala were found to be nonfunctional with no Iec/Bcc activities in the covered villages in the last month. Monitoring and supervision of Iec/Bcc activities were poor in both the districts. Conclusions: Iec/Bcc/HP is a neglected area in national health programs in the selected districts with inadequate budget, human resources with poor implementation, and requires strengthening for better implementation of the national health programs.
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Affiliation(s)
- Jarnail Singh Thakur
- School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, PGIMER, Chandigarh, India
| | - Nidhi Jaswal
- School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, PGIMER, Chandigarh, India
| | - Ashoo Grover
- Indian Council of Medical Research, New Delhi, India
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107
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Sinha R, Pati S. Addressing the escalating burden of chronic diseases in India: Need for strengthening primary care. J Family Med Prim Care 2017; 6:701-708. [PMID: 29564247 PMCID: PMC5848382 DOI: 10.4103/jfmpc.jfmpc_1_17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The growing epidemic of noncommunicable diseases (NCDs) has impacted the national health systems, policies, and socioeconomic developments, thereby leading to increasing country level disparities. Despite substantial improvements in health indicators made in the past decade, the Indian health-care system continues to contribute disproportionately to the global disease burden, wherein NCDs holds significant prominence. Against this background, the present review analyzes the current NCD landscape from the perspective of India's health system preparedness toward meeting this growing challenge. Implementation and delivery of strategies and interventions are often impeded by existing grass root level challenges. Recognizing the importance of effective primary care, the review highlights the importance of implementing affordable, accessible, and comprehensive interventions, and delivering them at societal, a community and individual level. This simultaneously calls for strengthening of the primary care system through appropriate strategy and policy frameworks. Toward addressing India-specific needs in NCD prevention and management, concerted efforts on development of robust surveillance mechanisms, intersectoral and interdepartmental collaborations, integration of national programs, enhanced role of education and awareness should be made, to ensure effectivity, scale-up, and outreach of services in primary care.
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Affiliation(s)
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
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108
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Daswani PG, Gholkar MS, Birdi TJ. Psidium guajava: A Single Plant for Multiple Health Problems of Rural Indian Population. Pharmacogn Rev 2017; 11:167-174. [PMID: 28989253 PMCID: PMC5628524 DOI: 10.4103/phrev.phrev_17_17] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The rural population in India faces a number of health problems and often has to rely on local remedies. Psidium guajava Linn. (guava), a tropical plant which is used as food and medicine can be used by rural communities due to its several medicinal properties. A literature search was undertaken to gauge the rural health scenario in India and compile the available literature on guava so as to reflect its usage in the treatment of multiple health conditions prevalent in rural communities. Towards this, electronic databases such as Pubmed, Science Direct, google scholar were scanned. Information on clinical trials on guava was obtained from Cochrane Central Register of Controlled Trials and Clinicaltrial.gov. The literature survey revealed that guava possesses various medicinal properties which have been reported from across the globe in the form of ethnobotanical/ethnopharmacological surveys, laboratory investigations and clinical trials. Besides documenting the safety of guava, the available literature shows that guava is efficacious against the following conditions which rural communities would encounter. (a) Gastrointestinal infections; (b) Malaria; (c)Respiratory infections; (d) Oral/dental infections; (e) Skin infections; (f) Diabetes; (g) Cardiovascular/hypertension; (h) Cancer; (i) Malnutrition; (j) Women problems; (k) Pain; (l) Fever; (m) Liver problems; (n) Kidney problems. In addition, guava can also be useful for treatment of animals and explored for its commercial applications. In conclusion, popularization of guava, can have multiple applications for rural communities.
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Affiliation(s)
- Poonam G Daswani
- Department of Medicinal Plants, The Foundation for Medical Research, Mumbai, Maharashtra, India
| | - Manasi S Gholkar
- Department of Medicinal Plants, The Foundation for Medical Research, Mumbai, Maharashtra, India
| | - Tannaz J Birdi
- Department of Medicinal Plants, The Foundation for Medical Research, Mumbai, Maharashtra, India
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109
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Sharma M, Banerjee B, Ingle GK, Garg S. Effect of mHealth on modifying behavioural risk-factors of non-communicable diseases in an adult, rural population in Delhi, India. Mhealth 2017; 3:42. [PMID: 29184894 PMCID: PMC5682360 DOI: 10.21037/mhealth.2017.08.03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/14/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The rising trend of non-communicable diseases (NCDs) has led to a "dual burden" in low and middle-income (LAMI) countries like India which are still battling with high prevalence of communicable diseases. The incorporation of a target specially dedicated to NCDs within the goal 3 of the newly adopted Sustainable Development Goals indicates the importance the world now accords to prevention and control of these diseases. Mobile phone technology is increasingly viewed as a promising communication channel that can be utilized for primary prevention of NCDs by promoting behaviour change and risk factor modification. METHODS A "Before and After" Intervention study was conducted on 400 subjects, over a period of one year, in Barwala village, Delhi, India. An mHealth intervention package consisting of weekly text messages and monthly telephone calls addressing lifestyle modification for risk factors of NCDs was given to the intervention group, compared to no intervention package in control group. RESULTS After Intervention Phase, significant reduction was seen in behavioural risk factors (unhealthy diet and insufficient physical activity) in the intervention group compared to control group. Body mass index (BMI), systolic blood pressure and fasting blood sugar level also showed significant difference in the intervention group as compared to controls. CONCLUSIONS Our study has demonstrated the usefulness of mHealth for health promotion and lifestyle modification at community level in a LAMI country. With the growing burden of NCDs in the community, such cost effective and innovative measures will be needed that can easily reach the masses.
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Affiliation(s)
- Malvika Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Bratati Banerjee
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - G K Ingle
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
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110
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Patel V, Xiao S, Chen H, Hanna F, Jotheeswaran AT, Luo D, Parikh R, Sharma E, Usmani S, Yu Y, Druss BG, Saxena S. The magnitude of and health system responses to the mental health treatment gap in adults in India and China. Lancet 2016; 388:3074-3084. [PMID: 27209149 DOI: 10.1016/s0140-6736(16)00160-4] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This Series paper describes the first systematic effort to review the unmet mental health needs of adults in China and India. The evidence shows that contact coverage for the most common mental and substance use disorders is very low. Effective coverage is even lower, even for severe disorders such as psychotic disorders and epilepsy. There are vast variations across the regions of both countries, with the highest treatment gaps in rural regions because of inequities in the distribution of mental health resources, and variable implementation of mental health policies across states and provinces. Human and financial resources for mental health are grossly inadequate with less than 1% of the national health-care budget allocated to mental health in either country. Although China and India have both shown renewed commitment through national programmes for community-oriented mental health care, progress in achieving coverage is far more substantial in China. Improvement of coverage will need to address both supply-side barriers and demand-side barriers related to stigma and varying explanatory models of mental disorders. Sharing tasks with community-based workers in a collaborative stepped-care framework is an approach that is ripe to be scaled up, in particular through integration within national priority health programmes. India and China need to invest in increasing demand for services through active engagement with the community, to strengthen service user leadership and ensure that the content and delivery of mental health programmes are culturally and contextually appropriate.
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Affiliation(s)
- Vikram Patel
- London School of Hygiene & Tropical Medicine, London, UK; Centre for the Control of Chronic Conditions, Guragon, India; Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China.
| | - Hanhui Chen
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fahmy Hanna
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - A T Jotheeswaran
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Dan Luo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China
| | - Rachana Parikh
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Eesha Sharma
- Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India
| | | | - Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China
| | - Benjamin G Druss
- Mental Health School of Public Health: Health Policy & Management, Emory University, Atlanta, GA, USA
| | - Shekhar Saxena
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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111
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Taing KY, Farkouh ME, Moineddin R, Tu JV, Jha P. Age and sex-specific associations of anthropometric measures of adiposity with blood pressure and hypertension in India: a cross-sectional study. BMC Cardiovasc Disord 2016; 16:247. [PMID: 27905876 PMCID: PMC5134088 DOI: 10.1186/s12872-016-0424-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A determinant of blood pressure is adiposity; however, there are uncertainties surrounding whether general or central adiposity is the more important determinant of blood pressure. Further, inconsistent results exist for the relationships of anthropometric measures with blood pressure and hypertension, and whether these relationships differ substantially by age and sex is unclear. We aimed to elucidate the associations of anthropometric measures of general and central adiposity with blood pressure and hypertension, and determine the effect of age and sex on these relationships. METHODS We used cross-sectional data from the Centre for Global Health Research health check-up survey conducted during 2006-2007 of the general population in India (n = 7 601; age 18-59 years). We examined the associations of anthropometric measures (body mass index, waist circumference, hip circumference, waist-hip ratio, waist-height ratio) with blood pressure components (systolic pressure, diastolic pressure, pulse pressure, mean arterial pressure, mid-blood pressure) and hypertension within four (18-29 years, 30-39 years, 40-49 years, 50-59 years) age groups, by sex. We adjusted all analyses for education and location, with further adjustments, variously, for either a measure of central (waist circumference) or general (body mass index) adiposity. RESULTS On average, every 5 kg/m2 greater body mass index or 10 cm wider waist circumference was associated with a 5 and 4 mmHg higher systolic blood pressure, respectively. When considered separately, each anthropometric measure was strongly and positively associated with most blood pressure components in all age groups, and for both sexes. However, with few exceptions, when considered jointly (body mass index adjusted for waist circumference), the associations of body mass index with blood pressure components and hypertension were greatly diminished for both sexes, and particularly in the ≥30 years age groups. By contrast, further adjustment of waist circumference for body mass index did not materially alter the associations of waist circumference with blood pressure components and hypertension. CONCLUSIONS Our findings indicate that central adiposity, as assessed with anthropometric measures, may be a more important determinant of blood pressure and hypertension than general adiposity for adults in India.
