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Mulchandani R, Lyngdoh T, Gandotra S, Isser HS, Dhamija RK, Kakkar AK. Field based research in the era of the pandemic in resource limited settings: challenges and lessons for the future. Front Public Health 2024; 12:1309089. [PMID: 38487184 PMCID: PMC10938915 DOI: 10.3389/fpubh.2024.1309089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/30/2024] [Indexed: 03/17/2024] Open
Abstract
The coronavirus pandemic that began in December 2019, has had an unprecedented impact on the global economy, health systems and infrastructure, in addition to being responsible for significant mortality and morbidity worldwide. The "new normal" has brought along, unforeseen challenges for the scientific community, owing to obstructions in conducting field-based research in lieu of minimizing exposure through in-person contact. This has had greater ramifications for the LMICs, adding to the already existing concerns. As a response to COVID-19 related movement restrictions, public health researchers across countries had to switch to remote data collections methods. However, impediments like lack of awareness and skepticism among participants, dependence on paper-based prescriptions, dearth of digitized patient records, gaps in connectivity, reliance on smart phones, concerns with participant privacy at home and greater loss to follow-up act as hurdles to carrying out a research study virtually, especially in resource-limited settings. Promoting health literacy through science communication, ensuring digitization of health records in hospitals, and employing measures to encourage research participation among the general public are some steps to tackle barriers to remote research in the long term. COVID-19 may not be a health emergency anymore, but we are not immune to future pandemics. A more holistic approach to research by turning obstacles into opportunities will not just ensure a more comprehensive public health response in the coming time, but also bolster the existing infrastructure for a stronger healthcare system for countries.
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Affiliation(s)
- Rubina Mulchandani
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Tanica Lyngdoh
- Division of Reproductive, Child Health and Nutrition, Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Sheetal Gandotra
- Institute of Genomics and Integrative Biology, Council of Scientific and Industrial Research (CSIR), New Delhi, India
| | - H. S. Isser
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rajinder K. Dhamija
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, University of Delhi, New Delhi, India
| | - Ashish Kumar Kakkar
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Agarwal T, Lyngdoh T, Khadgawat R, Prabhakaran D, Chandak GR, Walia GK. Genetic architecture of adiposity measures among Asians: Findings from GWAS. Ann Hum Genet 2023; 87:255-273. [PMID: 37671428 DOI: 10.1111/ahg.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023]
Abstract
Adiposity has gradually become a global public threat over the years with drastic increase in the attributable deaths and disability adjusted life years (DALYs). Given an increased metabolic risk among Asians as compared to Europeans for any given body mass index (BMI) and considering the differences in genetic architecture between them, the present review aims to summarize the findings from genome-wide scans for various adiposity indices and related anthropometric measures from Asian populations. The search for related studies, published till February 2022, were made on PubMed and GWAS Catalog using search strategy built with relevant keywords joined by Boolean operators. It was recorded that out of a total of 47 identified studies, maximum studies are from Korean population (n = 14), followed by Chinese (n = 7), and Japanese (n = 6). Nearly 200 loci have been identified for BMI, 660 for height, 16 for weight, 28 for circumferences (waist and hip), 32 for ratios (waist hip ratio [WHR] and thoracic hip ratio [THR]), 5 for body fat, 16 for obesity, and 28 for adiposity-related blood markers among Asians. It was observed that though, most of the loci were unique for each trait, there were 3 loci in common to BMI and WHR. Apart from validation of variants identified in European setting, there were many novel loci discovered in Asian populations. Notably, 125 novel loci form Asian studies have been reported for BMI, 47 for height, 5 for waist circumference, and 2 for adiponectin level to the existing knowledge of the genetic framework of adiposity and related measures. It is necessary to examine more advanced adiposity measures, specifically of relevance to abdominal adiposity, a major risk factor for cardiometabolic disorders among Asians. Moreover, in spite of being one continent, there is diversity among different ethnicities across Asia in terms of lifestyle, climate, geography, genetic structure and consequently the phenotypic manifestations. Hence, it is also important to consider ethnic specific studies for identifying and validating reliable genetic variants of adiposity measures among Asians.
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Affiliation(s)
- Tripti Agarwal
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Delhi, India
| | | | | | | | - Giriraj Ratan Chandak
- Genomic Research in Complex diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
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Mulchandani R, Lyngdoh T, Nangia R, Singh S, Grover S, Thakur JS. Relationship between serum lipids and depression: A cross sectional survey among adults in Haryana, India. Indian J Psychiatry 2023; 65:61-67. [PMID: 36874526 PMCID: PMC9983447 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_967_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 10/28/2022] [Accepted: 12/17/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Dyslipidemia and mental illnesses are significant contributors to the global noncommunicable disease burden and studies suggest an association between them. AIM Using data from a noncommunicable disease risk factor survey conducted in Haryana, India, we undertook a secondary data analysis to examine the association between lipids and depressive symptoms. METHODS The survey involved 5,078 participants and followed the World Health Organisation STEPwise approach to NCD risk factor surveillance approach. Biochemical assessments were undertaken in a subset of participants. Lipid markers were measured using wet chemistry methods. Depressive symptoms were assessed using the Patient Health Questionnaire-9. Descriptive statistics were presented for all variables; logistic regression was used for association analyses. RESULTS The mean age of the study population was 38 years and 55% of them were females. A majority of the participants belonged to a rural background. The mean total cholesterol was 176 mg/dL and approximately 5% of the participants were found to have moderate to severe depression. The association of total cholesterol (odds ratio [OR] 0.99, P = 0.84), LDL-cholesterol (OR = 1.00, P = 0.19), HDL-cholesterol (OR = 0.99, P = .76), and triglycerides (OR 1.00, P = .12) with depressive symptoms was not significant. CONCLUSION This study did not find any association between lipids and depressive symptoms. However, further investigations using prospective designs are warranted to understand this relationship and complex interactions with other mediating factors better.
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Affiliation(s)
- Rubina Mulchandani
- Department of Clinical Research, Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Tanica Lyngdoh
- Department of Clinical Research, Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurgaon, Haryana, India.,Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, New Delhi, India
| | - Ria Nangia
- Department of Community Medicine and School of Public Heath, Chandigarh, India
| | - Sukriti Singh
- Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan, Himachal Pradesh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - J S Thakur
- Department of Community Medicine and School of Public Heath, Chandigarh, India
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Misra S, Lyngdoh T, Mulchandani R. Guidelines for dyslipidemia management in India: A review of the current scenario and gaps in research. Indian Heart J 2022; 74:341-350. [PMID: 35940234 PMCID: PMC9647649 DOI: 10.1016/j.ihj.2022.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/31/2022] [Accepted: 07/27/2022] [Indexed: 12/02/2022] Open
Abstract
Cardiovascular Diseases (CVD) have a high disease burden in India. Dyslipidemia, a major CVD risk factor, requires effective management. Our review describes the appropriateness of the international dyslipidemia guidelines in the Indian context. A systematic search was performed in PubMed, Google Scholar, Cochrane Library and Science Direct to obtain relevant articles. Dyslipidemia management guidelines by western medical associations are based on their studies, with ethnic minorities underrepresented and biological features of other racial groups inadequately incorporated. The Lipid Association of India (LAI) came up with a consensus statement guided by an expert panel to adapt the western guidelines to Indians. However, absence of Indian guidelines has led to physicians basing treatment on individual preference, contributing to heterogeneity. Our review underscores the need for formulating Indian dyslipidemia management guidelines and CV risk estimation algorithms, highlighting the scope for further research. This could supplement the clinical expertise of LAI and enhance patient experience.
