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Rakesh PS, Nair S, Kamala R, Manu MS, Mrithunjayan SK, Valamparampil MJ, Kutty VR, Sadanandan R. Local government stewardship for TB elimination in Kerala, India. Public Health Action 2023; 13:44-50. [PMID: 36949740 PMCID: PMC9983805 DOI: 10.5588/pha.22.0037] [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: 05/15/2022] [Accepted: 10/04/2022] [Indexed: 03/07/2023] Open
Abstract
SETTING The southern Indian state of Kerala has implemented 'Kerala Tuberculosis Elimination Mission' as 'People's Movement against TB' under the stewardship of local governments (LGs). The state has been certified by the Government of India for being on track to attain the UN Sustainable Development Goals related to TB elimination. OBJECTIVE To document the role of LG stewardship in the successful implementation of the TB elimination activities in Kerala. DESIGN 1) Key informant interviews with four state officials, 2) desk review of available documents, 3) in-depth interviews with seven LG leaders, three mid-level programme managers and three health department field staff. RESULTS LG involvement led to the establishment of solutions based on local problems, enhanced outreach of services to the socially vulnerable individuals, improved treatment support to patients with TB, increased community ownership of TB elimination activities, reduced TB-related stigma and social determinants being addressed. Institutional mechanisms such as LG TB elimination task forces, formal guidance in planning interventions and appreciation of their performance in the form of awards were facilitators for LG involvement. CONCLUSION LG stewardship can accelerate TB elimination. A good plan for engagement and institutional mechanisms are crucial for LG involvement.
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Affiliation(s)
- P S Rakesh
- WHO Technical Support Network, State TB Cell, Thiruvananthapuram, India
| | - S Nair
- Department of Pulmonary Medicine, Government Medical College, Thrissur, India
- Decentralisation Study Group, Health Action by People, Thiruvananthapuram, India
| | - R Kamala
- Decentralisation Study Group, Health Action by People, Thiruvananthapuram, India
- Department of Pulmonary Medicine, Government Medical College, Thiruvananthapuram, India
| | - M S Manu
- Decentralisation Study Group, Health Action by People, Thiruvananthapuram, India
- Directorate of Health Services, State TB Cell, Thiruvananthapuram, India
| | - S K Mrithunjayan
- Decentralisation Study Group, Health Action by People, Thiruvananthapuram, India
- Directorate of Health Services, State TB Cell, Thiruvananthapuram, India
| | - M J Valamparampil
- Decentralisation Study Group, Health Action by People, Thiruvananthapuram, India
- Directorate of Health Services, State TB Cell, Thiruvananthapuram, India
| | - V Raman Kutty
- Decentralisation Study Group, Health Action by People, Thiruvananthapuram, India
| | - R Sadanandan
- Health Systems Transformation Platform, New Delhi, India
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Kochuvilayil A, Rajalakshmi S, Krishnan A, Vijayanand SM, Kutty VR, Iype T, Varma RP. Palliative care management committees: a model of collaborative governance for primary health care. Public Health Action 2023; 13:12-18. [PMID: 36949744 PMCID: PMC9983804 DOI: 10.5588/pha.22.0028] [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: 05/02/2022] [Accepted: 08/11/2022] [Indexed: 03/07/2023] Open
Abstract
SETTING The community-based primary palliative care programme in Kerala, India, has received international acclaim. Programme functioning is supported through Palliative Care Management Committees (PMCs) at the local government (LG) level. OBJECTIVE To study the functioning of the PMCs within the decentralised governance space to identify achievements, gaps and notable innovations. DESIGN This qualitative study included seven key informant interviews (KIIs), 28 in-depth interviews and a review of relevant publicly available policies and documents. Major themes were recognised from the KII transcripts. Codes emerging from the document review and in-depth interview transcripts were mapped into the identified thematic areas. RESULTS Successful PMCs raised resources like money, human resource, equipment, had good skilled care options for symptom relief and facilitated reduced out-of-pocket expenditure by providing home care and free medicines, and improved access to interventions that addressed the social determinants of suffering like poverty. PMCs had varying managerial and technical capacities. In some LGs, the programme was weak and mostly limited to the supply of medicines, basic aids and appliances to patients' homes. CONCLUSION Despite varied implementation patterns, PMCs in Kerala are examples of state-supported, community-owned care initiatives, that can potentially address medical and social determinants of suffering.
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Affiliation(s)
| | - S Rajalakshmi
- Centre for Health Research and Innovation, New Delhi, India
| | - A Krishnan
- State Health Systems Resource Centre - Kerala, Thiruvananthapuram, India
| | | | - V R Kutty
- Health Action by People, Thiruvananthapuram, India
| | - T Iype
- Health Action by People, Thiruvananthapuram, India
- Department of Neurology, Government Medical College, Thiruvananthapuram, India
| | - R P Varma
- Health Action by People, Thiruvananthapuram, India
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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Anju R, Sadanandan R, Vijayakumar K, Raman Kutty V, Soman B, Ravindran RM, Varma RP. Decentralisation, health and Sustainable Development Goal 3. Public Health Action 2023; 13:51-56. [PMID: 36949743 PMCID: PMC9983807 DOI: 10.5588/pha.22.0034] [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: 05/07/2022] [Accepted: 10/25/2022] [Indexed: 03/06/2023] Open
Abstract
SETTING Kerala State, India, implemented decentralising reforms of healthcare institutions 25 years ago through transfer of administrative control and a sizeable share of the financial allocation. OBJECTIVE To describe the main impacts of decentralisation in Kerala on local policy formulation, programme implementation and service delivery for sustainable health systems. DESIGN This was part of a broader qualitative study on decentralisation and health in Kerala. We conducted 25 in-depth interviews and reviewed 31 government orders or policy documents, five related transcripts and five thematic reports from the main study. RESULTS Liaising between health system and local governments has improved over time. A shift from welfare-centric projects to infrastructure, human resources and services was evident. Considerable heterogeneity existed due to varying degrees of involvement, capacity, resources and needs of the community. State-level discourse and recent augmentation efforts for moving towards the UN Sustainable Development Goals (SDGs) strongly uphold the role of local governments in planning, financing and implementation. CONCLUSION The 25-year history of decentralised healthcare administration in Kerala indicates both successes and failures. Central support without disempowering the local governments can be a viable option to allow flexible decision-making consistent with broader system goals.