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Affiliation(s)
- Kevin Y Taing
- Centre for Global Health Research, St. Michael's Hospital, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.,The Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, Toronto, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Jack V Tu
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Prabhat Jha
- Centre for Global Health Research, St. Michael's Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Das J, Chowdhury A, Hussam R, Banerjee AV. The impact of training informal health care providers in India: A randomized controlled trial. Science 2016; 354:354/6308/aaf7384. [DOI: 10.1126/science.aaf7384] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/25/2016] [Indexed: 11/02/2022]
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Abstract
In the last 60 years since independence, India had achieved considerable improvements in the health of its population as reflected in their life expectancies which have doubled within this period. This article aims at explaining pertinent health-care issues and challenges based on some health indicators in India by using the literature review method that involved collection of material from the online sources, which included government documents, articles and publications related to healthcare, healthcare indicators, poverty, financial burden and coping strategies. To avoid premature deaths among adults, children and maternal mortalities, greater attention should be given to prevention and treatment of non-communicable diseases, and women and other social determinants of health. More attention should also be given to the reduction of births among teenage girls in order to avoid premature morbidity and mortality. To protect the vulnerable and poor, the government should provide more resources since financial burden of curative care is higher among lower income groups. However, in poorer states, the government tends to have relatively low ability to raise their own resources and the people in these states have a lower ability to pay for private insurance. Therefore, it is worthwhile and pertinent that the government initiates social insurance.
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Affiliation(s)
- Maryam Sohrabi
- PhD Student, Department of Administrative Studies & Politics, Faculty of Economics and Administration Building, University of Malaya, Kuala Lumpur, Malaysia
| | - Makmor Tumin
- Associated Professor, Department of Administrative Studies & Politics, Faculty of Economics and Administration Building, University of Malaya, Kuala Lumpur, Malaysia
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Prashanth NS, Elias MA, Pati MK, Aivalli P, Munegowda CM, Bhanuprakash S, Sadhana SM, Criel B, Bigdeli M, Devadasan N. Improving access to medicines for non-communicable diseases in rural India: a mixed methods study protocol using quasi-experimental design. BMC Health Serv Res 2016; 16:421. [PMID: 27549020 PMCID: PMC4994301 DOI: 10.1186/s12913-016-1680-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 08/17/2016] [Indexed: 11/20/2022] Open
Abstract
Background India has the distinction of financing its healthcare mainly through out-of-pocket expenses by individual families contributing to catastrophic health expenditure and impoverishment. Nearly 70 % of the expenditure is on medicines purchased at private pharmacies. Patients with chronic ailments are especially affected, as they often need lifelong medicines. Over the past years in India, there have been several efforts to improve drug availability at government primary health centres. In this study, we aim to understand health system factors that affect utilisation and access to generic medicines for people with non-communicable diseases. Methods This study aims to understand if (and how) a package of interventions targeting primary health centres and community participation platforms affect utilisation and access to generic medicines for people with non-communicable diseases in the current district context in India. This study will employ a quasi-experimental design and a qualitative theory-driven approach. PHCs will be randomly assigned to one of three arms of the intervention. In one arm, PHCs will receive inputs to optimise service delivery for non-communicable diseases, while the second arm will receive an additional package of interventions to strengthen community participation platforms for improving non-communicable disease care. The third arm will be the control. We will conduct household and facility surveys, before and after the intervention and will estimate the effect of the intervention by difference-in-difference analysis. Sample size for measuring effects was calculated based on obtaining at least 30 households for each primary health centre spread across three distance-based clusters. Primary outcomes include availability and utilisation of medicines at primary health centres and out-of-pocket expenditure for medicines by non-communicable disease households. Focus group discussions with patients and in-depth interviews with health workers will also be conducted. Qualitative and process documentation data will be used to explain how the intervention could have worked. Discussion By taking into consideration several health system building blocks and trying to understand how they interact, our study aims to generate evidence for health planners on how to optimise health services to improve access to medicines. Trial registration Protocol registered on Clinical Trials Registry of India with registration identifier number CTRI/2015/03/005640 on 17th March 2015. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1680-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N S Prashanth
- Institute of Public Health, 250, 2 c main, 2 c cross, Girinagar I phase, Bangalore, 560 085, Karnataka, India.
| | - Maya Annie Elias
- Institute of Public Health, 250, 2 c main, 2 c cross, Girinagar I phase, Bangalore, 560 085, Karnataka, India
| | - Manoj Kumar Pati
- Institute of Public Health, 250, 2 c main, 2 c cross, Girinagar I phase, Bangalore, 560 085, Karnataka, India
| | - Praveenkumar Aivalli
- Institute of Public Health, 250, 2 c main, 2 c cross, Girinagar I phase, Bangalore, 560 085, Karnataka, India
| | - C M Munegowda
- Institute of Public Health, 250, 2 c main, 2 c cross, Girinagar I phase, Bangalore, 560 085, Karnataka, India
| | - Srinath Bhanuprakash
- Institute of Public Health, 250, 2 c main, 2 c cross, Girinagar I phase, Bangalore, 560 085, Karnataka, India
| | - S M Sadhana
- Karnataka Health Systems Resource Centre, Leprosy hospital campus, Magadi Road, 1st cross, Bangalore, 560023, Karnataka, India
| | - Bart Criel
- Institute of Tropical Medicine, Nationalestraat - 155, 2000, Antwerp, Belgium
| | - Maryam Bigdeli
- Alliance for Health Policy and Systems Research, World Health Organisation, Geneva, Switzerland
| | - Narayanan Devadasan
- Institute of Public Health, 250, 2 c main, 2 c cross, Girinagar I phase, Bangalore, 560 085, Karnataka, India
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Awareness, treatment adherence and risk predictors of uncontrolled hypertension at a tertiary care teaching hospital in Western India. Indian Heart J 2016; 68 Suppl 2:S251-S252. [PMID: 27751307 PMCID: PMC5067811 DOI: 10.1016/j.ihj.2016.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/09/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction Hypertension still remains poorly controlled. Result Adequate BP control was achieved in 37.4% of patients and significant attributes for poor control were BMI, marital status, literacy, socioeconomic status, smoking, medication adherence, absence of side effects, number of drugs, number of years on drug therapy and co-morbid conditions.
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Effect of Aerobic Exercise Training on Blood Pressure in Indians: Systematic Review. Int J Chronic Dis 2016; 2016:1370148. [PMID: 27493989 PMCID: PMC4967448 DOI: 10.1155/2016/1370148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 06/06/2016] [Accepted: 06/19/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction. High blood pressure (BP) is one of the most important modifiable risk factors for cardiovascular diseases, which accounts for one in every eight deaths worldwide. It has been predicted that, by 2020, there would be 111% increase in cardiovascular deaths in India. Aerobic exercise in the form of brisk walking, jogging, running, and cycling would result in reduction in BP. Many meta-analytical studies from western world confirm this. However, there is no such review from Indian subcontinent. Objective. Our objective is to systematically review and report the articles from India in aerobic exercise on blood pressure. Methodology. Study was done in March 2016 in Google Scholar using search terms “Aerobic exercise” AND “Training” AND “Blood pressure” AND “India.” This search produced 3210 titles. Results. 24 articles were identified for this review based on inclusion and exclusion criteria. Total of 1107 subjects participated with median of 25 subjects. Studies vary in duration from +3 weeks to 12 months with each session lasting 15–60 minutes and frequency varies from 3 to 8 times/week. The results suggest that there was mean reduction of −05.00 mmHg in SBP and −03.09 mmHg in DBP after aerobic training. Conclusion. Aerobic training reduces the blood pressure in Indians.
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Samudre S, Shidhaye R, Ahuja S, Nanda S, Khan A, Evans-Lacko S, Hanlon C. Service user involvement for mental health system strengthening in India: a qualitative study. BMC Psychiatry 2016; 16:269. [PMID: 27465387 PMCID: PMC4964288 DOI: 10.1186/s12888-016-0981-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 07/17/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is a wide recognition that involvement of service users and their caregivers in health system policy and planning processes can strengthen health systems; however, most evidence and experience has come from high-income countries. This study aimed to explore baseline experiences, barriers and facilitators to service user-caregiver involvement in the emerging mental health system in India, and stakeholders' perspectives on how greater involvement could be achieved. METHODS A qualitative study was conducted in Sehore district of Madhya Pradesh, India. In-depth interviews (n = 27) and a focus group discussion were conducted among service users, caregivers and their representatives at district, state and national levels and policy makers, service providers and mental health researchers. The topic guide explored the baseline situation in India, barriers and facilitators to service user and caregiver involvement in the following aspects of mental health systems: policy-making and planning, service development, monitoring and quality control, as well as research. Framework analysis was employed. RESULTS Respondents spoke of the limited involvement of service users and caregivers in the current Indian mental health system. The major reported barriers to this involvement were (1) unmet treatment and economic needs arising from low access to mental health services coupled with the high burden of illness, (2) pervasive stigmatising attitudes operating at the level of service user, caregiver, community, healthcare provider and healthcare administrators, and (3) entrenched power differentials between service providers and service users. Respondents prioritised greater involvement of service users in the planning of their own individual-level mental health care before considering involvement at the mental health system level. A stepwise progression was endorsed, starting from needs assessment, through empowerment and organization of service users and caregivers, leading finally to meaningful involvement. CONCLUSIONS Societal and system level barriers need to be addressed in order to facilitate the involvement of service users and caregivers to strengthen the Indian mental health system. Shifting from a largely 'provider-centric' to a more 'user-centric' model of mental health care may be a fundamental first step to sustainable user involvement at the system level.
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Affiliation(s)
- Sandesh Samudre
- Center for Chronic Conditions and Injuries, The Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Delhi, NCR 122002, India.
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, King's College London, PO29 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK.