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Mulchandani R, Babu GR, Kaur A, Singh R, Lyngdoh T. Factors associated with differential COVID-19 mortality rates in the SEAR nations: a narrative review. IJID Reg 2022; 3:54-67. [PMID: 35720145 PMCID: PMC8882069 DOI: 10.1016/j.ijregi.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 01/09/2023]
Abstract
Objectives Since December 2019, the world has been grappling with the COVID-19 pandemic, which has caused severe loss of lives, the breakdown of health infrastructure, and disruption of the global economy. There is growing evidence on mortality patterns in high-income countries. However, similar evidence from low/middle-income nations is lacking. Our review aimed to describe COVID-19 mortality patterns in the WHO-SEAR nations, and explore the associated factors in order to explain such trends. Methods A systematic and comprehensive search was undertaken in PubMed and Google Scholar to obtain maximum hits on COVID-19 mortality and its determinants in the SEAR, using a combination of MeSH terms and Boolean operators. The data were narratively synthesized in detail under appropriate themes. Results Our search identified 6411 unique records. Mortality patterns were described in terms of important demographical and epidemiological indicators. Gaps in available evidence and paucity of adequate research in this area were also highlighted. Conclusions This review examined significant contributors to COVID-19 mortality across SEAR nations, while emphasizing issues relating to insufficient studies and data quality, and reporting challenges and other concerns in resource-constrained settings. There is a compelling need for more work in this area, to help inform decision making and improve public-health response.
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Affiliation(s)
- Rubina Mulchandani
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurugram, India
| | - Giridhara R Babu
- Indian Institute of Public Health-Bengaluru, Public Health Foundation of India, Bengaluru, India
- Senior Fellow, DBT-Wellcome Trust-India Alliance
| | - Avinash Kaur
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurugram, India
| | - Ranjana Singh
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurugram, India
| | - Tanica Lyngdoh
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurugram, India
- Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, New Delhi, India
- Corresponding author: Dr Tanica Lyngdoh, Scientist ‘E’, Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, V. Ramalingaswami Bhawan, Ansari Nagar, New Delhi, India, Tel: +91 9560048416.
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Singhal D, Lyngdoh T, Prabhakaran P. Knowledge, Attitude and Practice Study of Health Risks Among E-waste Recyclers in Delhi. J Health Pollut 2021; 11:210306. [PMID: 33815904 PMCID: PMC8009644 DOI: 10.5696/2156-9614-11.29.210306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND India is the fifth biggest producer of e-waste in the world, discarding 1.7 million tons in 2014. E-waste gets recycled mainly in the informal sector which means activities are largely unaccounted for. Hazardous chemicals and metals are released during recycling processes (lead (Pb) being the most common). Compared to other developing countries, there are few studies from India on the awareness of recyclers of health risks related to e-waste recycling. OBJECTIVES The aim of the present study was to assess the knowledge, attitudes, and practices (KAP) of health-related risks and behaviors among e-waste workers/recyclers belonging to the informal sector in Delhi and to determine the concentration of Pb levels in hair samples from a subset of workers from selected recycling sites. METHODS A cross-sectional study was conducted in three e-waste informal recycling sites of Delhi: Seelampur, Mustafabad and Mandoli using an interviewer administered questionnaire among 220 e-waste workers. Percentages were presented for each KAP indicator. Analyses were computed using the statistical software STATA 14.2. RESULTS It was observed that 24% of participants had knowledge of the meaning of e-waste and 36% knew the chemicals that could be released from e-waste handling. Personal protective equipment (PPE) was used by only 12% of the workers. Twenty-six percent (26%) perceived occupational injuries (cuts or burns) as mild and 20% perceived coughing immediately after work as mild. Explorative analysis showed a link between worker education level and the type of work practices employed. The median level of Pb concentration among hair samples was 8 mg/kg with inter-quartile range between 5.8 to 12.4 mg/kg. CONCLUSIONS Knowledge and practices among e-waste workers regarding the health hazards associated with e-waste recycling were poor with little knowledge of or attention to health risks. A comprehensive remediation package covering sensitization and awareness-building strategies of the health risks associated with informal e-waste recycling should be an urgent priority. PARTICIPANT CONSENT Obtained. ETHICS APPROVAL Ethics approval was obtained from the Institutional Ethical Committee (IEC), Indian Institute of Public Health-Delhi. COMPETING INTERESTS The authors declare no competing financial interests.
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Affiliation(s)
- Diksha Singhal
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Institutional Area Gurugram, Delhi, India
| | - Tanica Lyngdoh
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Institutional Area Gurugram, Delhi, India
| | - Poormima Prabhakaran
- Centre for Environmental Health, Public Health Foundation of India, Institutional Area Gurugram, Delhi, India
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Mulchandani R, Lyngdoh T, Kakkar AK. Deciphering the COVID-19 cytokine storm: Systematic review and meta-analysis. Eur J Clin Invest 2021; 51:e13429. [PMID: 33058143 PMCID: PMC7646004 DOI: 10.1111/eci.13429] [Citation(s) in RCA: 145] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/22/2020] [Accepted: 10/06/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The coronavirus pandemic has affected more than 20 million people so far. Elevated cytokines and suppressed immune responses have been hypothesized to set off a cytokine storm, contributing to ARDS, multiple-organ failure and, in the most severe cases, death. We aimed to quantify the differences in the circulating levels of major inflammatory and immunological markers between severe and nonsevere COVID-19 patients. METHODS Relevant studies were identified from PubMed, EMBASE, Web of Science, SCOPUS and preprint servers. Risk of bias was assessed for each study, using appropriate checklists. All studies were described qualitatively and a subset was included in the meta-analysis, using forest plots. RESULTS Based on 23 studies, mean cytokine levels were significantly higher (IL-6: MD, 19.55 pg/mL; CI, 14.80, 24.30; IL-8: MD, 19.18 pg/mL; CI, 2.94, 35.43; IL-10: MD, 3.66 pg/mL; CI, 2.41, 4.92; IL-2R: MD, 521.36 U/mL; CI, 87.15, 955.57; and TNF-alpha: MD, 1.11 pg/mL; CI, 0.07, 2.15) and T-lymphocyte levels were significantly lower (CD4+ T cells: MD, -165.28 cells/µL; CI, -207.58, -122.97; CD8+ T cells: MD, -106.51 cells/µL; CI, -128.59, -84.43) among severe cases as compared to nonsevere ones. There was heterogeneity across studies due to small sample sizes and nonuniformity in outcome assessment and varied definitions of disease severity. The overall quality of studies was sub-optimal. CONCLUSION Severe COVID-19 is characterized by significantly increased levels of pro-inflammatory cytokines and reduced T lymphocytes. Well-designed and adequately powered prospective studies are needed to amplify the current evidence and provide definitive answers to dilemmas regarding timing and type of anti-COVID-19 therapy particularly in severe patients.