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Affiliation(s)
- R Anju
- Health Action by People, Thiruvananthapuram, India
| | - R Sadanandan
- Health Systems Transformation Platform, New Delhi, India
| | | | | | - B Soman
- Health Action by People, Thiruvananthapuram, India
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - R M Ravindran
- Health Action by People, Thiruvananthapuram, India
- State Health Systems Resource Centre-Kerala, Thiruvananthapuram, India
| | - R P Varma
- Health Action by People, Thiruvananthapuram, India
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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Jose P, Kumar SS, Chandru BA, Sundaram S, Vijayanand SM, Kutty VR, Varma RP. Local governments and community-based rehabilitation for developmental disabilities: leaving no one behind. Public Health Action 2023; 13:37-43. [PMID: 36949741 PMCID: PMC9983811 DOI: 10.5588/pha.22.0027] [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: 05/02/2022] [Accepted: 09/21/2022] [Indexed: 03/06/2023] Open
Abstract
SETTING The BUDS (not an acronym) institutions comprise a community-based rehabilitation initiative for children and families affected by developmental disabilities in Kerala, India. OBJECTIVE To explore the role of local governments in the establishment and functioning of BUDS institutions. DESIGN We used qualitative approaches comprising document review and in-depth interviews with trainers, parents of children with developmental disabilities and elected representatives. RESULTS BUDS was created by Kudumbasree, a decentralised women empowerment and poverty alleviation initiative. Our findings illustrate the role of local governments in facilitating expansion through the establishment of infrastructure, therapy equipment, transportation and financial allocation for these, as well as through the development of human resources, assistance with enrolment for financial assistance and insurance programmes, and coordination with education and health sectors. Programme implementation varied considerably regarding available infrastructure, staffing and services among the institutions studied. The institutions were physically closed during the COVID-19 pandemic but continued to function in alternative ways. CONCLUSION Despite variable implementation, local governments have supported the expansion of BUDS institutions, thereby creating more spaces for inclusive and integrated education and rehabilitation of persons with disabilities in Kerala. The expansion over the past two decades and measures during the COVID-19 pandemic suggest resilience and sustainability of the model.
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Affiliation(s)
- P Jose
- Health Action by People, Thiruvananthapuram, India
| | - S S Kumar
- Prajaahita Foundation, Kozhikode, India
| | - B A Chandru
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - S Sundaram
- Comprehensive Care Centre for Neurodevelopmental Disorders, Department of Neurology, SCTIMST, Thiruvananthapuram, India
| | | | - V R Kutty
- Health Action by People, Thiruvananthapuram, India
| | - R P Varma
- Health Action by People, Thiruvananthapuram, India
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
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Suresh N, Kutty VR, Kumar KN, Sarma PS, Vijayan AA, Aljuaid M, Shahid D, Thankappan KR. Effectiveness of an oral health education intervention among 6-12-year-old children: A cluster randomized controlled trial. Community Dent Health 2023. [PMID: 36853187 DOI: 10.1922/cdh_00164suresh06] [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] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/03/2022] [Indexed: 03/01/2023]
Abstract
OBJECTIVES Literature on the effectiveness of theory-based oral health education on the oral hygiene of children is limited. We aimed to determine the effectiveness of an health behaviour theory-based school oral health education intervention on 1) oral hygiene and 2) oral health-related knowledge, attitude and practices among 6-12-year-old children in Kerala, India. METHODS Cluster randomized controlled trial. Sixteen class divisions (clusters) were randomized into intervention and control groups of 225 and 228 children respectively. Primary and secondary outcomes were plaque score as measured using the simplified oral hygiene index (OHI-S) and oral health-related knowledge, attitude and practices respectively. The intervention group received structured oral health education classes for three months and materials including pamphlets. Children in the control group were not given the classes or materials. RESULTS Post-intervention OHI-S scores in the intervention group and control groups were 1.65 and 2.17 respectively (difference = -0.52, 95%CI -0.86, -0.18). All the secondary outcomes improved in the intervention group compared to the control group. CONCLUSIONS The intervention improved the oral hygiene status, oral health-related knowledge, attitude and practices of the children. Longer term follow-up and economic appraisal are needed to help policymakers plan and develop OHEI based on health behaviour theories.
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Affiliation(s)
- N Suresh
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - V R Kutty
- Research Director, Amala Research Centre, India
| | - K N Kumar
- Dental Public Health, Azeezia Dental College, India
| | - P S Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - A A Vijayan
- Dentistry, Mount Zion Medical College, India
| | - M Aljuaid
- Health Administration, College of Business Administration, Saudi Arabia
| | - D Shahid
- Master program, Hult International Business School, USA
| | - K R Thankappan
- Public Health and Community Medicine, Central University of Kerala, India
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Shani S, Varma RP, Sarma SP, Sreelakshmi R, Harikrishnan R, Kutty VR, Sylaja P. Treatment in stroke unit and risk factor control reduce recurrent stroke risk. Cerebrovasc Dis Extra 2022; 12:85-92. [PMID: 35793651 PMCID: PMC9574205 DOI: 10.1159/000525716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/13/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Risk factor control is an important predictor of risk of stroke recurrence. The attributable fraction which estimates the excess risk among the exposed stroke survivors has not been studied previously. We studied the attributable fraction for stroke recurrence in consecutive incident cases of recurrent stroke. Methods A case-control study with incident cases of recurrent stroke and controls matched for age and poststroke period was done. A structured interview was done to collect data on sociodemographic variables, lifestyle, and medication adherence. The risk factors, treatment of index stroke, and outcome were collected. Logistic regression analysis was done to find out the factors associated with stroke recurrence. Attributable fraction and average attributable fraction were calculated. Results Among the 103 matched pairs, more than 70% were rural residents. Male gender (OR 2.59; 95% CI 1.05–6.42), the presence of depression (OR 8.67; 95% CI 2.80–26.84), memory problem (OR 10.12; 95% CI 2.48–41.34), uncontrolled diabetes (OR 3.19; 95% CI 1.42–7.19), cardioembolic stroke (OR 4.45; 95% CI 1.12–17.62), and index stroke not being treated in a stroke unit (OR 6.60; 95% CI 2.86–15.23) were associated with increased risk of stroke recurrence. The maximum average attributable fraction for stroke recurrence risk was attributed to index stroke not being treated in the stroke unit and uncontrolled diabetes. Conclusion The index stroke treated in a comprehensive stroke care unit and control of risk factors can reduce recurrent stroke risk among stroke survivors. This population-attributable risk is important in planning secondary stroke prevention strategies.