- The Public Health Foundation of India House No. 19, Rishi Nagar Char Imli, Bhopal, 462016, India.
| | - Rahul Shidhaye
- Center for Chronic Conditions and Injuries, The Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Delhi, NCR 122002, India
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, King's College London, PO29 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Shalini Ahuja
- Center for Chronic Conditions and Injuries, The Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Delhi, NCR 122002, India
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, King's College London, PO29 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Sharmishtha Nanda
- Center for Chronic Conditions and Injuries, The Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Delhi, NCR 122002, India
| | - Azaz Khan
- Center for Chronic Conditions and Injuries, The Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Delhi, NCR 122002, India
| | - Sara Evans-Lacko
- Center for Chronic Conditions and Injuries, The Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Delhi, NCR 122002, India
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, King's College London, PO29 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
- London School of Economics and Political Science, Personal Social Services Research Unit, Houghton Street, London, WC2A 2AE, UK
| | - Charlotte Hanlon
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, King's College London, PO29 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, 6th Floor, College of Health Sciences Building, Tikur Anbessa Hospital, PO 9086, Addis Ababa, Ethiopia
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Sowmya N, Lakshmipriya N, Arumugam K, Venkatachalam S, Vijayalakshmi P, Ruchi V, Geetha G, Anjana RM, Mohan V, Krishnaswamy K, Sudha V. Comparison of dietary profile of a rural south Indian population with the current dietary recommendations for prevention of non-communicable diseases (CURES 147). Indian J Med Res 2016; 144:112-119. [PMID: 27834334 PMCID: PMC5116883 DOI: 10.4103/0971-5916.193297] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND & OBJECTIVES Despite the rising prevalence of non-communicable diseases (NCDs) in rural India, data on the dietary profile of the rural Indian population in relation to the recommendations for prevention of NCDs are scarce. This study was conducted to assess the dietary intake of a rural south Indian population in relation to the current dietary recommendations for the prevention of NCDs. METHODS The dietary profiles of 6907 adults aged ≥ 20 yr, from a cluster of 42 villages in Kancheepuram district of Tamil Nadu State in southern India, were assessed using a validated food frequency questionnaire. RESULTS The prevalence of general obesity was 27.4 per cent and that of abdominal obesity, 14.0 per cent among this rural population. The median daily energy intake of the population was 2034 (IQR 543) kcals. More than 3/4 th of the calories (78.1%) were provided by carbohydrates. Refined cereals, mainly polished rice, was the major contributor to total calories. About 45 per cent of the population did not meet WHO recommendation for protein due to low intake of pulses, flesh foods and dairy products and more than half (57.1%) exceeded the limit of salt intake; 99 per cent of the population did not meet WHO recommendations for fruits and vegetables and 100 per cent did not meet the requirement of n-3 poly unsaturated fatty acids. INTERPRETATION & CONCLUSIONS The dietary profile of this rural south Indian population reflected unhealthy choices, with the high consumption of refined cereals in the form of polished white rice and low intake of protective foods like fruits, vegetables, n-3 poly and monounsaturated fatty acids. This could potentially contribute to the increase in prevalence of NCDs like diabetes, hypertension and cardiovascular diseases in rural areas and calls for appropriate remedial action.
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Affiliation(s)
- Narasimhan Sowmya
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, International Diabetes Federation (IDF) Centre of Education, Chennai, India
| | - Nagarajan Lakshmipriya
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, International Diabetes Federation (IDF) Centre of Education, Chennai, India
| | - Kokila Arumugam
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, International Diabetes Federation (IDF) Centre of Education, Chennai, India
| | - Sivasankari Venkatachalam
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, International Diabetes Federation (IDF) Centre of Education, Chennai, India
| | - Parthasarathy Vijayalakshmi
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, International Diabetes Federation (IDF) Centre of Education, Chennai, India
| | - Vaidya Ruchi
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, International Diabetes Federation (IDF) Centre of Education, Chennai, India
| | - Gunasekaran Geetha
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, International Diabetes Federation (IDF) Centre of Education, Chennai, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, International Diabetes Federation (IDF) Centre of Education, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, International Diabetes Federation (IDF) Centre of Education, Chennai, India
| | - Kamala Krishnaswamy
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, International Diabetes Federation (IDF) Centre of Education, Chennai, India
| | - Vasudevan Sudha
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, International Diabetes Federation (IDF) Centre of Education, Chennai, India
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Bawah A, Houle B, Alam N, Razzaque A, Streatfield PK, Debpuur C, Welaga P, Oduro A, Hodgson A, Tollman S, Collinson M, Kahn K, Toan TK, Phuc HD, Chuc NTK, Sankoh O, Clark SJ. The Evolving Demographic and Health Transition in Four Low- and Middle-Income Countries: Evidence from Four Sites in the INDEPTH Network of Longitudinal Health and Demographic Surveillance Systems. PLoS One 2016; 11:e0157281. [PMID: 27304429 PMCID: PMC4909223 DOI: 10.1371/journal.pone.0157281] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 05/26/2016] [Indexed: 11/28/2022] Open
Abstract
This paper contributes evidence documenting the continued decline in all-cause mortality and changes in the cause of death distribution over time in four developing country populations in Africa and Asia. We present levels and trends in age-specific mortality (all-cause and cause-specific) from four demographic surveillance sites: Agincourt (South Africa), Navrongo (Ghana) in Africa; Filabavi (Vietnam), Matlab (Bangladesh) in Asia. We model mortality using discrete time event history analysis. This study illustrates how data from INDEPTH Network centers can provide a comparative, longitudinal examination of mortality patterns and the epidemiological transition. Health care systems need to be reconfigured to deal simultaneously with continuing challenges of communicable disease and increasing incidence of non-communicable diseases that require long-term care. In populations with endemic HIV, long-term care of HIV patients on ART will add to the chronic care needs of the community.
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Affiliation(s)
- Ayaga Bawah
- Regional Institute for Population Studies (RIPS), University of Ghana, Legon, Ghana
- INDEPTH Network, Accra, Ghana
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Brian Houle
- School of Demography, The Australian National University, Canberra, Australia
- MRC/Wits Rural Public Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States of America
| | - Nurul Alam
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Abdur Razzaque
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | | | - Paul Welaga
- Navrongo Health Research Centre, Navrongo, Ghana
| | | | | | - Stephen Tollman
- MRC/Wits Rural Public Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- INDEPTH Network, Accra, Ghana
| | - Mark Collinson
- MRC/Wits Rural Public Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- INDEPTH Network, Accra, Ghana
| | - Kathleen Kahn
- MRC/Wits Rural Public Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- INDEPTH Network, Accra, Ghana
| | - Tran Khan Toan
- Filabavi Health and Demographic Surveillance Site, Hanoi, Vietnam
| | - Ho Dang Phuc
- Filabavi Health and Demographic Surveillance Site, Hanoi, Vietnam
| | | | | | - Samuel J. Clark
- MRC/Wits Rural Public Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States of America
- INDEPTH Network, Accra, Ghana
- Department of Sociology, University of Washington, Seattle, Washington, United States of America
- ALPHA Network, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abstract
India is one of the epicentres of the global diabetes mellitus pandemic. Rapid socioeconomic development and demographic changes, along with increased susceptibility for Indian individuals, have led to the explosive increase in the prevalence of diabetes mellitus in India over the past four decades. Type 2 diabetes mellitus in Asian Indian people is characterized by a young age of onset and occurrence at low levels of BMI. Available data also suggest that the susceptibility of Asian Indian people to the complications of diabetes mellitus differs from that of white populations. Management of this disease in India faces multiple challenges, such as low levels of awareness, paucity of trained medical and paramedical staff and unaffordability of medications and services. Novel interventions using readily available resources and technology promise to revolutionise the care of patients with diabetes mellitus in India. As many of these challenges are common to most developing countries of the world, the lessons learnt from India's experience with diabetes mellitus are likely to be of immense global relevance. In this Review, we discuss the epidemiology of diabetes mellitus and its complications in India and outline the advances made in the country to ensure adequate care. We make specific references to novel, cost-effective interventions, which might be of relevance to other low-income and middle-income countries of the world.
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Affiliation(s)
- Ranjit Unnikrishnan
- Madras Diabetes Research Foundation &Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, IDF Centre of Education, No. 6 Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation &Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, IDF Centre of Education, No. 6 Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation &Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, IDF Centre of Education, No. 6 Conran Smith Road, Gopalapuram, Chennai, 600 086, India
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Kandpal V, Sachdeva MP, Saraswathy KN. An assessment study of CVD related risk factors in a tribal population of India. BMC Public Health 2016; 16:434. [PMID: 27225632 PMCID: PMC4880982 DOI: 10.1186/s12889-016-3106-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 05/14/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Non communicable diseases (NCDs) have become a major concern for global health. Cardiovascular diseases (CVDs) contribute 48 % towards the deaths due to NCDs in India. Though studies have been conducted in urban and rural areas, data related to tribal communities is limited. The present study aims to examine various CVD related risk factors including hypertension, elevated fasting blood glucose, obesity and metabolic syndrome among a tribal population. METHODS The present study was an observational, cross- sectional study conducted on Rang Bhotias, a tribal population of India. The participants were adults of age between 20 and 60 years. Prior to blood sample collection, interview schedule was administered which included relevant information like age, lifestyle, socio-economic status, education and occupation In addition to this, various anthropometric and physiological measurements were taken. Logistic regression was used to examine the association of the various health disorders related to CVDs with age, gender and behavioural factors (smoking, alcohol consumption and physical activity). RESULTS A total of 288 participants were surveyed for the study including 104 males and 184 females. High BMI (56.6 %), hypertension (43.4 %), metabolic syndrome (39.2 %) and abdominal obesity (33.7 %) were the most prevalent CVD risk factors observed in the population. The multivariate logistic regression analysis, conducted to examine the contribution of risk factors including behavioural risk factors on the studied abnormalities, revealed age to be a significant risk factor for all the abnormalities except elevated fasting blood glucose. Gender and physical inactivity contributed significantly towards development of hypertension. Physical inactivity was also found to be associated with high BMI levels. CONCLUSION In the present study, hypertension, high BMI levels, MS and abdominal obesity have been found to be high among the studied population. The status of the population with respect to these abnormalities implicates susceptibility of the community towards various common disorders. The prevention and treatment intervention programs should be implemented taking into consideration age and gender.