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Affiliation(s)
- Rubina Mulchandani
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India
| | - Tanica Lyngdoh
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India
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Abstract
Non-communicable diseases (NCD) are reaching epidemic proportions in India and the escalating burden is expected to deepen economic load by putting further pressure into an already constrained health system. One of the serious constraints of the health systems is poorly skilled staff widening the gap between the demand and supply of healthcare professionals trained in NCDs. The current article reviews efforts made towards capacity building initiatives undertaken in India to address the limited human resources to counter the emerging burden posed by NCDs. This paper reviews existing literature on capacity building efforts on NCDs in India through gathering information from search engines such as Google Scholar and PubMed and other relevant websites. Even though health care professionals across all levels of health care have a critical role in prevention and control of NCDs, this review suggests minimal consolidated efforts at capacity building in the area of NCD within the health systems in India, albeit isolated efforts identified from different sectors. This review makes a case to upgrade and advance sustained efforts to enhance and improve capacity of workforce and to incorporate a component of NCD training into medical curricula.
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Affiliation(s)
- Tanica Lyngdoh
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurugram, Haryana, India
- Public Health Foundation of India, Gurugram, Haryana, India
| | - Anjali Sharma
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurugram, Haryana, India
| | - Sanjay Zodpey
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurugram, Haryana, India
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Abstract
Background: Low vital capacity, one of the consequences of restricted lung growth, is a strong predictor of cardiovascular mortality. Vital capacity is lower in the developing world than the developed world, even after adjusting for height, weight and gender. This difference is typically dismissed as ethnic variation, adjusted for by redefining normal. Whether this is a consequence of stunted lung growth, rather than just genetically smaller lungs, has not been investigated in detail. Therefore, we sought to compare factors implicated in both stunting and lung development, particularly in the developing world. Methods: We conducted a manual screen of articles identified through Google Scholar and assessed risk of bias. No language restrictions were applied, so long as there was an associated English abstract. We queried VizHub (Global Burden of Disease Visualization Tool) and Google Dataset search engines for disease burden and genome wide association studies. The scope of the article and the heterogeneity of the outcome measures reported required a narrative review of available evidence. To the extent possible, the review follows PRISMA reporting guidelines. Results: Early life influences operate in synergism with genetic, environmental and nutritional factors to influence lung growth and development in children. Low lung function and stunting have common anthropometric, environmental and nutritional correlates originating during early development. Similar anthropometric correlates shared chronic inflammatory pathways, indicated that the two conditions were analogous. Conclusion: The analogy between poor lung function and stunting is conspicuous in the developing world, with malnutrition at the center of non -achievement of growth potential, susceptibility to infectious diseases and intrauterine programming for metabolic syndrome. This counter the idea of redefining the normal for lung function measurements, since observed inter-ethnic variations are likely a mix of natural genetic differences as well as differences in nurture such that reduced lung function reflects early life adversities.
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Affiliation(s)
- Navya Mishra
- Public Health Foundation of India, Delhi, India.,Academy of Scientific and Innovative Research, Ghaziabad, India
| | | | | | - Anurag Agrawal
- Academy of Scientific and Innovative Research, Ghaziabad, India.,CSIR Institute of Genomics and Integrative Biology, Delhi, Delhi, India
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Mulchandani R, Lyngdoh T, Kakkar AK. Statins-induced hepatotoxicity: still more questions than answers. Expert Opin Drug Saf 2020; 19:1653-1654. [PMID: 33031710 DOI: 10.1080/14740338.2020.1835045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rubina Mulchandani
- Indian Institute of Public Health -Delhi, Public Health Foundation of India , Gurgaon, India
| | - Tanica Lyngdoh
- Indian Institute of Public Health -Delhi, Public Health Foundation of India , Gurgaon, India
| | - Ashish Kumar Kakkar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
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Mulchandani R, Lyngdoh T, Kakkar AK. Statin use and safety concerns: an overview of the past, present, and the future. Expert Opin Drug Saf 2020; 19:1011-1024. [PMID: 32668998 DOI: 10.1080/14740338.2020.1796966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Dyslipidemia is a significant risk factor for cardiovascular disorders and contributes to significant morbidity and mortality associated with CAD and stroke worldwide. Statins are the most commonly prescribed drugs for the prevention and management of dyslipidemia globally. Although they provide immense therapeutic benefit, they are associated with clinically significant adverse effects, predominantly muscle, nerve, liver, and cognition-related besides new-onset diabetes. This has sparked various controversies, bringing to the fore, ambiguities that continue to exist in the scientific evidence, in relation to statin-associated harms. Therefore, it becomes essential to have a better understanding of safety issues related to statin use in various populations. AREAS COVERED This review describes the most common adverse effects of statins, examines available evidence and highlights the role of ethnicity, lipophilicity and other biological factors that could mediate and/or influence the relationship. MEDLINE was searched via PubMed to obtain relevant articles on dyslipidemia and statin safety. EXPERT OPINION The effectiveness of statins is presently unmatched. Further research is warranted to gain insights into the diverse pharmacological effects of statins in various population subgroups. This would assist prescribers in making better informed decisions. Specific treatment strategies for vulnerable groups can significantly attenuate harms, improve risk-benefit ratios, and ultimately enhance patient experience.
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Affiliation(s)
- Rubina Mulchandani
- Indian Institute of Public Health-Delhi, Public Health Foundation of India , Gurgaon, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad - 201002, India
| | - Tanica Lyngdoh
- Indian Institute of Public Health-Delhi, Public Health Foundation of India , Gurgaon, India
| | - Ashish Kumar Kakkar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
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Kinra S, Mallinson PAC, Cresswell JA, Bowen LJ, Lyngdoh T, Prabhakaran D, Reddy KS, Vaz M, Kurpad AV, Davey Smith G, Ben-Shlomo Y, Ebrahim S. Relative contribution of diet and physical activity to increased adiposity among rural to urban migrants in India: A cross-sectional study. PLoS Med 2020; 17:e1003234. [PMID: 32764760 PMCID: PMC7413404 DOI: 10.1371/journal.pmed.1003234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 07/08/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In common with many other low- and middle-income countries (LMICs), rural to urban migrants in India are at increased risk of obesity, but it is unclear whether this is due to increased energy intake, reduced energy expenditure, or both. Knowing this and the relative contribution of specific dietary and physical activity behaviours to greater adiposity among urban migrants could inform policies for control of the obesity epidemic in India and other urbanising LMICs. In the Indian Migration Study, we previously found that urban migrants had greater prevalence of obesity and diabetes compared with their nonmigrant rural-dwelling siblings. In this study, we investigated the relative contribution of energy intake and expenditure and specific diet and activity behaviours to greater adiposity among urban migrants in India. METHODS AND FINDINGS The Indian Migration Study was conducted between 2005 and 2007. Factory workers and their spouses from four cities in north, central, and south of India, together with their rural-dwelling siblings, were surveyed. Self-reported data on diet and physical activity was collected using validated questionnaires, and adiposity was estimated from thickness of skinfolds. The association of differences in dietary intake, physical activity, and adiposity between siblings was examined using multivariable linear regression. Data on 2,464 participants (median age 43 years) comprised of 1,232 sibling pairs (urban migrant and their rural-dwelling sibling) of the same sex (31% female) were analysed. Compared with the rural siblings, urban migrants had 18% greater adiposity, 12% (360 calories/day) more energy intake, and 18% (11 kilojoules/kg/day) less energy expenditure (P < 0.001 for all). Energy intake and expenditure were independently associated with increased adiposity of urban siblings, accounting for 4% and 6.5% of adiposity difference between siblings, respectively. Difference in dietary fat/oil (10 g/day), time spent engaged in moderate or vigorous activity (69 minutes/day), and watching television (30 minutes/day) were associated with difference in adiposity between siblings, but no clear association was observed for intake of fruits and vegetables, sugary foods and sweets, cereals, animal and dairy products, and sedentary time. The limitations of this study include a cross-sectional design, systematic differences in premigration characteristics of migrants and nonmigrants, low response rate, and measurement error in estimating diet and activity from questionnaires. CONCLUSIONS We found that increased energy intake and reduced energy expenditure contributed equally to greater adiposity among urban migrants in India. Policies aimed at controlling the rising prevalence of obesity in India and potentially other urbanising LMICs need to be multicomponent, target both energy intake and expenditure, and focus particularly on behaviours such as dietary fat/oil intake, time spent on watching television, and time spent engaged in moderate or vigorous intensity physical activity.