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Affiliation(s)
- S.D. Shani
- Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - Ravi Prasad Varma
- Achutha Menon Centre for Health Sciences Studies (AMCHSS), SCTIMST, Thiruvananthapuram, India
| | - Sankara P. Sarma
- Department of Biostatistics, AMCHSS, SCTIMST, Thiruvananthapuram, India
| | | | | | | | - P.N. Sylaja
- Department of Neurology, SCTIMST, Thiruvananthapuram, India
- *P.N. Sylaja,
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Sreelakshmi PR, Iype T, Varma R, Moloney S, Babu V, Krishnapilla V, Kutty VR, Robinson L. Exploring the barriers for guideline-based management of dementia amongst consultants in Kerala, South India: A qualitative study. Indian J Med Res 2022; 155:311-314. [PMID: 35946210 PMCID: PMC9629520 DOI: 10.4103/ijmr.ijmr_3_20] [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: 11/04/2022] Open
Affiliation(s)
- P Raghunath Sreelakshmi
- Department of Community Medicine, SUT Academy of Medical Sciences, Vattappara, Thiruvananthapuram 695 028, Kerala, India
| | - Thomas Iype
- Department of Neurology, Government Medical College, Thiruvananthapuram 695 011, Kerala, India
| | - Raviprasad Varma
- Department of Public Health, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram 695 011, Kerala, India
| | - Susan Moloney
- NIHR Global Health Research Group on Dementia Prevention & Enhanced Care, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE4 5PL, United Kingdom
| | - Veena Babu
- Health Action by People, Thiruvananthapuram 695 011, Kerala, India
| | - Vijayakumar Krishnapilla
- Department of Community Medicine, Amrita Institute of Medical Sciences, Edappally, Kochi 682 041, Kerala, India
| | - V Raman Kutty
- Department of Public Health, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences & Technology; Health Action by People, Thiruvananthapuram 695 011, Kerala, India
| | - Louise Robinson
- Department of Primary Care & Ageing, Population Health Sciences Institute, Newcastle University Institute for Ageing, Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom
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Thulaseedharan JV, Sarma PS, Thankappan KR, Soman B, Varma RP, Srinivasan K, Nair MR, Jeemon P, Kutty VR. Consumption of fruits, vegetables and salt in the context of control of type 2 diabetes and hypertension in Kerala, India. J Family Med Prim Care 2021; 10:2646-2654. [PMID: 34568150 PMCID: PMC8415664 DOI: 10.4103/jfmpc.jfmpc_2469_20] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/21/2021] [Accepted: 04/09/2021] [Indexed: 11/04/2022] Open
Abstract
Background Proper diet is necessary to control hypertension and diabetes. This paper describes the combined fruit and vegetable, and salt intake of adults (>=18 years) who were detected to have hypertension or diabetes. Methods We analysed the data from a state-wide survey of 12012 adults using the World Health Organization STEPs for NCD risk factor surveillance. We evaluated the recommended intake of fruit and vegetable (>=5 servings/day) and salt (<5 gm/day) across participants divided into four strata, and the probabilities were also estimated using the fitted multiple binary logistic regression models. Results Overall, 13.9% (95%CI: 12.2%-15.9%) and 29.4% (95%CI: 28%-30.8%) of participants consumed the recommended level of fruit and vegetable, and salt, respectively. Adjusted odds ratios were not significantly different across the four strata based on the status of treatment and control of diabetes or hypertension. The likelihood of following the recommended fruit and vegetable intake was highest for 50-69-year-old females with above high school education, obese, under treatment for diabetes or hypertension, and had normal values of FBS and BP (0.28). The likelihood for recommended salt intake was highest for 50-69-year-old males with above high school education and had normal BMI, under treatment for diabetes or hypertension, and had normal values of FBS and BP (0.69). Conclusion The status of diabetes or hypertension did not show considerable influence in the fruit, vegetable, and salt intake of adults in general. A detailed exploration of the accessibility and acceptability of such recommended intakes in the Kerala context is warranted.
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Affiliation(s)
- Jissa V Thulaseedharan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Kavumpurath R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.,Department of Public Health and Community Medicine, School of Medicine and Public Health (SMPH), Central University of Kerala, Kasaragod, India
| | - Biju Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ravi P Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Kannan Srinivasan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Manju R Nair
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Panniyammakkal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - V Raman Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Shani SD, Sylaja PN, Sankara Sarma P, Raman Kutty V. Facilitators and barriers to medication adherence among stroke survivors in India. J Clin Neurosci 2021; 88:185-190. [PMID: 33992182 DOI: 10.1016/j.jocn.2021.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/20/2020] [Revised: 02/21/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
Strict compliance with medication and life style modification are integral to secondary stroke prevention. This study was undertaken to find out medication adherence among stroke survivors and factors associated with it. Cross sectional survey among stroke survivors was conducted. Interview based self-reported medication adherence was defined as consumption at least >80% of their medications for last two weeks, based on last prescription. Structured interview using pretested interview schedule was done to collect other data. Sequential step wise logistic regression analysis was done to find out the facilitators and barriers to medication adherence. Two hundred and forty stroke survivors (mean age 58.64 ± 10.96 years; 25.4% females) with a mean post-stroke period of 6.65 ± 3.36 months were participated. Overall medication adherence was 43.8% (n = 105). Medication adherence was 34.3% (n = 134), 52.6% (n = 190) and 56.7% (n = 224) for antidiabetics, antihypertensives and statins respectively and was associated with risk factor control (Diabetes: Odds Ratio (OR) = 4.85; 95% Confidence Interval (CI) 2.12-11.08, Hypertension: OR = 3.42; 95% CI 1.83-6.4, Dyslipidaemia: OR = 3.88; 95% CI 1.96-4.04). Having daily routine (OR = 2.82; 95% CI 1.52-5.25), perceived need of medication (OR = 2.33; 95% CI 1.04-5.2) and perceived poor state of health (OR = 2.65; 95% CI 1.30-5.40) were facilitators. Memory issues (OR = 0.34; 95% CI 0.16-0.71), side effects (OR = 0.24; 95% CI 0.11-0.42) and financial constraints (OR = 0.46; 95% CI 0.24-0.91) were barriers to medication adherence. Establishing daily routines, periodic reminders, financial supports to buy medicines and patient education can enhance medication adherence to prevent future strokes.