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Affiliation(s)
- Vani Kandpal
- Department of Anthropology, University of Delhi, Delhi, India.
| | - M P Sachdeva
- Department of Anthropology, University of Delhi, Delhi, India
| | - K N Saraswathy
- Department of Anthropology, University of Delhi, Delhi, India
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Newman C, Ajay VS, Srinivas R, Bhalla S, Prabhakaran D, Banerjee A. Drugs for cardiovascular disease in India: perspectives of pharmaceutical executives and government officials on access and development-a qualitative analysis. J Pharm Policy Pract 2016; 9:16. [PMID: 27141309 PMCID: PMC4852445 DOI: 10.1186/s40545-016-0065-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 04/10/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND India shoulders the greatest global burden of cardiovascular diseases (CVDs), which are the leading cause of mortality worldwide. Drugs are the bedrock of treatment and prevention of CVD. India's pharmaceutical industry is the third largest, by volume, globally, but access to CVD drugs in India is poor. There is a lack of qualitative data from government and pharmaceutical sectors regarding CVD drug development and access in India. METHODS By purposive sampling, we recruited either Indian government officials, or pharmaceutical company executives. We conducted a stakeholder analysis via semi-structured, face-to-face interviews in India. Topic guides allow for the exploration of key issues across multiple interviews, along with affording the interviewer the flexibility to examine matters arising from the discussions themselves. After transcription, interviews underwent inductive thematic analysis. RESULTS Ten participants were interviewed (Government Officials: n = 5, and Pharmaceutical Executives: n = 5). Two themes emerged: i) 'Policy-derived Factors'; ii) 'Patient- derived Factors' with three findings. First, both government and pharmaceutical participants felt that the focus of Indian pharma is shifting to more complex, high-quality generics and to new drug development, but production of generic drugs rather than new molecular entities will remain a major activity. Second, current trial regulations in India may restrict India's potential role in the future development of CVD drugs. Third, it is likely that the Indian government will tighten its intellectual property regime in future, with potentially far-reaching implications on CVD drug development and access. CONCLUSIONS Our stakeholder analysis provides some support for present patent regulations, whilst suggesting areas for further research in order to inform future policy decisions regarding CVD drug development and availability. Whilst interviewees suggested government policy plays an important role in shaping the industry, a significant force for change was ascribed to patient-derived factors. This suggests a potential role for Indian initiatives that market the unique advantages of its patient population for drug research in influencing national and multinational pharmaceutical companies to undertake CVD drug development in India, rather than simply IP policy-directed factors.
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Affiliation(s)
- Charles Newman
- />University of Birmingham, Medical School, Birmingham, UK
| | | | - Ravi Srinivas
- />Research and Information Systems for Developing Countries (RIS), New Delhi, India
| | | | | | - Amitava Banerjee
- />University of Birmingham Centre for Cardiovascular Sciences, Birmingham, UK
- />Present address: Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London, NW1 2DA UK
- />School of Health, University of Central Lancashire, Preston, UK
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Abstract
This paper argues that health is a realistic productive force that may enhance the index of happiness. As the basis of all developments and the source of a person's and his/her family's happiness, health requires not only primary and secondary prevention, but also policy prevention, that is to say, grade-zero prevention. Therefore, people should pay more attention to Health in All Policies. As a new preventive strategy, the policy prevention will help improve people's health significantly and promote the concepts of "Healthy China" and "the Chinese Dream" or "the World Dream" to realize a dream from reality to the future.
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Affiliation(s)
- Chunsong Hu
- Department of Cardiovascular Medicine, Nanchang University Hospital, Nanchang University, Nanchang, 330006, China.
| | - Qinghua Wu
- Department of Cardiovascular Medicine, Nanchang University Hospital, Nanchang University, Nanchang, 330006, China.
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124
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Kastor A, Mohanty SK. Associated Covariates of Functional Limitation Among Older Adults in India: an Exploration. AGEING INTERNATIONAL 2016. [DOI: 10.1007/s12126-016-9241-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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125
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Adlakha D, Hipp JA, Brownson RC. Adaptation and Evaluation of the Neighborhood Environment Walkability Scale in India (NEWS-India). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:401. [PMID: 27049394 PMCID: PMC4847063 DOI: 10.3390/ijerph13040401] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 11/29/2022]
Abstract
Physical inactivity is the fourth leading risk factor for global mortality, with most of these deaths occurring in low and middle-income countries (LMICs) like India. Research from developed countries has consistently demonstrated associations between built environment features and physical activity levels of populations. The development of culturally sensitive and reliable measures of the built environment is a necessary first step for accurate analysis of environmental correlates of physical activity in LMICs. This study systematically adapted the Neighborhood Environment Walkability Scale (NEWS) for India and evaluated aspects of test-retest reliability of the adapted version among Indian adults. Cultural adaptation of the NEWS was conducted by Indian and international experts. Semi-structured interviews were conducted with local residents and key informants in the city of Chennai, India. At baseline, participants (N = 370; female = 47.2%) from Chennai completed the adapted NEWS-India surveys on perceived residential density, land use mix-diversity, land use mix-access, street connectivity, infrastructure and safety for walking and cycling, aesthetics, traffic safety, and safety from crime. NEWS-India was administered for a second time to consenting participants (N = 62; female = 53.2%) with a gap of 2-3 weeks between successive administrations. Qualitative findings demonstrated that built environment barriers and constraints to active commuting and physical activity behaviors intersected with social ecological systems. The adapted NEWS subscales had moderate to high test-retest reliability (ICC range 0.48-0.99). The NEWS-India demonstrated acceptable measurement properties among Indian adults and may be a useful tool for evaluation of built environment attributes in India. Further adaptation and evaluation in rural and suburban settings in India is essential to create a version that could be used throughout India.
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Affiliation(s)
- Deepti Adlakha
- Center for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University-Belfast, Belfast BT7 1NN, UK.
| | - J Aaron Hipp
- Department of Parks, Recreation, and Tourism Management and Center for Geospatial Analytics, College of Natural Resources, North Carolina State University, Raleigh, NC 27695, USA.
| | - Ross C Brownson
- Prevention Research Center, Brown School, Division of Public Health Sciences and Siteman Cancer Center, School of Medicine, Washington University in St. Louis, St. Louis, MO 63130, USA.
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126
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Agarwal B, Shah M, Andhare N, Mullerpatan R. Incremental shuttle walk test: Reference values and predictive equation for healthy Indian adults. Lung India 2016; 33:36-41. [PMID: 26933305 PMCID: PMC4748663 DOI: 10.4103/0970-2113.173056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Physical inactivity in Indians is leading to an increase in noncommunicable disorders at an early age in life. Early identification and quantification of the lack of physical activity using simple and reliable exercise testing is the need of the hour. The incremental shuttle walk test (ISWT) is an externally paced walk test widely used for the evaluation of exercise capacity. Currently the normative values available for clinical reference are generated from Western populations. Hence, the study was conducted to find normative values for the ISWT in healthy Indian adults (17-75 years). MATERIALS AND METHODS A convenience sample of 862 subjects was recruited after ethical approval was obtained. All subjects were divided into groups as per age and gender. For age, the grouping was as follows: Group 1: Young adulthood (17-40 years), group 2: Middle adulthood (40-65 years), and group 3: Old adulthood (>65 years). The ISWT was performed as per standard protocol by Sally Singh. RESULTS The average distance walked were 709.2m,556.4m and 441.3m in females and 807.9 m, 639.6 m and 478.2 m in males in the three respective age groups. Stepwise regression analysis revealed age and gender as key variables correlating with incremental shuttle walk distance (ISWD). The derived predictive equations for males and females may be given as follows: 740.351 - (5.676 × age) + (99.007 × gender). CONCLUSION Reference values were generated for healthy Indian adults. Physiological response to the ISWT was shown to be affected by gender and increasing age. Easily measurable variables explained 68% of the variance seen in the test, making the reference equation a relevant part of the evaluation of the ISWT.
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Affiliation(s)
- Bela Agarwal
- Department of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Monal Shah
- Department of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Nilesh Andhare
- Department of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Rajani Mullerpatan
- Department of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
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127
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Ahlin T, Nichter M, Pillai G. Health insurance in India: what do we know and why is ethnographic research needed. Anthropol Med 2016; 23:102-24. [PMID: 26828125 DOI: 10.1080/13648470.2015.1135787] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The percentage of India's national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP). Currently, efforts are being made to expand health insurance coverage as one means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarize the country's history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of out-patient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. We argue that ethnographic case studies could add much to existing health service and policy research, and provide a better understanding of the life cycle and impact of insurance programs on both insurance holders and healthcare providers. Drawing on preliminary fieldwork in South India and recognizing the need for a broad-based implementation science perspective (studying up, down and sideways), we identify six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences health care utilization; (3) differences in behavior patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) (mis)trust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses.