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Affiliation(s)
- Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Poppy Alice Carson Mallinson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jenny A. Cresswell
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Liza J. Bowen
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | - Mario Vaz
- St John’s Research Institute, St John’s National Academy of Health Sciences, Bangalore, India
| | - Anura V. Kurpad
- St John’s Research Institute, St John’s National Academy of Health Sciences, Bangalore, India
| | - George Davey Smith
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Shah Ebrahim
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Mishra N, Salvi S, Lyngdoh T, Agrawal A. Low lung function in the developing world is analogous to stunting: a review of the evidence. Wellcome Open Res 2020; 5:147. [DOI: 10.12688/wellcomeopenres.15929.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Low vital capacity, one of the consequences of restricted lung growth, is a strong predictor of cardiovascular mortality. Vital capacity is lower in the developing world than the developed world, even after adjusting for height, weight and gender. This difference is typically dismissed as ethnic variation, adjusted for by redefining normal. Whether this is a consequence of stunted lung growth, rather than genetically smaller lungs, has not been investigated in detail. Therefore, we sought to compare factors implicated in both stunting and lung development, particularly in the developing world. Methods: We conducted a manual screen of articles identified through Google Scholar and assessed risk of bias. No language restrictions were applied, so long as there was an associated English abstract. We queried VizHub (Global Burden of Disease Visualization Tool) and Google Dataset search engines for disease burden and genome wide association studies. The scope of the article and the heterogeneity of the outcome measures reported required a narrative review of available evidence. To the extent possible, the review follows PRISMA reporting guidelines. Results: Early life influences operate in synergism with environmental and nutritional factors to influence lung growth and development in children. Low lung function and stunting have common anthropometric, environmental and nutritional correlates originating during early development. Similar anthropometric correlates and shared chronic inflammatory pathways indicated that the two conditions were analogous. Conclusion: The analogy between poor lung function and stunting is conspicuous in the developing world, where malnutrition lies at the center of non -achievement of growth potential, susceptibility to infectious diseases and intrauterine programming for metabolic syndrome. The common pathological mechanisms governing stunting and lung function deficits counter the idea of redefining the normal for lung function measurements.
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Joshi U, Lyngdoh T, Shidhaye R. Validation of hindi version of Edinburgh postnatal depression scale as a screening tool for antenatal depression. Asian J Psychiatr 2020; 48:101919. [PMID: 31927197 DOI: 10.1016/j.ajp.2019.101919] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/25/2019] [Accepted: 12/25/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Antenatal depression is recognized as one of the strongest predictors of postnatal depression, which itself is a strong predictor of mental disorders. The detection of antenatal depression is important and requires an accurate and valid screening tool. The Edinburgh Postnatal Depression Scale (EPDS) is one of the most extensively studied screening instruments for assessing postnatal depression. AIM To validate a linguistically and contextually appropriate Hindi version of the EPDS for use in women attending antenatal care in Sehore, Madhya Pradesh. METHODS AND MATERIAL A rigorously translated and modified Hindi version of the EPDS was developed and validated using the Hindi version of the PHQ-9 as a gold standard. A consecutive sample of women (n = 100) attending antenatal check-ups in healthcare facilities in Sehore district were interviewed. RESULTS The validity measure of Receiver Operator Characteristic curve was plotted for different cutoffs of EPDS. The optimal cutoff score for the Hindi validation of the EPDS was 9/10 for antenatal depression with sensitivity, specificity, positive and negative predictive value of 65.38%, 79.73%, 53.13%, and 86.76% respectively and area under the curve 0.7346. The internal consistency using Cronbach's alpha was 0.86 indicating good homogeneity. CONCLUSION Findings of this study suggest that the Hindi version of the EPDS can be used as a valid measure to screen antenatal depression in India.
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Affiliation(s)
- Udita Joshi
- Sangath, 120, Deepak Society, Chuna Bhatti, Bhopal, Madhya Pradesh 462016, India.
| | - Tanica Lyngdoh
- Indian Institute of Public Health, Delhi. Plot No. 47, Sector 44, Institutional Area, Gurgao 122003, India
| | - Rahul Shidhaye
- Pravara Institute of Medical Sciences, Loni, Maharastra 413736, India
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Agarwal T, Lyngdoh T, Dudbridge F, Chandak GR, Kinra S, Prabhakaran D, Reddy KS, Relton CL, Davey Smith G, Ebrahim S, Gupta V, Walia GK. Causal relationships between lipid and glycemic levels in an Indian population: A bidirectional Mendelian randomization approach. PLoS One 2020; 15:e0228269. [PMID: 31995593 PMCID: PMC6988960 DOI: 10.1371/journal.pone.0228269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/12/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dyslipidemia and abnormal glycemic traits are leading causes of morbidity and mortality. Although the association between the two traits is well established, there still exists a gap in the evidence for the direction of causality. OBJECTIVE This study aimed to examine the direction of the causal relationship between lipids and glycemic traits in an Indian population using bidirectional Mendelian randomization (BMR). METHODS The BMR analysis was conducted on 4900 individuals (2450 sib-pairs) from the Indian Migration Study. Instrument variables were generated for each lipid and glycemic trait (fasting insulin, fasting glucose, HOMA-IR, HOMA-β, LDL-cholesterol, HDL-cholesterol, total cholesterol and triglycerides) to examine the causal relationship by applying two-stage least squares (2SLS) regression in both directions. RESULTS Lipid and glycemic traits were found to be associated observationally, however, results from 2SLS showed that only triglycerides, defined by weighted genetic risk score (wGRS) of 3 SNPs (rs662799 at APOAV, rs780094 at GCKR and rs4420638 at APOE/C1/C4), were observed to be causally effecting 1.15% variation in HOMA-IR (SE = 0.22, P = 0.010), 1.53% in HOMA- β (SE = 0.21, P = 0.001) and 1.18% in fasting insulin (SE = 0.23, P = 0.009). No evidence for a causal effect was observed in the reverse direction or between any other lipid and glycemic traits. CONCLUSION The study findings suggest that triglycerides may causally impact various glycemic traits. However, the findings need to be replicated in larger studies.