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Affiliation(s)
- S D Shani
- Achutha Menon Centre for Health Sciences Studies (AMCHSS), Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala 695 011, India.
| | - P Sankara Sarma
- Achutha Menon Centre for Health Sciences Studies (AMCHSS), Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - V Raman Kutty
- Research Director, Amala Cancer Research Centre, Thrissur 680555, India
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Shani SD, Varma RP, Sarma PS, Sylaja PN, Kutty VR. Life Style and Behavioural Factors are Associated with Stroke Recurrence Among Survivors of First Episode of Stroke: A Case Control Study. J Stroke Cerebrovasc Dis 2021; 30:105606. [PMID: 33548808 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/12/2020] [Revised: 12/04/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Secondary stroke prevention treatment is associated with an 80% reduction in risk of recurrent stroke. But one out of every four strokes are recurrent. Adherence to pharmacological therapy and strict control of risk factors are essential for prevention of recurrent strokes. METHODS Pair matched incident case control study was done to find out the factors associated with stroke recurrence after first ever stroke. Incident cases of recurrent strokes and age and post stroke period matched controls were recruited prospectively. The estimated sample size for the study was 70 matched pairs. Data collected from medical records and by visiting their homes. Analysis was done using R statistical software. RESULTS Bivariate analysis showed cardio embolic stroke subtype, poor lipid control, unhealthy diet, physical inactivity, medication nonadherence, presence of depression, memory problems no discharge advice at index admission and low income were associated increased risk of recurrence. Higher mean NIHSS score and a greater number of days of hospitalisation during index stroke had less risk of recurrence. Conditional logistic regression analysis revealed non adherence to medication (OR 7.46, 1.67-33.28) and not receiving discharge advice at index admission (OR 10.79, 2.38-49.02) were associated with increased risk of recurrence whereas lacunar stroke (OR 0.08, 0.01-0.59) and a greater number of days of hospitalization during index stroke (OR 0.82, 0.67-0.99) were associated with less risk of recurrence. CONCLUSION Individualised patient education regarding stroke, recurrence risk, medication adherence, healthy lifestyle and risk factor control can reduce stroke recurrence risk.
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Affiliation(s)
- S D Shani
- Achutha Menon Centre for Health Sciences Studies (AMCHSS), Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - R P Varma
- Achutha Menon Centre for Health Sciences Studies (AMCHSS), Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - P S Sarma
- Achutha Menon Centre for Health Sciences Studies (AMCHSS), Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram 695 011, Kerala, India.
| | - V Raman Kutty
- Ex- Professor, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Honorary Chairman, Health Action by People, Trivandrum 695011 INDIA
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Valson JS, Kutty VR, Soman B, Jissa VT. Using open-source data to explore distribution of built environment characteristics across Kerala, India. Indian J Public Health 2020; 64:191-197. [PMID: 32584304 DOI: 10.4103/ijph.ijph_472_19] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Built environment characteristics in the neighborhood are of utmost priority for a healthy lifestyle in the fast-urbanizing countries. These characteristics are closely linked to the disease burden and challenges in low- and middle-income countries (LMICs), which have been unexplored using open-source data. The present technology offers online resources and open source software that enable researchers to explore built environment characteristics with health and allied phenomena. Objectives This article intends to delineate methods to capture available and accessible objective built environment variables for a state in India and determine their distribution across the state. Methods Built environment variables such as population density and residential density were collated from the Census of India. Safety from crime and traffic were captured as crime rates and pedestrian accident rates, respectively, acquired from State Crime Records Bureau. Greenness, built-up density, and land slope were gathered from open-source satellite imagery repository. Road intersection density was derived from OpenStreetMap. Processing and analysis differed for each dataset depending on its source and nature. Results Each variable showed a distinct pattern across the state. Population and residential density were found to be closely related to each other across both districts and subdistricts. They were both positively related to crime rates, pedestrian accident rates, built-up density, and intersection density, whereas negatively related to land slope and greenness across the subdistricts. Conclusion Delineating the distribution of built environment variables using available and open-source data in resource-poor settings is a first in public health research among LMICs. Cost-effectiveness and reproducible nature of open-source solutions could equip researchers in resource-poor settings to identify built environment characteristics and patterns across regions.
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Affiliation(s)
- Joanna Sara Valson
- PhD Scholar, Achutha Menon Centre for Health Science Studies, SCTIMST, Thiruvananthapuram, Kerala, India
| | - V Raman Kutty
- Professor, Achutha Menon Centre for Health Science Studies, SCTIMST, Thiruvananthapuram, Kerala, India
| | - Biju Soman
- Professor, Achutha Menon Centre for Health Science Studies, SCTIMST, Thiruvananthapuram, Kerala, India
| | - V T Jissa
- Scientist B, Achutha Menon Centre for Health Science Studies, SCTIMST, Thiruvananthapuram, Kerala, India
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Garg S, Kutty VR. The ethical responsibility of healthcare providers to advise patients with diabetes on lifestyle modifications. Indian J Med Ethics 2020; V:124-127. [PMID: 32393460 DOI: 10.20529/ijme.2020.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is clear evidence of a link between health and physical activity (PA). PA is universally prescribed as a primary treatment for most chronic diseases. However, studies show that not many health professionals advise patients about PA. The current study examines how a cost-effective tool to improve population health has been completely neglected in professional practice in a state with maximum healthcare availability. Is this malfeasance in practice or a violation of human rights? Are healthcare providers exempted from their responsibilities because they choose to neglect them? Who should be held responsible for the increasing disease-related deaths that are easily preventable? Keywords: physical activity, inactivity, advice, low- and middle-income country, health professionals, providers, chronic disease, diabetes, lifestyle modification, counselling.
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Affiliation(s)
- Shalini Garg
- Sr Doctoral Fellow, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 650 119, INDIA
| | - V Raman Kutty
- Professor Emeritus, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal institute for Medical Science and Technology, Thiruvananthapuram, 650 119 INDIA
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13
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Valson JS, Kutty VR, Soman B, Jissa VT. Spatial Clusters of Diabetes and Physical Inactivity: Do Neighborhood Characteristics in High and Low Clusters Differ? Asia Pac J Public Health 2019; 31:612-621. [PMID: 31602998 DOI: 10.1177/1010539519879322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/15/2022]
Abstract
This study aims to find spatial clusters of diabetes and physical inactivity among a sample population in Kerala, India, and evaluate built environment characteristics within the high and low spatial clusters. Spatial clusters with a higher and lower likelihood of diabetes and physical inactivity were identified using spatial scan statistic at various radii. Built environment characteristics were captured at panchayat level and 1600 m buffer around participant location using Geographical Information Systems. Comparison of sociodemographic and built environment factors was carried out for participants within high and low spatial clusters using t tests. Ten high and 8 low spatial clusters of diabetes and 17 high and 23 low spatial clusters of physical inactivity were identified in urban and rural areas of Kerala. Significant differences in built environment characteristics were consistent for low spatial clusters of diabetes and physical inactivity in the urban scenario. Built environment characteristics were found to be relevant in both urban and rural areas of Kerala. There is an urgent call to explore spatial clustering of non-communicable diseases in Kerala and undo the one-size-fits-all approach for prevention and control of non-communicable diseases.