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Affiliation(s)
- Tanja Ahlin
- a University of Amsterdam, Amsterdam Institute of Social Science Research , Nieuwe Achtergracht 166 , 1018 WV Amsterdam , the Netherlands
| | - Mark Nichter
- b School of Anthropology , University of Arizona , 1009 E. South Campus drive, Tucson , AZ 85721 , USA
| | - Gopukrishnan Pillai
- c University of Leiden, Leyden Academy on Vitality and Aging , Poortgebouw LUMC, Rijnburgerweg 10, 2333 AA, Leiden , the Netherlands
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128
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Sawant SH, Bodhankar SL. Flax lignan concentrate reverses alterations in blood pressure, left ventricular functions, lipid profile and antioxidant status in DOCA-salt induced renal hypertension in rats. Ren Fail 2016; 38:411-23. [DOI: 10.3109/0886022x.2015.1136895] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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129
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Rao D, Lipira L, Kumar S, Mohanraj R, Poongothai S, Tandon N, Sridhar GR, Katon W, Narayan KV, Chwastiak L, Mohan V, Ali MK. Input of stakeholders on reducing depressive symptoms and improving diabetes outcomes in India: Formative work for the INDEPENDENT Study. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2016; 1:65-75. [PMID: 29075675 DOI: 10.4103/2468-8827.191979] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS Depression and diabetes are highly comorbid, adversely affecting treatment adherence and resulting in poor outcomes. To improve treatment and outcomes for people dually-affected by diabetes and depression in India, we aimed to develop and test an integrated care model. In the formative phase of this INtegrated DEPrEssioN and Diabetes TreatmENT (INDEPENDENT) study, we sought stakeholder perspectives to inform culturally-sensitive adaptations of the intervention. METHODS At our Delhi, Chennai, and Vishakhapatnam sites, we conducted focus groups for patients with diabetes and depression and interviewed healthcare workers, family members, and patients. These key informants were asked about experiences with diabetes and depression and for feedback on intervention materials. Data were analyzed using a grounded theory approach. RESULTS Three major themes emerged that have bearing on adaptation of the proposed intervention: importance of family assistance, concerns regarding patient/family understanding of diabetes, and feedback regarding the proposed intervention (e.g. adequate time needed for implementation; training program and intervention should address stigma). CONCLUSIONS Based on our findings, the following components would add value when incorporated into the intervention: 1) engaging families in the treatment process, 2) clear/simple written information, 3) clear non-jargon verbal explanations, and 4) coaching to help patients cope with stigma.
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Affiliation(s)
- Deepa Rao
- Department of Global Health; Department of Psychiatry and Behavioral Sciences, Health Services University of Washington, Seattle, USA
| | - Lauren Lipira
- Department of Health Services, University of Washington, Seattle, USA
| | - Shuba Kumar
- Samarth, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rani Mohanraj
- Samarth, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Subramani Poongothai
- Department of Clinical Trials, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - G R Sridhar
- Endocrine and Diabetes Centre, Visakhapatnam, Andhra Pradesh, India
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Km Venkat Narayan
- Department of Global Health and Epidemiology; Department of Medicine, Emory University, Atlanta, GA, USA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Mohammed K Ali
- Department of Medicine, Emory University, Atlanta, GA, USA
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130
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Patel V, Parikh R, Nandraj S, Balasubramaniam P, Narayan K, Paul VK, Kumar AKS, Chatterjee M, Reddy KS. Assuring health coverage for all in India. Lancet 2015; 386:2422-35. [PMID: 26700532 DOI: 10.1016/s0140-6736(15)00955-1] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Successive Governments of India have promised to transform India's unsatisfactory health-care system, culminating in the present government's promise to expand health assurance for all. Despite substantial improvements in some health indicators in the past decade, India contributes disproportionately to the global burden of disease, with health indicators that compare unfavourably with other middle-income countries and India's regional neighbours. Large health disparities between states, between rural and urban populations, and across social classes persist. A large proportion of the population is impoverished because of high out-of-pocket health-care expenditures and suffers the adverse consequences of poor quality of care. Here we make the case not only for more resources but for a radically new architecture for India's health-care system. India needs to adopt an integrated national health-care system built around a strong public primary care system with a clearly articulated supportive role for the private and indigenous sectors. This system must address acute as well as chronic health-care needs, offer choice of care that is rational, accessible, and of good quality, support cashless service at point of delivery, and ensure accountability through governance by a robust regulatory framework. In the process, several major challenges will need to be confronted, most notably the very low levels of public expenditure; the poor regulation, rapid commercialisation of and corruption in health care; and the fragmentation of governance of health care. Most importantly, assuring universal health coverage will require the explicit acknowledgment, by government and civil society, of health care as a public good on par with education. Only a radical restructuring of the health-care system that promotes health equity and eliminates impoverishment due to out-of-pocket expenditures will assure health for all Indians by 2022--a fitting way to mark the 75th year of India's independence.
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Affiliation(s)
- Vikram Patel
- London School of Hygiene & Tropical Medicine, London, UK; Public Health Foundation of India, Gurgaon, India.
| | | | | | - Priya Balasubramaniam
- Public Health Foundation of India, Gurgaon, India; Public Health Foundation of India and Royal Norwegian Embassy Universal Health Initiative, New Delhi, India
| | | | - Vinod K Paul
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Mirai Chatterjee
- Sewa, Ahmedabad, India; VimoSEWA Cooperative, Ahmedabad, India; Lok Swasthya Health Cooperative, Ahmedabad, India
| | - K Srinath Reddy
- Public Health Foundation of India, Gurgaon, India; World Heart Federation, New Delhi, India
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131
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Tomar AS, Tallapragada DSP, Nongmaithem SS, Shrestha S, Yajnik CS, Chandak GR. Intrauterine Programming of Diabetes and Adiposity. Curr Obes Rep 2015; 4:418-28. [PMID: 26349437 DOI: 10.1007/s13679-015-0175-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The prevalence of diabetes and adiposity has increased at an alarming rate and together they contribute to the rise in morbidity and mortality worldwide. Genetic studies till date have succeeded in explaining only a proportion of heritability, while a major component remains unexplained. Early life determinants of future risk of these diseases are likely contributors to the missing heritability and thus have a significant potential in disease prevention. Epidemiological and animal studies show the importance of intrauterine and early postnatal environment in programming of the fetus to adverse metabolic outcomes and support the notion of Developmental Origins of Health and Disease (DOHaD). Emerging evidence highlights the role of epigenetic mechanisms in mediating effects of environmental exposures, which in certain instances may exhibit intergenerational transmission even in the absence of exposure. In this article, we will discuss the complexity of diabetes and increased adiposity and mechanisms of programming of these adverse metabolic conditions.
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Affiliation(s)
- Ashutosh Singh Tomar
- CSIR-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, 500 007, India
| | | | | | - Smeeta Shrestha
- CSIR-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, 500 007, India
| | | | - Giriraj Ratan Chandak
- CSIR-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, 500 007, India.
- Adjunct Group Leader, Genome Institute of Singapore, Singapore, Singapore.
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132
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Bansal SK, Agarwal S, Daga MK. Conventional and Advanced Lipid Parameters in Premature Coronary Artery Disease Patients in India. J Clin Diagn Res 2015; 9:BC07-11. [PMID: 26674304 DOI: 10.7860/jcdr/2015/14818.6844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/03/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) is the leading cause of death worldwide and has assumed alarming proportions in India with gradual increase in its incidence and prevalence over the last decade. India is in the middle of epidemic of coronary artery disease which is leading cause of hospital admissions, morbidity and mortality. In the Indian population, there is higher tendency to develop CAD at a younger age, which cannot be explained on the basis of conventional lipid parameters. AIM The purpose of this study is to find advanced lipid parameters which correlate better with premature CAD, as compared to the conventional lipid parameters. MATERIALS AND METHODS Thirty middle aged individuals suffering from premature CAD and 30 age and gender matched healthy individuals without any history of clinical evidence suggestive of CAD were studied. Fasting venous blood samples of all the subjects under study were collected after an overnight fasting and conventional lipid parameters and advanced lipid parameters (i.e. oxidized LDL, Lp (a), ApoA-1, small dense LDL, ApoB) were estimated. Correlation of conventional and advanced lipid parameters with premature CAD and among each other was calculated using Pearson correlation coefficient. RESULTS In our study the values of ox-LDL, sdLDL, Lp (a) and ApoB, total cholesterol, TG, LDL-C were significantly higher while HDL-C and Apo A1 and were significantly lower in cases than in controls. Advanced lipid parameters have higher correlation with premature CAD as compared to conventional lipid parameters. Ox-LDL show the highest correlation coefficient (r=+0.89) among these parameters followed by Lp (a) (r=+0.86) and ApoB (r=+0.79). CONCLUSION Advanced lipid parameters (i.e. oxidized LDL, Lp (a), ApoA-1, small dense LDL, ApoB) are better discriminator of premature CAD as compared to conventional lipid parameters (total cholesterol, triglycerides, low density lipoprotein and high density lipoprotein). Oxidised LDL, small dense LDL and lipoprotein (a) can explain occurrence of CAD in normolipidemic patients and proved to be better markers for explaining high degree of prematurity, morbidity and mortality of CAD in Indian population. They can prove to be better marker for early detection and intervention in premature CAD and site for targeted drug therapy.
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Affiliation(s)
- Sanjiv Kumar Bansal
- Associate Professor, Department of Biochemistry, SGT Medical College , Hospital & Research Institute, Budhera, Gurgaon, India
| | - Sarita Agarwal
- Director-Professor, Department of Biochemistry, Maulana Azad Medical College , New Delhi, India
| | - Mridul Kumar Daga
- Director-Professor, Department of Medicine, Maulana Azad Medical College , New Delhi, India
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133
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Challenges for Transformation: A Situational Analysis of Mental Health Care Services in Sehore District, Madhya Pradesh. Community Ment Health J 2015; 51:903-12. [PMID: 26059181 PMCID: PMC4615668 DOI: 10.1007/s10597-015-9893-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 05/02/2015] [Indexed: 11/13/2022]
Abstract
The proportion of individuals with mental disorders receiving evidence based treatments in India is very small. In order to address this huge treatment gap, programme for improving mental health care is being implemented in Sehore district of Madhya Pradesh, India. The aim of this study was to complete the situational analysis consisting of two parts; document review of Sehore district mental health programme followed by a qualitative study. The findings suggest that there are major health system challenges in developing and implementing the mental health care plan to be delivered through primary health care system in Sehore district.