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Affiliation(s)
- Tripti Agarwal
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India
| | - Tanica Lyngdoh
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India
| | - Frank Dudbridge
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | | | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Caroline L. Relton
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Shah Ebrahim
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vipin Gupta
- Department of Anthropology, University of Delhi, Delhi, India
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Thakur JS, Jeet G, Nangia R, Singh D, Grover S, Lyngdoh T, Pal A, Verma R, Aggarwal R, Khan MH, Saran R, Jain S, Gupta KL, Kumar V. Non-communicable diseases risk factors and their determinants: A cross-sectional state-wide STEPS survey, Haryana, North India. PLoS One 2019; 14:e0208872. [PMID: 31774812 PMCID: PMC6881003 DOI: 10.1371/journal.pone.0208872] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 10/21/2019] [Indexed: 12/28/2022] Open
Abstract
Background Recent studies have documented high variation in epidemiologic transition levels among Indian states with noncommunicable disease epidemic rising swiftly. However, the estimates suffer from non-availability of reliable data for NCDs from sub populations. In order to fill the knowledge gap, the distribution and determinants of NCD risk factors were studied along with awareness, treatment and control of NCDs among the adult population in Haryana, India. Methods NCD risk factors survey was conducted among 5078 residents, aged 18–69 years during 2016–17. Behavioural risk factors were assessed using STEPS instrument, administered through an android software (mSTEPS). This was followed by physical measurements using standard protocols. Finally, biological risk factors were determined through the analysis of serum and urine samples. Results Males were found to be consuming tobacco and alcohol at higher rates of 38.9% (95% CI: 35.3–42.4) and 18.8% (95% CI: 15.8–21.8). One- tenth (11%) (95% CI: 8.6–13.4) of the respondents did not meet the specified WHO recommendations for physical activity for health. Around 35.2% (95%CI: 32.6–37.7) were overweight or obese. Hypertension and diabetes were prevalent at 26.2% (95% CI: 24.6–27.8) and 15.5% (95% CI: 11.0–20.0). 91.3% (95% CI: 89.3–93.3) of the population had higher salt intake than recommended 5gms per day. Conclusion The documentation of strikingly high and uniform distribution of different NCDs and their risk factors in state warrants urgent need for evidence based interventions and advocacy of policy measures.
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Affiliation(s)
- JS Thakur
- Department of Community Medicine and School of Public Heath, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- * E-mail:
| | - Gursimer Jeet
- Department of Community Medicine and School of Public Heath, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ria Nangia
- Department of Community Medicine and School of Public Heath, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Singh
- Department of Community Medicine and School of Public Heath, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate of Medical Education and Research, Chandigarh, India
| | - Tanica Lyngdoh
- Indian Institute of Public Health Association, Public Health Foundation of India, Gurugram, India
| | - Arnab Pal
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramesh Verma
- Department of Social and Preventive Medicine, Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Ramnika Aggarwal
- Department of Community Medicine, Kalpana Chawla Medical College, Karnal, India
| | - Mohd. Haroon Khan
- Department of Community Medicine, Shaheed Hasan Khan Mewati Government Medical College, Mewat, India
| | - Rajiv Saran
- Department of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sanjay Jain
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K. L. Gupta
- Department of Nephrology, Post Graduate of Medical Education and Research, Chandigarh, India
| | - Vivek Kumar
- Department of Nephrology, Post Graduate of Medical Education and Research, Chandigarh, India
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Mishra N, Agrawal A, Salvi S, Yajnik C, Lyngdoh T, Aggarwal M. Factors affecting early adult lung function. Epidemiology 2019. [DOI: 10.1183/13993003.congress-2019.pa2802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mulchandani R, Lyngdoh T, Chakraborty P, Kakkar AK. Satisfaction With Statin Treatment Among Adult Coronary Artery Disease Patients: An Experience From a Resource-Constrained Setting. Heart Lung Circ 2018; 28:1788-1794. [PMID: 30704841 DOI: 10.1016/j.hlc.2018.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 10/09/2018] [Accepted: 10/25/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Statins are the most widely prescribed hypolipidaemic drugs for coronary artery disease (CAD) patients, but have been found to cause muscle and nerve related adverse effects which can affect patient satisfaction with treatment. Literature on treatment satisfaction among statin users, especially from resource-limited settings is inadequate. The aim of this cross-sectional study was to assess the level of satisfaction with treatment among statin users and evaluate the relationship between adverse effects experienced by patients and their satisfaction with the medication. METHODS This study included 300 adult CAD patients visiting the cardiology department of a tertiary care hospital in the northern region of India, who were prescribed statins for their diagnoses. An interviewer administered, validated and standardised Treatment Satisfaction Questionnaire for Medication (version 1.4) was used for data collection. RESULTS Around three quarters of the population reported being overall satisfied with their medication. Mean scores were calculated for Effectiveness, Convenience, Side-Effects and Global Satisfaction. The patients reported high scores (above 60%) for all domains. Those experiencing any adverse effect were found to be more likely to report lower effectiveness. Additionally, medication effectiveness showed a positive correlation with overall treatment satisfaction. CONCLUSIONS The study shows that treatment satisfaction is critical to gauge patient experiences with the treatment which can impact medication adherence and compliance. It's a crucial measure especially among CAD and other chronic disease patients since greater satisfaction can improve clinical outcomes. More research is warranted to better understand the relationship between medication effectiveness and treatment satisfaction.
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Affiliation(s)
| | | | - Praloy Chakraborty
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ashish Kumar Kakkar
- Department of Pharmacology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
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Ghosh-Jerath S, Singh A, Lyngdoh T, Magsumbol MS, Kamboj P, Goldberg G. Estimates of Indigenous Food Consumption and Their Contribution to Nutrient Intake in Oraon Tribal Women of Jharkhand, India. Food Nutr Bull 2018; 39:581-594. [DOI: 10.1177/0379572118805652] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Suparna Ghosh-Jerath
- Indian Institute of Public Health–Delhi (IIPH-Delhi), Public Health Foundation of India (PHFI), Gurgaon, India
| | - Archna Singh
- All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Tanica Lyngdoh
- Indian Institute of Public Health–Delhi (IIPH-Delhi), Public Health Foundation of India (PHFI), Gurgaon, India
| | | | - Preeti Kamboj
- Lady Irwin College, Delhi University, New Delhi, Delhi, India
| | - Gail Goldberg
- Nutrition and Bone Health Research Group, MRC Human Nutrition Research, Cambridge, United Kingdom
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Abstract
BACKGROUND Statins are the most widely prescribed class of drugs for coronary artery disease (CAD) patients and yet literature on the prevalence of statin related adverse effects (AEs) and gaps in patient education is quite limited especially in resource-limited settings of developing world. OBJECTIVES The present study was conducted to determine the prevalence of myopathy (muscle ailments) and other statin associated adverse effects among CAD patients on statin therapy. The study also aimed to assess patient perceptions, attitudes and awareness concerning the use of statins. METHODS It was a cross-sectional study conducted among 300 adult CAD patients visiting the out-patient department of a tertiary care hospital in North India, who were receiving statins for their diagnosis. An interviewer administered questionnaire was used to collect data on statin use among patients and adverse effects experienced. RESULTS Myopathy or muscle related ailments like muscle pain, cramps and muscle weakness were the most prevalent (32, 34 and 47%, respectively), followed by numbness, tingling and burning in the extremities (31%). Joint pain and cognitive impairments were seen in nearly 20% of the patients. The level of awareness among participants regarding the use of statins was sub-optimal. Lack of knowledge and under-reporting of adverse effects were major concerns. CONCLUSION The study shows that a considerable proportion of statin users experience adverse effects and knowledge and awareness amongst patients is inadequate. Awareness programmes and counselling for patients, sensitisation of healthcare professionals and better screening systems for monitoring AEs can help improve the scenario.