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Affiliation(s)
- Joanna Sara Valson
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| | - V Raman Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| | - Biju Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| | - V T Jissa
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
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14
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Sankar UV, Kutty VR, Anand TN. Measuring childhood socioeconomic position in health research: Development and validation of childhood socioeconomic position questionnaire using mixed method approach. Health Promot Perspect 2019; 9:40-49. [PMID: 30788266 PMCID: PMC6377695 DOI: 10.15171/hpp.2019.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/12/2018] [Indexed: 12/31/2022] Open
Abstract
Background: There is no single best indicator to assess the childhood socioeconomic position (CSEP) in public health research. The aim of the study is to develop and validate a new questionnaire, with adequate psychometric properties, to measure the childhood SEP of the young adults. Methods: The first phase consisted of a qualitative phase to identify the variables to measure childhood SEP through the in-depth interviews among 15 young adults (18-45 years) of rural Kerala. The second phase was a quantitative phase to validate the questionnaire through a cross sectional survey among 200 young adults of Kerala. We did content validity, reliability tests and construct validity by using exploratory factor analysis of the questionnaire to demonstrate its psychometric properties. Results: The qualitative analysis reported 26 variables spread across 5 domains to measure the CSEP. Finally, the questionnaire has 11 questions with 3 domains named as value added through paternity, maternal occupation-related factors and parental education. The questionnaire has good reliability (Cronbach's α=0.88) also. Conclusion: We have developed a reliable and valid questionnaire to measure the childhood SEP of younger adults and can be used in various public health research.
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Affiliation(s)
- Uma Vadassery Sankar
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| | - V Raman Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| | - T N Anand
- Research Fellow, Health Action by People, Thiruvananathapuram, Kerala, India
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15
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Vijayakumar G, Manghat S, Vijayakumar R, Simon L, Scaria LM, Vijayakumar A, Sreehari GK, Kutty VR, Rachana A, Jaleel A. Incidence of type 2 diabetes mellitus and prediabetes in Kerala, India: results from a 10-year prospective cohort. BMC Public Health 2019; 19:140. [PMID: 30704495 PMCID: PMC6357479 DOI: 10.1186/s12889-019-6445-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 01/16/2019] [Indexed: 12/02/2022] Open
Abstract
Background Kerala, the southern state of India, has experienced sudden rise in the prevalence estimates of diabetes. A cohort study on the incidence of type 2 diabetes mellitus (T2DM) in Kerala state thus aptly bridges the lacuna of incidence estimate of T2DM from a population at risk. Methods A 10-year prospective cohort study was carried out in two urban wards of central Kerala. The individuals who participated in the baseline survey in 2007 were again invited for a follow-up study in 2017. The data was analyzed using IBM SPSS Statistics for windows (version 21.0). Logistic regression analysis was used to estimate odds ratios and 95% confidence intervals. Findings are based on the 10-year follow-up data from 869 participants from the cohort. Results The overall follow-up and response rate of the study was 68.9 and 86.9% respectively. During the follow-up period, 190 people (21.9%) developed T2DM. The incidence rate of T2DM and impaired fasting glucose (IFG) were 24.5 per 1000 person years and 45.01 per 1000 person years respectively. Nearly 60% of participants with baseline IFG were converted to T2DM group in the follow-up period. Age > 45 years, family history of T2DM, BMI ≥ 25 kg/m2 and presence of central obesity emerged as important risk factors for incident T2DM. Conclusion High incidence of prediabetes over diabetes observed in this study shows an epidemic trend of T2DM in Kerala, India. It requires an immediate public health action.
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Affiliation(s)
- Gadadharan Vijayakumar
- Medical Trust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta (district), Kerala, 689503, India
| | - Sreeja Manghat
- Medical Trust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta (district), Kerala, 689503, India
| | - Revathi Vijayakumar
- Medical Trust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta (district), Kerala, 689503, India
| | - Leena Simon
- Medical Trust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta (district), Kerala, 689503, India
| | - Liss Maria Scaria
- Medical Trust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta (district), Kerala, 689503, India
| | - Aswathi Vijayakumar
- Medical Trust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta (district), Kerala, 689503, India
| | - Ganapathy K Sreehari
- Medical Trust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta (district), Kerala, 689503, India
| | - V Raman Kutty
- Achutha Menon Centre, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Arun Rachana
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Abdul Jaleel
- Rajiv Gandhi Centre for Biotechnology, Thycaud post, Poojappura, Thiruvananthapuram, Kerala, 695014, India.
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16
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Valson JS, Kutty VR. Gender differences in the relationship between built environment and non-communicable diseases: A systematic review. J Public Health Res 2018; 7:1239. [PMID: 29780764 PMCID: PMC5941255 DOI: 10.4081/jphr.2018.1239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 04/13/2018] [Indexed: 01/03/2023] Open
Abstract
Non-communicable diseases are on the rise globally. Risk factors of non-communicable diseases continue to be a growing concern in both developed and developing countries. With significant rise in population and establishment of buildings, rapid changes have taken place in the built environment. Relationship between health and place, particularly with non-communicable diseases has been established in previous literature. This systematic review assesses the current evidence on influence of gender in the relationship between built environment and non-communicable diseases. A systematic literature search using PubMed was done to identify all studies that reported relationship between gender and built environment. All titles and abstracts were scrutinised to include only articles based on risk factors, prevention, treatment and outcome of non-communicable diseases. The Gender Analysis Matrix developed by the World Health Organization was used to describe the findings of gender differences. Sex differences, biological susceptibility, gender norms/ values, roles and activities related to gender and access to/control over resources were themes for the differences in the relationship. A total of 15 out of 214 articles met the inclusion criteria. Majority of the studies were on risk factors of non-communicable diseases, particularly cardiovascular diseases. Gender differences in physical access to recreational facilities, neighbourhood perceptions of safety and walkability have been documented. Men and women showed differential preferences to walking, engaging in physical activity and in perceiving safety of the neighbourhood. Girls and boys showed differences in play activities at school and in their own neighbourhood environment. Safety from crime and safety from traffic were also perceived important to engage in physical activity. Gender norms and gender roles and activities have shown basis for the differences in the prevalence of non-communicable diseases. Sparse evidence was found on how built environment affects health seeking behaviour, preventive options or experience with health providers. Though yet unexplored in the developing or low/middle income countries, there seems to be a major role in the gendered perception of how men and women are affected by noncommunicable diseases. Large gaps still exist in the research evidence on gender-based differences in non-communicable diseases and built environment relationship. Future research directions could bring out underpinnings of how perceived and objective built environment could largely affect the health behaviour of men and women across the globe. Significance for public health Tackling non-communicable diseases is a major hurdle for majority of the countries worldwide. Varied built environmental conditions and facilities bear differing influences on both men and women. Women in particular face difficulties more than men in access and control over resources to deal with non-communicable disease conditions. This paper tries to bring out the differences from published literature. Moreover, this paper has attempted to review articles which have delved beyond sex differences and included other axes. The Gender Analysis Matrix developed by WHO was incorporated in this paper to aid in categorising and delineating these differences. These results would be fundamental in further primary research and help in policy and planning of non-communicable diseases.