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134
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Sharma N, Sharma SK, Maheshwari VD, Sharma KK, Gupta R. Association of low educational status with microvascular complications in type 2 diabetes: Jaipur diabetes registry. Indian J Endocrinol Metab 2015; 19:775-780. [PMID: 26693427 PMCID: PMC4673805 DOI: 10.4103/2230-8210.167552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To determine the association of educational status (ES), as marker of socioeconomic status, with the prevalence of microvascular complications in diabetes. METHODS Successive patients (n = 1214) presenting to our center were evaluated for sociodemographic, anthropometric, clinical, and therapeutic variables. Subjects were classified according to ES into Group 1 (illiterate, 216); Group 2 (≤ primary, 537), Group 3 (≤ higher secondary, 312), and Group 4 (any college, 149). Descriptive statistics is reported. RESULTS Mean age of patients was 52 ± 10 years, duration of diabetes 7 ± 7 years and 55% were men. Prevalence of various risk factors was smoking/tobacco 25.5%, obesity body mass index ≥25 kg/m(2) 64.0%, abdominal obesity 63.4%, hypertension 67.5%, high fat diet 14.5%, low fruits/vegetables 31.8%, low fiber intake 60.0%, high salt diet 16.9%, physical inactivity 27.5%, coronary or cerebrovascular disease 3.0%, and microvascular disease (peripheral, ocular or renal) in 20.7%. Microvascular disease was significantly greater in illiterate (25.9%) and low (23.6%) compared to middle (15.0%) and high (14.7%) ES groups (P < 0.05). Age- and sex-adjusted logistic regression analysis revealed that in illiterate and low ES groups respectively, prevalence of smoking/tobacco use (odds ratio 3.84, confidence interval: 09-7.05 and 2.15, 1.36-3.41); low fruit/vegetable (2.51, 1.53-4.14 and 1.99, 1.30-3.04) and low fiber intake (4.02, 2.50-6.45 and 1.78, 1.23-2.59) was greater compared to high ES. Poor diabetes control (HbA1c >.0%) was significantly greater in illiterate (38.0%), low (46.0%), and middle (41.0%) compared to high (31.5%) ES subjects (P < 0.05). CONCLUSIONS There is a greater prevalence of the microvascular disease in illiterate and low ES diabetes patients in India. This is associated with the higher prevalence of smoking/tobacco use, poor quality diet, and sub-optimal diabetes control.
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Affiliation(s)
- Niharikaa Sharma
- Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | | | - Vitthal D. Maheshwari
- Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | | | - Rajeev Gupta
- Department of Medicine, Fortis Escorts Hospital, Jaipur, Rajasthan, India
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135
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Pati S, Swain S, Hussain MA, van den Akker M, Metsemakers J, Knottnerus JA, Salisbury C. Prevalence and outcomes of multimorbidity in South Asia: a systematic review. BMJ Open 2015; 5:e007235. [PMID: 26446164 PMCID: PMC4606435 DOI: 10.1136/bmjopen-2014-007235] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To systematically review the studies of prevalence, patterns and consequences of multimorbidity reported from South Asia. DESIGN Systematic review. SETTING South Asia. DATA SOURCES Articles were retrieved from two electronic databases (PubMed and Embase) and from the relevant references lists. Methodical data extraction according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was followed. English-language studies published between 2000 and March 2015 were included. ELIGIBILITY CRITERIA Studies addressing prevalence, consequences and patterns of multimorbidity in South Asia. Articles documenting presence of two or more chronic conditions were included in the review. The quality and risk of bias were assessed using STROBE criteria. DATA SELECTION Two reviewers independently assessed studies for eligibility, extracted data and assessed study quality. Due to heterogeneity in methodologies among reported studies, only narrative synthesis of the results was carried out. RESULTS Of 11,132, 61 abstracts were selected and 13 were included for final data synthesis. The number of health conditions analysed per study varied from 7 to 22, with prevalence of multimorbidity from 4.5% to 83%. The leading chronic conditions were hypertension, arthritis, diabetes, cardiac problems and skin diseases. The most frequently reported outcomes were increased healthcare utilisation, lowered physical functioning and quality of life, and psychological distress. CONCLUSIONS Our study, a comprehensive mapping of multimorbidity research in South Asia, reveals the insufficient volume of work carried out in this domain. The published studies are inadequate to provide an indication of the magnitude of multimorbidity in these countries. Research into clinical and epidemiological aspects of multimorbidity is warranted to build up scientific evidence in this geographic region. The wide heterogeneity observed in the present review calls for greater methodological rigour while conducting these epidemiological studies. TRIAL REGISTRATION NUMBER CRD42013005456.
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Affiliation(s)
- Sanghamitra Pati
- Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, Odisha, India
| | - Subhashisa Swain
- Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, Odisha, India
| | - Mohammad Akhtar Hussain
- Division of Epidemiology and Biostatistics, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Marjan van den Akker
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of General Practice, KU Leuven, Leuven, Belgium
| | - Job Metsemakers
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - J André Knottnerus
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
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136
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Sharma N, Sharma SK, Maheshwari VD, Sharma KK, Gupta R. Association of low educational status with microvascular complications in type 2 diabetes: Jaipur diabetes registry-1. Indian J Endocrinol Metab 2015; 19:667-672. [PMID: 26425480 PMCID: PMC4566351 DOI: 10.4103/2230-8210.163206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the association of educational status (ES), as a marker of socioeconomic status, with the prevalence of microvascular complications in diabetes. METHODS Successive patients (n = 1214) presenting to our centre were evaluated for sociodemographic, anthropometric, clinical, and therapeutic variables. Subjects were classified according to ES into Group 1 (illiterate, 216); Group 2 (<primary, 537), Group 3 (<higher secondary, 312), and Group 4 (any college, 149). Descriptive statistics are reported. RESULTS Mean age of patients was 52 ± 10 years, duration of diabetes 7 ± 7 years, and 55% were men. Prevalence of various risk factors was smoking/tobacco 25.5%, obesity body mass index ≥25 kg/m(2) 64.0%, abdominal obesity 63.4%, hypertension 67.5%, high fat diet 14.5%, low fruits/vegetables 31.8%, low fibre intake 60.0%, high salt diet 16.9%, physical inactivity 27.5%, coronary, or cerebrovascular disease 3.0%, and microvascular disease (peripheral, ocular or renal) in 20.7%. Microvascular disease was significantly greater in illiterate (25.9%) and low (23.6%) compared to middle (15.0%) and high (14.7%) ES groups (P < 0.05). Age- and sex-adjusted logistic regression analysis revealed that in illiterate and low ES groups respectively, prevalence of smoking/tobacco use (odds ratio 3.84, confidence intervals 2.09-7.05 and 2.15, 1.36-3.41); low fruit/vegetable (2.51, 1.53-4.14 and 1.99, 1.30-3.04) and low fibre intake (4.02, 2.50-6.45 and 1.78, 1.23-2.59) was greater compared to high ES. Poor diabetes control (HbA1c >8.0%) was significantly greater in illiterate (38.0%), low (46.0%) and middle (41.0%) compared to high (31.5%) ES subjects (P < 0.05). CONCLUSIONS There is a greater prevalence of the microvascular disease in illiterate and low ES diabetes patients in India. This is associated with the higher prevalence of smoking/tobacco use, poor quality diet and sub-optimal diabetes control.
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Affiliation(s)
- Niharikaa Sharma
- Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | | | - Vitthal D. Maheshwari
- Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | | | - Rajeev Gupta
- Department of Medicine, Fortis Escorts Hospital, Jaipur, Rajasthan, India
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Rodriguez-Galindo C, Friedrich P, Alcasabas P, Antillon F, Banavali S, Castillo L, Israels T, Jeha S, Harif M, Sullivan MJ, Quah TC, Patte C, Pui CH, Barr R, Gross T. Toward the Cure of All Children With Cancer Through Collaborative Efforts: Pediatric Oncology As a Global Challenge. J Clin Oncol 2015; 33:3065-73. [PMID: 26304881 DOI: 10.1200/jco.2014.60.6376] [Citation(s) in RCA: 274] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Advances in the treatment of childhood cancers have resulted in part from the development of national and international collaborative initiatives that have defined biologic determinants and generated risk-adapted therapies that maximize cure while minimizing acute and long-term effects. Currently, more than 80% of children with cancer who are treated with modern multidisciplinary treatments in developed countries are cured; however, of the approximately 160,000 children and adolescents who are diagnosed with cancer every year worldwide, 80% live in low- and middle-income countries (LMICs), where access to quality care is limited and chances of cure are low. In addition, the disease burden is not fully known because of the lack of population-based cancer registries in low-resource countries. Regional and ethnic variations in the incidence of the different childhood cancers suggest unique interactions between genetic and environmental factors that could provide opportunities for etiologic research. Regional collaborative initiatives have been developed in Central and South America and the Caribbean, Africa, the Middle East, Asia, and Oceania. These initiatives integrate regional capacity building, education of health care providers, implementation of intensity-graduated treatments, and establishment of research programs that are adjusted to local capacity and local needs. Together, the existing consortia and regional networks operating in LMICs have the potential to reach out to almost 60% of all children with cancer worldwide. In summary, childhood cancer burden has been shifted toward LMICs and, for that reason, global initiatives directed at pediatric cancer care and control are needed. Regional networks aiming to build capacity while incorporating research on epidemiology, health services, and outcomes should be supported.