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Affiliation(s)
| | | | - Praloy Chakraborty
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ashish Kumar Kakkar
- Department of Pharmacology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Lyngdoh T, Neogi SB, Ahmad D, Soundararajan S, Mavalankar D. Intensity of contact with frontline workers and its influence on maternal and newborn health behaviors: cross-sectional survey in rural Uttar Pradesh, India. J Health Popul Nutr 2018; 37:2. [PMID: 29310705 PMCID: PMC5759258 DOI: 10.1186/s41043-017-0129-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND India is committed to improving maternal and newborn health in order to achieve the targets for India's Millennium Development Goal 4. Considering their role as a link between community and health systems, frontline workers (FLWs) can be effectively utilized in strengthening maternal and newborn care. In this paper, we set out to examine the effect of intensity of contact with FLWs on key maternal and newborn health behaviors and to determine if this association varies by status of Self Help Group (SHG) membership. METHODS This population-based cross-sectional study included 2208 currently married women aged 15-49 years who had delivered a baby during the last 15 months prior to the survey and selected through a multi-stage cluster sampling from rural villages and urban wards. The outcome of interest included variables related to key knowledge and practice of healthy behavior in relation to maternal and newborn health and exposure variable considered was intensity of contact with FLWs. RESULTS Of the women interviewed, 1729 (78%) belonged to SHG household. For knowledge on the need for at least 3 antenatal care (ANC) check-ups, two tetanus toxoid (TT) injections and consumption of 100 or more iron-folic acid (IFA) tablets, proportion of those who were aware of these practices increased with increasing number of contacts with FLWs (P value < 0.001). Practice for TT injections showed an increasing trend with increasing number of contacts with FLW. An increase in the odds of delivering in an institution was observed in those who had higher number of contacts as compared to those with no contacts (P value < 0.001). With regard to newborn healthy behavior practice, breastfeeding within 1 h of delivery showed significant association and the odds of this practice improved in those who had ≥ 3 contacts with FLW as compared to those had no contacts. Except for consumption of 100 or more IFA tablets, there was no interaction of these associations by SHG status. CONCLUSION There was an overall low prevalence of both knowledge and practice of key maternal and newborn healthy behaviors and only a few of these were associated with frequency of contacts with FLW. Findings not only highlight the urgent need for effectively leveraging FLWs to strengthen maternal and newborn care but also to improve the quality of services provided by them.
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Affiliation(s)
- Tanica Lyngdoh
- Indian Institute of Public Health Delhi, Public Health foundation of India, New Delhi, India.
- Indian Institute of Public Health Delhi, Public Health foundation of India, Plot No. 47, Sector-44, Institutional Area, Gurgaon, 122002, India.
| | - Sutapa B Neogi
- Indian Institute of Public Health Delhi, Public Health foundation of India, New Delhi, India
| | - Danish Ahmad
- Public Health foundation of India, New Delhi, India
| | | | - Dileep Mavalankar
- Indian Institute of Public Health Gandhinagar, Public Health Foundation of India, New Delhi, India
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Shidhaye R, Lyngdoh T, Murhar V, Samudre S, Krafft T. Predictors, help-seeking behaviour and treatment coverage for depression in adults in Sehore district, India. BJPsych Open 2017; 3:212-222. [PMID: 28904815 PMCID: PMC5592386 DOI: 10.1192/bjpo.bp.116.004648] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/28/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND National Mental Health Survey found that in India, the point prevalence of major depressive disorder (MDD) was 2.7% and the treatment gap was 85.2%, whereas in Madhya Pradesh the point prevalence of MDD was 1.4% and the treatment gap was 80%. AIMS To describe the baseline prevalence of depression among adults, association of various demographic and socioeconomic variables with depression and estimation of contact coverage for the same. METHOD Population-based cross-sectional survey of 3220 adults in Sehore district of Madhya Pradesh, India. The outcome of interest was a probable diagnosis of depression that was measured using the Patient Health Questionnaire (PHQ-9) and the proportion of individuals with depression (PHQ-9>9) who sought care for the same. The data were analysed using simple and multiple log-linear regression. RESULTS Low educational attainment, unemployment and indebtedness were associated with both moderate/severe depression (PHQ-9 score >9) and severe depression only (PHQ-9 score >14), whereas age, caste and marital status were associated with only moderate or severe depression. Religion, type of house, land ownership and amount of loan taken were not associated with either moderate/severe or only severe depression. The contact coverage for moderate/severe depression was 13.08% (95% CI 10.2-16.63). CONCLUSIONS There is an urgent need to bridge the treatment gap by targeting individuals with social vulnerabilities and integrating evidence-based interventions in primary care. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Rahul Shidhaye
- , MD, Associate Professor, Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India; CAPHRI (Care and Public Health Research Institute), Maastricht University, Maastricht, The Netherlands, and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tanica Lyngdoh
- , MD, MSc, PhD, Associate Professor, Indian Institute of Public Health Delhi, Public Health Foundation of India, New Delhi, India
| | - Vaibhav Murhar
- , MA (Applied Psychology), MSW, Project Director (PRIME), Sangath, Bhopal, India
| | - Sandesh Samudre
- , MPH, Senior Research Associate, Center for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India, and Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, King's College London, London, UK
| | - Thomas Krafft
- , PhD, Professor, CAPHRI (Care and Public Health Research Institute), Maastricht University, Maastricht, The Netherlands, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, China, and Institute of Environment Education and Research, Bharati Vidyapeeth University, Pune, India
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Lyngdoh T, Bochud M, Glaus J, Castelao E, Waeber G, Vollenweider P, Preisig M. Associations of serum uric acid and SLC2A9 variant with depressive and anxiety disorders: a population-based study. PLoS One 2013; 8:e76336. [PMID: 24204615 PMCID: PMC3812204 DOI: 10.1371/journal.pone.0076336] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 08/22/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Limited information exists regarding the association between serum uric acid (SUA) and psychiatric disorders. We explored the relationship between SUA and subtypes of major depressive disorder (MDD) and specific anxiety disorders. Additionally, we examined the association of SLC2A9 rs6855911 variant with anxiety disorders. METHODS We conducted a cross-sectional analysis on 3,716 individuals aged 35-66 years previously selected for the population-based CoLaus survey and who agreed to undergo further psychiatric evaluation. SUA was measured using uricase-PAP method. The French translation of the semi-structured Diagnostic Interview for Genetic Studies was used to establish lifetime and current diagnoses of depression and anxiety disorders according to the DSM-IV criteria. RESULTS Men reported significantly higher levels of SUA compared to women (357±74 µmol/L vs. 263±64 µmol/L). The prevalence of lifetime and current MDD was 44% and 18% respectively while the corresponding estimates for any anxiety disorders were 18% and 10% respectively. A quadratic hockey-stick shaped curve explained the relationship between SUA and social phobia better than a linear trend. However, with regards to the other specific anxiety disorders and other subtypes of MDD, there was no consistent pattern of association. Further analyses using SLC2A9 rs6855911 variant, known to be strongly associated with SUA, supported the quadratic relationship observed between SUA phenotype and social phobia. CONCLUSIONS A quadratic relationship between SUA and social phobia was observed consistent with a protective effect of moderately elevated SUA on social phobia, which disappears at higher concentrations. Further studies are needed to confirm our observations.