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Affiliation(s)
- Joanna Sara Valson
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - V Raman Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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17
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Miller V, Mente A, Dehghan M, Rangarajan S, Zhang X, Swaminathan S, Dagenais G, Gupta R, Mohan V, Lear S, Bangdiwala SI, Schutte AE, Wentzel-Viljoen E, Avezum A, Altuntas Y, Yusoff K, Ismail N, Peer N, Chifamba J, Diaz R, Rahman O, Mohammadifard N, Lana F, Zatonska K, Wielgosz A, Yusufali A, Iqbal R, Lopez-Jaramillo P, Khatib R, Rosengren A, Kutty VR, Li W, Liu J, Liu X, Yin L, Teo K, Anand S, Yusuf S. Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. Lancet 2017; 390:2037-2049. [PMID: 28864331 DOI: 10.1016/s0140-6736(17)32253-5] [Citation(s) in RCA: 345] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/25/2017] [Accepted: 08/01/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND The association between intake of fruits, vegetables, and legumes with cardiovascular disease and deaths has been investigated extensively in Europe, the USA, Japan, and China, but little or no data are available from the Middle East, South America, Africa, or south Asia. METHODS We did a prospective cohort study (Prospective Urban Rural Epidemiology [PURE] in 135 335 individuals aged 35 to 70 years without cardiovascular disease from 613 communities in 18 low-income, middle-income, and high-income countries in seven geographical regions: North America and Europe, South America, the Middle East, south Asia, China, southeast Asia, and Africa. We documented their diet using country-specific food frequency questionnaires at baseline. Standardised questionnaires were used to collect information about demographic factors, socioeconomic status (education, income, and employment), lifestyle (smoking, physical activity, and alcohol intake), health history and medication use, and family history of cardiovascular disease. The follow-up period varied based on the date when recruitment began at each site or country. The main clinical outcomes were major cardiovascular disease (defined as death from cardiovascular causes and non-fatal myocardial infarction, stroke, and heart failure), fatal and non-fatal myocardial infarction, fatal and non-fatal strokes, cardiovascular mortality, non-cardiovascular mortality, and total mortality. Cox frailty models with random effects were used to assess associations between fruit, vegetable, and legume consumption with risk of cardiovascular disease events and mortality. FINDINGS Participants were enrolled into the study between Jan 1, 2003, and March 31, 2013. For the current analysis, we included all unrefuted outcome events in the PURE study database through March 31, 2017. Overall, combined mean fruit, vegetable and legume intake was 3·91 (SD 2·77) servings per day. During a median 7·4 years (5·5-9·3) of follow-up, 4784 major cardiovascular disease events, 1649 cardiovascular deaths, and 5796 total deaths were documented. Higher total fruit, vegetable, and legume intake was inversely associated with major cardiovascular disease, myocardial infarction, cardiovascular mortality, non-cardiovascular mortality, and total mortality in the models adjusted for age, sex, and centre (random effect). The estimates were substantially attenuated in the multivariable adjusted models for major cardiovascular disease (hazard ratio [HR] 0·90, 95% CI 0·74-1·10, ptrend=0·1301), myocardial infarction (0·99, 0·74-1·31; ptrend=0·2033), stroke (0·92, 0·67-1·25; ptrend=0·7092), cardiovascular mortality (0·73, 0·53-1·02; ptrend=0·0568), non-cardiovascular mortality (0·84, 0·68-1·04; ptrend =0·0038), and total mortality (0·81, 0·68-0·96; ptrend<0·0001). The HR for total mortality was lowest for three to four servings per day (0·78, 95% CI 0·69-0·88) compared with the reference group, with no further apparent decrease in HR with higher consumption. When examined separately, fruit intake was associated with lower risk of cardiovascular, non-cardiovascular, and total mortality, while legume intake was inversely associated with non-cardiovascular death and total mortality (in fully adjusted models). For vegetables, raw vegetable intake was strongly associated with a lower risk of total mortality, whereas cooked vegetable intake showed a modest benefit against mortality. INTERPRETATION Higher fruit, vegetable, and legume consumption was associated with a lower risk of non-cardiovascular, and total mortality. Benefits appear to be maximum for both non-cardiovascular mortality and total mortality at three to four servings per day (equivalent to 375-500 g/day). FUNDING Full funding sources listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Victoria Miller
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
| | - Andrew Mente
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Mahshid Dehghan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Xiaohe Zhang
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Gilles Dagenais
- Institut universitaire de cardiologie et pneumologie de Quebec, Université Laval, QC, Canada
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, Dr Mohan's Diabetes Specialties Centre, Chennai, India
| | - Scott Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | | | - Aletta E Schutte
- South African Medical Research Council/North-West University, Potchefstroom, South Africa
| | | | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, University Santo Amaro, São Paulo, Brazil
| | - Yuksel Altuntas
- Istanbul Sisli Hamidiye Etfal Health Training and Research Center, Istanbul, Turkey
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selayang, Selangor, Malaysia; UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Noorhassim Ismail
- Department of Community Health, Faculty of Medicine, University of Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Jephat Chifamba
- Physiology Department, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica ECLA, Rosaria, Argentina
| | | | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Katarzyna Zatonska
- Department of Social Medicine, Medical University of Wroclaw, Wroclaw, Poland
| | | | - Afzalhussein Yusufali
- Hatta Hospital, Dubai Health Authority and Dubai Medical College, Dubai, United Arab Emirates
| | | | | | - Rasha Khatib
- Public Health Sciences, Stritch School of Medicine, IL, USA
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital/Őstra, Gőteborg, Sweden
| | | | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Jiankang Liu
- Jianshe Road Community Health Center, Chengdu, Sichuan Province, China
| | - Xiaoyun Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Koon Teo
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Sonia Anand
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
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Bhandari TR, Kutty VR, Sarma PS, Dangal G. Safe delivery care practices in western Nepal: Does women's autonomy influence the utilization of skilled care at birth? PLoS One 2017; 12:e0182485. [PMID: 28771579 PMCID: PMC5542628 DOI: 10.1371/journal.pone.0182485] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 11/02/2016] [Accepted: 07/19/2017] [Indexed: 12/04/2022] Open
Abstract
Despite various efforts to increase the utilization of skilled birth attendants (SBA), nearly two-thirds of deliveries take place at home without the assistance of SBAs in Nepal. We hypothesized that the ability of women to take decisions about their own lives—women’s autonomy—plays an important part in birth choices. To know this, we conducted a community-based cross-sectional study for assessing women’s autonomy and utilization of safe delivery care service in Kapilvastu district of Nepal from June to October 2014. We used multivariate modeling to associate socioeconomic factors and women’s autonomy with the utilization of safe delivery care services. Just over one-third of women sought institutional delivery care during the birth of their last child. Out of the total deliveries at health facilities, nearly 58% women visited health facility for self-reported emergency obstructive care. Only 6.2% home deliveries were handled by health workers and 14.7% women used the safe delivery kit for home delivery care. Higher levels of women’s education had a strong positive association (odds ratio = 24.11, CI = 9.43–61.64) with institutional delivery care. Stratified analysis showed that when the husband is educated, women’s education seems to work partly through their autonomy in decision making. Educational status of women emerged as one of the key predictors of the utilization of delivery care services in Kapilvastu district. Economic status of household and husband’s education are other dominant predictors of the utilization of safe delivery care services. Improving the economic and educational status may be the way out for improving the proportion of institutional deliveries. Women’s autonomy may be an important mediating factor in this pathway.