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Affiliation(s)
- Carlos Rodriguez-Galindo
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD.
| | - Paola Friedrich
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Patricia Alcasabas
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Federico Antillon
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Shripad Banavali
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Luis Castillo
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Trijn Israels
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Sima Jeha
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Mhammed Harif
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Michael J Sullivan
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Thuan Chong Quah
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Catherine Patte
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Ching-Hon Pui
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Ronald Barr
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Thomas Gross
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
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Joshi R, Santoshi JA, Rai N, Pakhare A. Prevalence and Patterns of Coexistence of Multiple Chronic Conditions: A Study from Indian Urban Outpatient Setting. J Family Med Prim Care 2015; 4:411-5. [PMID: 26288783 PMCID: PMC4535105 DOI: 10.4103/2249-4863.161340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Chronic diseases are a common cause for seeking care in a hospital, however little is known about prevalence and spectrum of multiple chronic conditions (MCC) in Indian context. Estimates for coexistence of MCC range from one-fourth of all primary care attendees in Spain to two-thirds of all medicare attendees in the United States. This study was designed to estimate the similar prevalence and patterns in an Indian outpatient setting. Materials and Methods: This study was performed at All India Institute of Medical Sciences Bhopal between May and June 2013, a hospital which had just started outpatient services in this period. All consecutive patients that presented to Medicine, Neurology, and Orthopedics clinics were sought to be included in the study, and information about their current diagnoses was abstracted from their outpatient records. All patients with one or more chronic disease diagnosis were asked about their monthly out-of-pocket expenditure. We performed a descriptive analysis of the demographic, medical diagnoses, and out-of-pocket expenditure variables. Results: A total of 785 patients were included in the study, and 286 (36%) of them had one or more chronic disease diagnosis. Of these, 103 (13%) had a single chronic disease, while 183 (23%) had more than one chronic disease diagnosis. Among those with MCCs, chronic vascular diseases in combination, followed by combinations of chronic vascular and immunological diseases were common patterns. There was a significant rising trend in average out-of-pocket expenditure with increasing number of chronic disease diagnoses. Conclusion: Co-existence of multiple chronic diseases is common in those who seek hospital-based care. This fact has important implications for education and clinical decision making in primary care.
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Affiliation(s)
- Rajnish Joshi
- Department of Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - John A Santoshi
- Department of Orthopedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Nirendra Rai
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Abhijit Pakhare
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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139
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Gowda MJ, Bhojani U, Devadasan N, Beerenahally TS. The rising burden of chronic conditions among urban poor: a three-year follow-up survey in Bengaluru, India. BMC Health Serv Res 2015; 15:330. [PMID: 26275608 PMCID: PMC4537574 DOI: 10.1186/s12913-015-0999-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 08/11/2015] [Indexed: 11/13/2022] Open
Abstract
Background Chronic conditions are on rise globally and in India. Prevailing intra-urban inequities in access to healthcare services compounds the problems faced by urban poor. This paper reports the trends in self-reported prevalence of chronic conditions and health-seeking pattern among residents of a poor urban neighborhood in south India. Methods A cross sectional survey of 1099 households (5340 individuals) was conducted using a structured questionnaire. The prevalence and health-seeking pattern for chronic conditions in general and for hypertension and diabetes in particular were assessed and compared with a survey conducted in the same community three years ago. The predictors of prevalence and health-seeking pattern were analyzed through a multivariable logistic regression analysis. Results The overall self-reported prevalence of chronic conditions was 12 %, with hypertension (7 %) and diabetes (5.8 %) being the common conditions. The self-reported prevalence of chronic conditions increased by 3.8 percentage point over a period of three years (OR: 1.5). Older people, women and people living below the poverty line had greater odds of having chronic conditions across the two studies compared. Majority of patients (89.3 %) sought care from private health facilities indicating a decrease by 8.7 percentage points in use of government health facility compared to the earlier study (OR: 0.5). Patients seeking care from super specialty hospitals and those living below the poverty line were more likely to seek care from government health facilities. Conclusion There is need to strengthen health services with a preferential focus on government services to assure affordable care for chronic conditions to urban poor.
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Affiliation(s)
- Mrunalini J Gowda
- Institute of Public Health, 250, 2nd C Main, Girinagar 1st Phase, Bengaluru, 560085, India.
| | - Upendra Bhojani
- Institute of Public Health, 250, 2nd C Main, Girinagar 1st Phase, Bengaluru, 560085, India. .,Department of Public Health, Ghent University, De Pintelaan 185 4K3 9000, Ghent, Belgium.
| | - Narayanan Devadasan
- Institute of Public Health, 250, 2nd C Main, Girinagar 1st Phase, Bengaluru, 560085, India.
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Patil VM, Chakraborty S, Bhattacharjee A, Dessai S. Survey of the State of Implementation of the American Society of Clinical Oncology/Oncology Nursing Society Safety Standards for Chemotherapy Administration in India. J Oncol Pract 2015; 11:365-9. [PMID: 26265175 DOI: 10.1200/jop.2015.004481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The American Society of Clinical Oncology and the Oncology Nursing Society have proposed a set of standards for safe chemotherapy administration. The state of implementation of these standards in oncologic practices in India is not understood properly. METHODS An anonymized survey was designed that consisted of items from all 37 standards that were described in the 2013 update of the standards. The survey was distributed via e-mail as well as in paper format among oncologists working in various oncology practices in the country. A standard was considered as fully implemented if more than 90% of the items beneath it had the most positive response (Yes/Always). RESULTS Responses were obtained from 75 of 114 (65.8%) of the institutions surveyed. Only one institution had fully implemented the standards, whereas only six (8.0%) institutions had implemented more than 90% of the standards fully. The general chemotherapy administration-related domain was implemented fully by the least number of institutions. Although characteristics such as location, funding, and type of institution (teaching or not) failed to influence implementation rates, institutions of respondents who were aware of chemotherapy practice-related standards reported full implementation of a larger number of standards. Lack of national-level guidelines/policies was identified as the most common difficulty in implementing standards. CONCLUSION This survey indicates that there is an urgent need to formulate national-level guidelines for safe chemotherapy administration.
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Tian M, Ajay VS, Dunzhu D, Hameed SS, Li X, Liu Z, Li C, Chen H, Cho K, Li R, Zhao X, Jindal D, Rawal I, Ali MK, Peterson ED, Ji J, Amarchand R, Krishnan A, Tandon N, Xu LQ, Wu Y, Prabhakaran D, Yan LL. A Cluster-Randomized, Controlled Trial of a Simplified Multifaceted Management Program for Individuals at High Cardiovascular Risk (SimCard Trial) in Rural Tibet, China, and Haryana, India. Circulation 2015; 132:815-24. [PMID: 26187183 DOI: 10.1161/circulationaha.115.015373] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 06/22/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In rural areas in China and India, the cardiovascular disease burden is high but economic and healthcare resources are limited. This study (the Simplified Cardiovascular Management Study [SimCard]) aims to develop and evaluate a simplified cardiovascular management program delivered by community health workers with the aid of a smartphone-based electronic decision support system. METHODS AND RESULTS The SimCard study was a yearlong cluster-randomized, controlled trial conducted in 47 villages (27 in China and 20 in India). Recruited for the study were 2086 individuals with high cardiovascular risk (aged ≥40 years with self-reported history of coronary heart disease, stroke, diabetes mellitus, and/or measured systolic blood pressure ≥160 mm Hg). Participants in the intervention villages were managed by community health workers through an Android-powered app on a monthly basis focusing on 2 medication use and 2 lifestyle modifications. In comparison with the control group, the intervention group had a 25.5% (P<0.001) higher net increase in the primary outcome of the proportion of patient-reported antihypertensive medication use pre- and post-intervention. There were also significant differences in certain secondary outcomes: aspirin use (net difference: 17.1%; P<0.001) and systolic blood pressure (-2.7 mm Hg; P=0.04). However, no significant changes were observed in the lifestyle factors. The intervention was culturally tailored, and country-specific results revealed important differences between the regions. CONCLUSIONS The results indicate that the simplified cardiovascular management program improved quality of primary care and clinical outcomes in resource-poor settings in China and India. Larger trials in more places are needed to ascertain the potential impacts on mortality and morbidity outcomes. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01503814.
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Affiliation(s)
- Maoyi Tian
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Vamadevan S Ajay
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Danzeng Dunzhu
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Safraj S Hameed
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Xian Li
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Zhong Liu
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Cong Li
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Hao Chen
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - KaWing Cho
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Ruilai Li
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Xingshan Zhao
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Devraj Jindal
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Ishita Rawal
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Mohammed K Ali
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Eric D Peterson
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Jiachao Ji
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Ritvik Amarchand
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Anand Krishnan
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Nikhil Tandon
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Li-Qun Xu
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Yangfeng Wu
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.)
| | - Dorairaj Prabhakaran
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.).
| | - Lijing L Yan
- From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.).
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Daivadanam M, Wahlström R, Thankappan KR, Ravindran TKS. Balancing expectations amidst limitations: the dynamics of food decision-making in rural Kerala. BMC Public Health 2015; 15:644. [PMID: 26164527 PMCID: PMC4499445 DOI: 10.1186/s12889-015-1880-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 05/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Food decision-making is a complex process and varies according to the setting, based on cultural and contextual factors. The study aimed to understand the process of food decision-making in households in rural Kerala, India, to inform the design of a dietary behaviour change intervention. METHODS Three focus group discussions (FGDs) and 17 individual interviews were conducted from September 2010 to January 2011 among 13 men and 40 women, between 23 and 75 years of age. An interview guide facilitated the process to understand: 1) food choices and decision-making in households, with particular reference to access; and 2) beliefs about foods, particularly fruits, vegetables, salt, sugar and oil. The interviews and FGDs were transcribed verbatim and analysed using qualitative content analysis. RESULTS The analysis revealed one main theme: 'Balancing expectations amidst limitations' with two sub-themes: 'Counting and meeting the costs'; and 'Finding the balance'. Food decisions were made at the household level, with money, time and effort costs weighed against the benefits, estimated in terms of household needs, satisfaction and expectations. The most crucial decisional point was affordability in terms of money costs, followed by food preferences of husband and children. Health and the risk of acquiring chronic diseases was not a major consideration in the decision-making process. Foods perceived as essential for children were purchased irrespective of cost, reportedly owing to the influence of food advertisements. The role of the woman as the homemaker has gendered implications, as the women disproportionately bore the burden of balancing the needs and expectations of all the household members within the available means. CONCLUSIONS The food decision-making process occurred at household level, and within the household, by the preferences of spouse and children, and cost considerations. The socio-economic status of households was identified as limiting their ability to manoeuvre this fine balance. The study has important policy implications in terms of the need to raise public awareness of the strong link between diet and chronic non-communicable diseases.