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Affiliation(s)
- Tanica Lyngdoh
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Murielle Bochud
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
- * E-mail:
| | | | | | - Gerard Waeber
- Department of Medicine, Internal Medicine, CHUV and Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, CHUV and Faculty of Biology and Medicine, Lausanne, Switzerland
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Lyngdoh T, Viswanathan B, van Wijngaarden E, Myers GJ, Bovet P. Cross-Sectional and Longitudinal Associations between Body Mass Index and Cardiometabolic Risk Factors in Adolescents in a Country of the African Region. Int J Endocrinol 2013; 2013:801832. [PMID: 24062771 PMCID: PMC3766579 DOI: 10.1155/2013/801832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 07/21/2013] [Accepted: 07/22/2013] [Indexed: 01/02/2023] Open
Abstract
We assessed the association between several cardiometabolic risk factors (CRFs) (blood pressure, LDL-cholesterol, HDL-cholesterol, triglycerides, uric acid, and glucose) in 390 young adults aged 19-20 years in Seychelles (Indian Ocean, Africa) and body mass index (BMI) measured either at the same time (cross-sectional analysis) or at the age of 12-15 years (longitudinal analysis). BMI tracked markedly between age of 12-15 and age of 19-20. BMI was strongly associated with all considered CRFs in both cross-sectional and longitudinal analyses, with some exceptions. Comparing overweight participants with those having a BMI below the age-specific median, the odds ratios for high blood pressure were 5.4/4.7 (male/female) cross-sectionally and 2.5/3.9 longitudinally (P < 0.05). Significant associations were also found for most other CRFs, with some exceptions. In linear regression analysis including both BMI at age of 12-15 and BMI at age of 19-20, only BMI at age of 19-20 remained significantly associated with most CRFs. We conclude that CRFs are predicted strongly by either current or past BMI levels in adolescents and young adults in this population. The observation that only current BMI remained associated with CRFs when including past and current levels together suggests that weight control at a later age may be effective in reducing CRFs in overweight children irrespective of past weight status.
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Affiliation(s)
- Tanica Lyngdoh
- Institute of Social and Preventive Medicine, Lausanne University Hospital, CH-1010 Lausanne, Switzerland
| | | | - Edwin van Wijngaarden
- Department of Community and Preventive Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Gary J. Myers
- Departments of Neurology, Pediatrics, and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, CH-1010 Lausanne, Switzerland
- Section of Noncommunicable Diseases, Ministry of Health, Victoria, Seychelles
- *Pascal Bovet:
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Lyngdoh T, Vuistiner P, Marques-Vidal P, Rousson V, Waeber G, Vollenweider P, Bochud M. Serum uric acid and adiposity: deciphering causality using a bidirectional Mendelian randomization approach. PLoS One 2012; 7:e39321. [PMID: 22723994 PMCID: PMC3378571 DOI: 10.1371/journal.pone.0039321] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 05/19/2012] [Indexed: 11/26/2022] Open
Abstract
Background Although the relationship between serum uric acid (SUA) and adiposity is well established, the direction of the causality is still unclear in the presence of conflicting evidences. We used a bidirectional Mendelian randomization approach to explore the nature and direction of causality between SUA and adiposity in a population-based study of Caucasians aged 35 to 75 years. Methods and Findings We used, as instrumental variables, rs6855911 within the SUA gene SLC2A9 in one direction, and combinations of SNPs within the adiposity genes FTO, MC4R and TMEM18 in the other direction. Adiposity markers included weight, body mass index, waist circumference and fat mass. We applied a two-stage least squares regression: a regression of SUA/adiposity markers on our instruments in the first stage and a regression of the response of interest on the fitted values from the first stage regression in the second stage. SUA explained by the SLC2A9 instrument was not associated to fat mass (regression coefficient [95% confidence interval]: 0.05 [−0.10, 0.19] for fat mass) contrasting with the ordinary least square estimate (0.37 [0.34, 0.40]). By contrast, fat mass explained by genetic variants of the FTO, MC4R and TMEM18 genes was positively and significantly associated to SUA (0.31 [0.01, 0.62]), similar to the ordinary least square estimate (0.27 [0.25, 0.29]). Results were similar for the other adiposity markers. Conclusions Using a bidirectional Mendelian randomization approach in adult Caucasians, our findings suggest that elevated SUA is a consequence rather than a cause of adiposity.
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Affiliation(s)
- Tanica Lyngdoh
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Philippe Vuistiner
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Valentin Rousson
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Gérard Waeber
- Department of Medicine, Internal Medicine, CHUV, Lausanne, Switzerland
| | | | - Murielle Bochud
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
- * E-mail:
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Kinra S, Andersen E, Ben-Shlomo Y, Bowen L, Lyngdoh T, Prabhakaran D, Reddy KS, Ramakrishnan L, Bharathi A, Vaz M, Kurpad A, Smith GD, Ebrahim S. Association between urban life-years and cardiometabolic risk: the Indian migration study. Am J Epidemiol 2011; 174:154-64. [PMID: 21622949 PMCID: PMC3132275 DOI: 10.1093/aje/kwr053] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 02/11/2011] [Indexed: 01/26/2023] Open
Abstract
Urban living is associated with an increase in cardiometabolic risks, but the speed at which these risks are accrued over time is unknown. Using a cross-sectional sibling-pair design, the authors surveyed migrant factory workers and their spouses from 4 cities in India together with their rural-dwelling siblings and examined the associations between urban life-years and cardiometabolic risk factors. Data on 4,221 participants (39% women; mean age = 41 years) were available (2005-2007). In regression models, a 2-slope pattern for body fat (with a marked shift at 10 years) was found, whereas a common slope could be accepted for other risk factors. In men, the regression coefficients (per decade of urban life) were 2.5% in the first decade and 0.1% thereafter for body fat; 1.4 mm Hg for systolic blood pressure; and 7% for fasting insulin. Age, gender, marital status, household structure, and occupation did not influence the patterns appreciably; however, stronger gradients for adiposity were noted in migrants from lower socioeconomic positions. The findings suggest that body fat increases rapidly when one first moves to an urban environment, whereas other cardiometabolic risk factors evolve gradually. Public health interventions focused on the control of obesity in newer migrants to urban areas, particularly those from lower socioeconomic positions, may be beneficial.