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Affiliation(s)
- Tulsi Ram Bhandari
- Department of Public Health, School of Health and Allied Sciences, Pokhara University, Kaski, Nepal
- AchuthaMenon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
- * E-mail:
| | - V. Raman Kutty
- AchuthaMenon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P. Sankara Sarma
- AchuthaMenon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ganesh Dangal
- Department of Obstetrics and Gynaecology, Kathmandu Model Hospital, Bagbazaar, Kathmandu, Nepal
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Abstract
Trust is an important factor in improving the performance of the healthcare system. This study aimed to develop a validated scale to measure trust in the public healthcare system. We adopted a sequential exploratory mixed study design, with developmental and testing phases. In the developmental phase, the construct of "healthcare system trust" was conceptualised and items were generated on the basis of information from a review of the literature on trust, in-depth interviews and a review of other scales. Exploratory factor analysis was employed for item reduction. In the testing phase, the reliability and validity measures were established. The face validity, content validity and construct validity of the scale were assessed. The final scale was a Likert-type scale with 23 items, 16 of which measured trust in the healthcare providers and 7, in healthcare institutions. The scale is a valid and reliable tool for measuring trust in the public healthcare system.
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Affiliation(s)
- T N Anand
- MPH scholar, Achutha Menon Centre for Health Science Studies, Sree Chita Tirunal Institute for Medical Sciences and Technology, Medical College PO, Trivandrum, Kerala 695 011, India,.
| | - V Raman Kutty
- Professor, Achutha Menon Centre for Health Science Studies, Sree Chita Tirunal Institute for Medical Sciences and Technology, Medical College PO, Trivandrum, Kerala 695 011, India,.
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20
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Leong DP, Teo KK, Rangarajan S, Kutty VR, Lanas F, Hui C, Quanyong X, Zhenzhen Q, Jinhua T, Noorhassim I, AlHabib KF, Moss SJ, Rosengren A, Akalin AA, Rahman O, Chifamba J, Orlandini A, Kumar R, Yeates K, Gupta R, Yusufali A, Dans A, Avezum Á, Lopez-Jaramillo P, Poirier P, Heidari H, Zatonska K, Iqbal R, Khatib R, Yusuf S. Reference ranges of handgrip strength from 125,462 healthy adults in 21 countries: a prospective urban rural epidemiologic (PURE) study. J Cachexia Sarcopenia Muscle 2016; 7:535-546. [PMID: 27104109 PMCID: PMC4833755 DOI: 10.1002/jcsm.12112] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [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: 08/26/2015] [Revised: 01/16/2016] [Accepted: 02/14/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The measurement of handgrip strength (HGS) has prognostic value with respect to all-cause mortality, cardiovascular mortality and cardiovascular disease, and is an important part of the evaluation of frailty. Published reference ranges for HGS are mostly derived from Caucasian populations in high-income countries. There is a paucity of information on normative HGS values in non-Caucasian populations from low- or middle-income countries. The objective of this study was to develop reference HGS ranges for healthy adults from a broad range of ethnicities and socioeconomically diverse geographic regions. METHODS HGS was measured using a Jamar dynamometer in 125,462 healthy adults aged 35-70 years from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study. RESULTS HGS values differed among individuals from different geographic regions. HGS values were highest among those from Europe/North America, lowest among those from South Asia, South East Asia and Africa, and intermediate among those from China, South America, and the Middle East. Reference ranges stratified by geographic region, age, and sex are presented. These ranges varied from a median (25th-75th percentile) 50 kg (43-56 kg) in men <40 years from Europe/North America to 18 kg (14-20 kg) in women >60 years from South East Asia. Reference ranges by ethnicity and body-mass index are also reported. CONCLUSIONS Individual HGS measurements should be interpreted using region/ethnic-specific reference ranges.