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Affiliation(s)
- Meena Daivadanam
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, India. .,Department of Food, Nutrition and Dietetics, Uppsala University, Box 560, SE-751 22, Uppsala, Sweden. .,Department of Public Health Sciences (Global Health), Tomtebodavägen 18A, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Rolf Wahlström
- Department of Public Health Sciences (Global Health), Tomtebodavägen 18A, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Family Medicine and Preventive Medicine, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - K R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, India.
| | - T K Sundari Ravindran
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, India.
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Gupta R. Convergence in urban–rural prevalence of hypertension in India. J Hum Hypertens 2015; 30:79-82. [DOI: 10.1038/jhh.2015.48] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/16/2015] [Accepted: 04/20/2015] [Indexed: 11/09/2022]
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144
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Ketkar AR, Veluswamy SK, Prabhu N, Maiya AG. Screening for noncommunicable disease risk factors at a workplace in India: A physiotherapy initiative in a healthcare setting. Hong Kong Physiother J 2015. [DOI: 10.1016/j.hkpj.2014.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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145
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Mendenhall E. Beyond Comorbidity: A Critical Perspective of Syndemic Depression and Diabetes in Cross-cultural Contexts. Med Anthropol Q 2015; 30:462-478. [PMID: 25865829 DOI: 10.1111/maq.12215] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article examines the comorbidity concept in medical anthropology. I argue that the dearth of articles on comorbidity in medical anthropology may result from the rise of syndemic theory. Syndemics recognize how social realities shape individual illness experiences as well as distribution of diseases across populations. I discuss synergistic interactions foundational to the syndemics construct through my research of depression and diabetes comorbidity in vulnerable populations from urban United States, India, and South Africa. I argue that social and economic factors that cluster with depression and diabetes alone and together exemplify the biosocial processes that are at the heart of syndemics. In doing so, I illustrate how social, cultural, and economic factors shape individual-level experiences of co-occurring diseases despite similar population-level trends. Finally, I discuss the relevance of syndemics for the fields of medicine and public health while cautioning what must not be lost in translation across disciplines.
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Affiliation(s)
- Emily Mendenhall
- Science, Technology, and International Affairs Program, Edmund A. Walsh School of Foreign Service, Georgetown University
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146
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Kataoka E, Griffin M, Durham J. The characteristics of, and risk factors for, child injuries in Andhra Pradesh, India: the Young Lives project. Int Health 2015; 7:447-54. [PMID: 25908716 DOI: 10.1093/inthealth/ihv022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/29/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Injuries are an emerging public health issue among children worldwide, and one of the leading causes of disability-adjusted life years lost for children aged 0-14 years. Few studies, particularly in low- and middle-income countries, have analysed characteristics and risk factors for these injuries. METHODS This study examined the occurrence and risk factors of serious non-fatal injuries in children aged 7-9 years (n=1820) from Andhra Pradesh, India. Logistic regression models were used to explore potential risk factors for these injuries. RESULTS Based on a 3-year recall period, 336 (18.5%) children reported serious non-fatal injuries. Incidence was higher among males (209/971; 21.5%) compared to females (127/849; 15.0%). Of the most serious non-fatal injuries reported, falls (n=186, 55.4%) were the major cause of injuries, followed by road traffic injuries (50, 14.9%), and assaults/blows/hits (26, 7.7%). Twenty children (6.0%) did not fully recover from their injuries, and 14 (4.2%) had long-term health problems as a result of their injuries. The logistic regression analyses indicated that being male (AOR 1.59; 95% CI: 1.25-2.05), in poor health (AOR 2.50; 95% CI: 1.88-3.31), and having a caregiver with low education (AOR 1.53; 95% CI: 1.15-2.05) were associated with an increased risk of non-fatal injury. CONCLUSIONS Urgent attention is needed to reduce child injuries and address risk factors according to local context.
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Affiliation(s)
- Erika Kataoka
- School of Population Health, The University of Queensland, 4006 Brisbane, QLD, Australia
| | - Mark Griffin
- Australian Development Agency for Statistics and Information Systems, 4109 Brisbane, Australia
| | - Jo Durham
- School of Population Health, The University of Queensland, 4006 Brisbane, QLD, Australia
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147
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Affiliation(s)
- Abhishek Sharma
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA. E-mail:
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148
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Choudhry NK, Dugani S, Shrank WH, Polinski JM, Stark CE, Gupta R, Prabhakaran D, Brill G, Jha P. Despite increased use and sales of statins in India, per capita prescription rates remain far below high-income countries. Health Aff (Millwood) 2015; 33:273-82. [PMID: 24493771 DOI: 10.1377/hlthaff.2013.0388] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Statin use has increased substantially in North America and Europe, with resultant reductions in cardiovascular mortality. However, little is known about statin use in lower-income countries. India is of interest because of its burden of cardiovascular disease, the unique nature of its prescription drug market, and the growing globalization of drug sales. We conducted an observational study using IMS Health data for the period February 2006-January 2010. During the period, monthly statin prescriptions increased from 45.8 to 84.1 per 1,000 patients with coronary heart disease-an increase of 0.80 prescriptions per month. The proportion of the Indian population receiving a defined daily statin dose increased from 3.35 percent to 7.78 percent. Nevertheless, only a fraction of those eligible for a statin appeared to receive the therapy, even though there were 259 distinct statin products available to Indian consumers in January 2010. Low rates of statin use in India may reflect problems with access to health care, affordability, underdiagnosis, and cultural beliefs. Because of the growing burden of cardiovascular disease in lower-income countries such as India, there is an urgent need to increase statin use and ensure access to safe products whose use is based on evidence. Policies are needed to expand insurance, increase medications' affordability, educate physicians and patients, and improve regulatory oversight.
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149
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Low Prevalence of AHA-Defined Ideal Cardiovascular Health Factors: A Study of Urban Indian Men and Women. Glob Heart 2015; 12:219-225. [PMID: 26014652 DOI: 10.1016/j.gheart.2014.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 09/14/2014] [Accepted: 09/16/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Coronary heart disease risk factors are widely prevalent among urban subjects in India but the prevalence of good cardiovascular health is unknown. OBJECTIVES This multisite study sought to determine the prevalence of American Heart Association-defined ideal cardiovascular health factors. METHODS The study was performed in 11 cities using cluster sampling. Middle-class urban subjects ages 20 to 75 years (N = 6,198; men: 3,426; women: 2,772, response: 62%) were evaluated for socioeconomic, biophysical, and biochemical factors. Prevalence of ideal cardiovascular health using 7-factor American Heart Association metric (nonsmoking, moderate or greater physical activity, low-fat, high-fruit/vegetable diet, body mass index <25 kg/m2, untreated blood pressure <120/<80 mm Hg, cholesterol <200 mg/dl, and fasting glucose <100 mg/dl) was determined. Descriptive statistics are reported. RESULTS Age-adjusted prevalences of ideal health factors in men and women, respectively, were non-tobacco use in 72.0% and 89.6%, moderate physical activity in 20.1% and 20.6%, healthy diet in 10.6% and 10.6%, normal body mass index in 57.7% and 52.8%, normotension in 17.1% and 22.4%, normocholesterolemia in 72.4% and 72.7%, and normoglycemia in 57.4% and 59.5%. Prevalence of all the 7 health factors was in <1.0% in both men and women, any 6 in 3.4% and 3.5%, any 5 in 12.7% and 17.8%, any 4 in 36.9% and 44.7%, any 3 in 67.2% and 70.8%, any 2 in 89.1% and 92.4%, and 1 in 98.2% and 99.1%. Cardiovascular health was poor (1 to 3 factors) in 62.4% of men and 54.9% of women, average (4 to 5 factors) in 34.1% and 41.5%, and good (≥6 factors) in 3.5% and 3.6%. With increasing age, the behavioral health factors (tobacco use, physical activity, healthy diet) did not change, whereas others declined (ptrend < 0.01). Clustering of average and good health factors also declined with age (ptrend < 0.01). There were no socioeconomic status-related differences in prevalence of good cardiovascular health. CONCLUSIONS Good cardiovascular health factors-physical activity, healthy diet, and desirable body mass index, blood pressure, and glucose levels-are low in urban Asian Indians.
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150
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Shrivastav R, Nazar GP, Stigler MH, Arora M. Health promotion for primordial prevention of tobacco use. Glob Heart 2015; 7:143-50. [PMID: 25691311 DOI: 10.1016/j.gheart.2012.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 06/11/2012] [Indexed: 11/16/2022] Open
Abstract
Prevention of tobacco use is critical for primordial prevention of cardiovascular diseases. Low- and middle-income countries such as India face a burgeoning burden of tobacco-related cardiovascular diseases. A focus on adolescents and young people is consistent with a primordial approach to cardiovascular disease prevention and appropriate given the natural history of tobacco use, in regards to its onset and progression. The primordial prevention approach is feasible, because it attempts to bring about behavior change (sustained abstinence for nonusers) at the population level. This paper reviews effective strategies for population-based tobacco control among adolescents including settings-based interventions at school, at home, and in the community, as well as policy and media interventions. It goes on to briefly touch on the pivotal role that medical professionals, particularly cardiologists, play in fortifying such interventions and summarizes some key recommendations based on review of evidence on the effectiveness of these interventions.
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Affiliation(s)
- Radhika Shrivastav
- Health Related Information Dissemination Amongst Youth (HRIDAY), New Delhi, India
| | - Gaurang P Nazar
- Health Related Information Dissemination Amongst Youth (HRIDAY), New Delhi, India
| | - Melissa H Stigler
- Michael and Susan Dell Center for Healthy Living, School of Public Health, University of Texas, Austin Regional Campus, Austin, TX, USA
| | - Monika Arora
- Health Related Information Dissemination Amongst Youth (HRIDAY), New Delhi, India; Public Health Foundation of India (PHFI), New Delhi, India
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