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Affiliation(s)
- Sanjay Kinra
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
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Kinra S, Bowen LJ, Lyngdoh T, Prabhakaran D, Reddy KS, Ramakrishnan L, Gupta R, Bharathi AV, Vaz M, Kurpad AV, Smith GD, Ben-Shlomo Y, Ebrahim S. Sociodemographic patterning of non-communicable disease risk factors in rural India: a cross sectional study. BMJ 2010; 341:c4974. [PMID: 20876148 PMCID: PMC2946988 DOI: 10.1136/bmj.c4974] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2010] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To investigate the sociodemographic patterning of non-communicable disease risk factors in rural India. DESIGN Cross sectional study. SETTING About 1600 villages from 18 states in India. Most were from four large states due to a convenience sampling strategy. PARTICIPANTS 1983 (31% women) people aged 20-69 years (49% response rate). MAIN OUTCOME MEASURES Prevalence of tobacco use, alcohol use, low fruit and vegetable intake, low physical activity, obesity, central adiposity, hypertension, dyslipidaemia, diabetes, and underweight. RESULTS Prevalence of most risk factors increased with age. Tobacco and alcohol use, low intake of fruit and vegetables, and underweight were more common in lower socioeconomic positions; whereas obesity, dyslipidaemia, and diabetes (men only) and hypertension (women only) were more prevalent in higher socioeconomic positions. For example, 37% (95% CI 30% to 44%) of men smoked tobacco in the lowest socioeconomic group compared with 15% (12% to 17%) in the highest, while 35% (30% to 40%) of women in the highest socioeconomic group were obese compared with 13% (7% to 19%) in the lowest. The age standardised prevalence of some risk factors was: tobacco use (40% (37% to 42%) men, 4% (3% to 6%) women); low fruit and vegetable intake (69% (66% to 71%) men, 75% (71% to 78%) women); obesity (19% (17% to 21%) men, 28% (24% to 31%) women); dyslipidaemia (33% (31% to 36%) men, 35% (31% to 38%) women); hypertension (20% (18% to 22%) men, 22% (19% to 25%) women); diabetes (6% (5% to 7%) men, 5% (4% to 7%) women); and underweight (21% (19% to 23%) men, 18% (15% to 21%) women). Risk factors were generally more prevalent in south Indians compared with north Indians. For example, the prevalence of dyslipidaemia was 21% (17% to 33%) in north Indian men compared with 33% (29% to 38%) in south Indian men, while the prevalence of obesity was 13% (9% to 17%) in north Indian women compared with 24% (19% to 30%) in south Indian women. CONCLUSIONS The prevalence of most risk factors was generally high across a range of sociodemographic groups in this sample of rural villagers in India; in particular, the prevalence of tobacco use in men and obesity in women was striking. However, given the limitations of the study (convenience sampling design and low response rate), cautious interpretation of the results is warranted. These data highlight the need for careful monitoring and control of non-communicable disease risk factors in rural areas of India.
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Affiliation(s)
- Sanjay Kinra
- Non-communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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Ebrahim S, Kinra S, Bowen L, Andersen E, Ben-Shlomo Y, Lyngdoh T, Ramakrishnan L, Ahuja RC, Joshi P, Das SM, Mohan M, Davey Smith G, Prabhakaran D, Reddy KS. The effect of rural-to-urban migration on obesity and diabetes in India: a cross-sectional study. PLoS Med 2010; 7:e1000268. [PMID: 20436961 PMCID: PMC2860494 DOI: 10.1371/journal.pmed.1000268] [Citation(s) in RCA: 212] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 03/18/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Migration from rural areas of India contributes to urbanisation and may increase the risk of obesity and diabetes. We tested the hypotheses that rural-to-urban migrants have a higher prevalence of obesity and diabetes than rural nonmigrants, that migrants would have an intermediate prevalence of obesity and diabetes compared with life-long urban and rural dwellers, and that longer time since migration would be associated with a higher prevalence of obesity and of diabetes. METHODS AND FINDINGS The place of origin of people working in factories in north, central, and south India was identified. Migrants of rural origin, their rural dwelling sibs, and those of urban origin together with their urban dwelling sibs were assessed by interview, examination, and fasting blood samples. Obesity, diabetes, and other cardiovascular risk factors were compared. A total of 6,510 participants (42% women) were recruited. Among urban, migrant, and rural men the age- and factory-adjusted percentages classified as obese (body mass index [BMI] >25 kg/m(2)) were 41.9% (95% confidence interval [CI] 39.1-44.7), 37.8% (95% CI 35.0-40.6), and 19.0% (95% CI 17.0-21.0), respectively, and as diabetic were 13.5% (95% CI 11.6-15.4), 14.3% (95% CI 12.2-16.4), and 6.2% (95% CI 5.0-7.4), respectively. Findings for women showed similar patterns. Rural men had lower blood pressure, lipids, and fasting blood glucose than urban and migrant men, whereas no differences were seen in women. Among migrant men, but not women, there was weak evidence for a lower prevalence of both diabetes and obesity among more recent (=10 y) migrants. CONCLUSIONS Migration into urban areas is associated with increases in obesity, which drive other risk factor changes. Migrants have adopted modes of life that put them at similar risk to the urban population. Gender differences in some risk factors by place of origin are unexpected and require further exploration. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Shah Ebrahim
- Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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Lyngdoh T, Kinra S, Shlomo YB, Reddy S, Prabhakaran D, Smith GD, Ebrahim S. Sib-recruitment for studying migration and its impact on obesity and diabetes. Emerg Themes Epidemiol 2006; 3:2. [PMID: 16533387 PMCID: PMC1468400 DOI: 10.1186/1742-7622-3-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2005] [Accepted: 03/13/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urban-rural comparisons are of limited relevance in examining the effects of urban migration in developing countries where urbanisation is due to growth of existing urban populations, expansion of urban boundaries, and rural in-migration. Cultural, genetic and life-style backgrounds of migrants and host populations further limit the value of rural-urban comparisons. Therefore we evaluated a sib-comparison design intended to overcome the limitations of urban-rural comparisons. METHODS Using the framework of a current cardiovascular risk factor screening study conducted in Indian factories, we recruited the non-migrant rural sibs of migrant urban factory workers and the urban sibs of non-migrant factory workers. The response rate, completed interviews and examinations conducted were assessed. Adequacy of generic food frequency questionnaires and WHO quality of life questionnaire were assessed. RESULTS All the urban factory workers and spouses approached agreed to be interviewed. Of the 697 participants interviewed, 293 (42%) had at least one rural dwelling sibling. Twenty (22%) siblings lived further than 100 km from the study site. An additional 21 urban siblings of non-migrant factory workers were also investigated to test the logistics of this element of the study. Obesity (BMI >25 kg/m2) was more common in rural sibs than urban factory workers (age adjusted prevalence: 21.1% (17.1 to 25.0) vs. 16.1% (11.9, 20.3). Diabetes prevalence (fasting plasma glucose greater than 126 mg/dl) was higher than expected (age-adjusted prevalence: 12.5% (22 out of 93) in urban migrants and 4.5% (8 out of 90) in rural non-migrant sibs. CONCLUSION The sib-comparison design is robust and has been adopted in the main study. It is possible that simple urban-rural study designs under-estimate the true differences in diabetes risk between migrants and non-migrants.
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Affiliation(s)
- Tanica Lyngdoh
- Centre for Chronic Disease Control, T-7, Green Park Extn, Delhi, 110 016, India
| | - Sanjay Kinra
- Department of Social Medicine, University of Bristol, Senate House, Tyndall Avenue, Bristol, UK
| | - Yoav Ben Shlomo
- Department of Social Medicine, University of Bristol, Senate House, Tyndall Avenue, Bristol, UK
| | - Srinath Reddy
- Centre for Chronic Disease Control, T-7, Green Park Extn, Delhi, 110 016, India
- All India Institute of Medical Sciences, Angari Nagar, Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, T-7, Green Park Extn, Delhi, 110 016, India
- All India Institute of Medical Sciences, Angari Nagar, Delhi, India
| | - George Davey Smith
- Department of Social Medicine, University of Bristol, Senate House, Tyndall Avenue, Bristol, UK
| | - Shah Ebrahim
- Department of Epidemiology & Population Health, Keppel St, London School of Hygiene & Tropical Medicine, London, UK
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