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Affiliation(s)
- Darryl P Leong
- The Population Health Research Institute McMaster University and Hamilton Health Sciences Hamilton ON Canada
| | - Koon K Teo
- The Population Health Research Institute McMaster University and Hamilton Health Sciences Hamilton ON Canada
| | - Sumathy Rangarajan
- The Population Health Research Institute McMaster University and Hamilton Health Sciences Hamilton ON Canada
| | - V Raman Kutty
- Health Action by People, 'Chemmanam', Navarangam Lane Medical College Post Office Trivandrum India
| | | | - Chen Hui
- Medical Research & Biometrics Center National Center for Cardiovascular Diseases, FuWai Hospital Beijing China
| | - Xiang Quanyong
- Jiangsu Provincial Center for Disease Control &12 Prevention Nanjing City China
| | - Qian Zhenzhen
- Jiangxinzhou community health service center Nanjing City China
| | | | - Ismail Noorhassim
- Universiti Kebangsaan Malaysia Medical Center(UKMMC) Kuala Lumpur Malaysia
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center College of Medicine, King Saud University Riyadh Saudi Arabia
| | - Sarah J Moss
- North-West University Physical activity, Sport and Recreation Research Focus Area, Faculty of Health Sciences Potchefstroom South Africa
| | | | - Ayse Arzu Akalin
- Department of Family Medicine and Department of Medical Education Yeditepe University Medical Faculty Atasehir, Istanbul Turkey
| | - Omar Rahman
- Independent University Bangladesh Bangladesh
| | - Jephat Chifamba
- University of Zimbabwe College of Health Sciences Department of Physiology Harare
| | | | | | - Karen Yeates
- Department of Medicine Queen's University Kingston ON Canada
| | | | | | - Antonio Dans
- College of Medicine University of the Philippines - Manila Malate Philippines
| | - Álvaro Avezum
- Dante Pazzanese Institute of Cardiology São Paulo Brazil
| | - Patricio Lopez-Jaramillo
- Fundacion Oftalmologica de Santander (FOSCAL) Universidad de Santander (UDES) Bucaramanga Colombia
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec Québec Canada
| | - Hosein Heidari
- Cardiac Rehabilitation Research Center Isfahan University of Medical Sciences Isfahan Iran
| | | | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine Aga Khan University Pakistan
| | - Rasha Khatib
- Institute of Community and Public Health Birzeit University Ramallah Palestine
| | - Salim Yusuf
- The Population Health Research Institute McMaster University and Hamilton Health Sciences Hamilton ON Canada
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21
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Koshy L, Anju AL, Harikrishnan S, Kutty VR, Jissa VT, Kurikesu I, Jayachandran P, Jayakumaran Nair A, Gangaprasad A, Nair GM, Sudhakaran PR. Evaluating genomic DNA extraction methods from human whole blood using endpoint and real-time PCR assays. Mol Biol Rep 2016; 44:97-108. [PMID: 27686559 DOI: 10.1007/s11033-016-4085-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 09/22/2016] [Indexed: 11/29/2022]
Abstract
The extraction of genomic DNA is the crucial first step in large-scale epidemiological studies. Though there are many popular DNA isolation methods from human whole blood, only a few reports have compared their efficiencies using both end-point and real-time PCR assays. Genomic DNA was extracted from coronary artery disease patients using solution-based conventional protocols such as the phenol-chloroform/proteinase-K method and a non-phenolic non-enzymatic Rapid-Method, which were evaluated and compared vis-a-vis a commercially available silica column-based Blood DNA isolation kit. The appropriate method for efficiently extracting relatively pure DNA was assessed based on the total DNA yield, concentration, purity ratios (A260/A280 and A260/A230), spectral profile and agarose gel electrophoresis analysis. The quality of the isolated DNA was further analysed for PCR inhibition using a murine specific ATP1A3 qPCR assay and mtDNA/Y-chromosome ratio determination assay. The suitability of the extracted DNA for downstream applications such as end-point SNP genotyping, was tested using PCR-RFLP analysis of the AGTR1-1166A>C variant, a mirSNP having pharmacogenetic relevance in cardiovascular diseases. Compared to the traditional phenol-chloroform/proteinase-K method, our results indicated the Rapid-Method to be a more suitable protocol for genomic DNA extraction from human whole blood in terms of DNA quantity, quality, safety, processing time and cost. The Rapid-Method, which is based on a simple salting-out procedure, is not only safe and cost-effective, but also has the added advantage of being scaled up to process variable sample volumes, thus enabling it to be applied in large-scale epidemiological studies.
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Affiliation(s)
- Linda Koshy
- Department of Biotechnology, Inter-University Centre for Genomics and Gene Technology, University of Kerala, Trivandrum, 695 581, India.
| | - A L Anju
- Department of Biotechnology, Inter-University Centre for Genomics and Gene Technology, University of Kerala, Trivandrum, 695 581, India
| | - S Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695 011, India
| | - V R Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695 011, India
| | - V T Jissa
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695 011, India
| | - Irin Kurikesu
- Department of Biotechnology, Inter-University Centre for Genomics and Gene Technology, University of Kerala, Trivandrum, 695 581, India
| | - Parvathy Jayachandran
- Department of Biotechnology, Inter-University Centre for Genomics and Gene Technology, University of Kerala, Trivandrum, 695 581, India
| | - A Jayakumaran Nair
- Department of Biotechnology, Inter-University Centre for Genomics and Gene Technology, University of Kerala, Trivandrum, 695 581, India
| | - A Gangaprasad
- Department of Biotechnology, Inter-University Centre for Genomics and Gene Technology, University of Kerala, Trivandrum, 695 581, India.,Deparment of Botany, University of Kerala, Trivandrum, 695 581, India
| | - G M Nair
- Department of Biotechnology, Inter-University Centre for Genomics and Gene Technology, University of Kerala, Trivandrum, 695 581, India
| | - P R Sudhakaran
- Department of Biotechnology, Inter-University Centre for Genomics and Gene Technology, University of Kerala, Trivandrum, 695 581, India.,Department of Computational Biology and Bioinformatics, University of Kerala, Trivandrum, 695 581, India
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22
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Dagenais GR, Gerstein HC, Zhang X, McQueen M, Lear S, Lopez-Jaramillo P, Mohan V, Mony P, Gupta R, Kutty VR, Kumar R, Rahman O, Yusoff K, Zatonska K, Oguz A, Rosengren A, Kelishadi R, Yusufali A, Diaz R, Avezum A, Lanas F, Kruger A, Peer N, Chifamba J, Iqbal R, Ismail N, Xiulin B, Jiankang L, Wenqing D, Gejie Y, Rangarajan S, Teo K, Yusuf S. Variations in Diabetes Prevalence in Low-, Middle-, and High-Income Countries: Results From the Prospective Urban and Rural Epidemiological Study. Diabetes Care 2016; 39:780-7. [PMID: 26965719 DOI: 10.2337/dc15-2338] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/11/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The goal of this study was to assess whether diabetes prevalence varies by countries at different economic levels and whether this can be explained by known risk factors. RESEARCH DESIGN AND METHODS The prevalence of diabetes, defined as self-reported or fasting glycemia ≥7 mmol/L, was documented in 119,666 adults from three high-income (HIC), seven upper-middle-income (UMIC), four lower-middle-income (LMIC), and four low-income (LIC) countries. Relationships between diabetes and its risk factors within these country groupings were assessed using multivariable analyses. RESULTS Age- and sex-adjusted diabetes prevalences were highest in the poorer countries and lowest in the wealthiest countries (LIC 12.3%, UMIC 11.1%, LMIC 8.7%, and HIC 6.6%; P < 0.0001). In the overall population, diabetes risk was higher with a 5-year increase in age (odds ratio 1.29 [95% CI 1.28-1.31]), male sex (1.19 [1.13-1.25]), urban residency (1.24 [1.11-1.38]), low versus high education level (1.10 [1.02-1.19]), low versus high physical activity (1.28 [1.20-1.38]), family history of diabetes (3.15 [3.00-3.31]), higher waist-to-hip ratio (highest vs. lowest quartile; 3.63 [3.33-3.96]), and BMI (≥35 vs. <25 kg/m(2); 2.76 [2.52-3.03]). The relationship between diabetes prevalence and both BMI and family history of diabetes differed in higher- versus lower-income country groups (P for interaction < 0.0001). After adjustment for all risk factors and ethnicity, diabetes prevalences continued to show a gradient (LIC 14.0%, LMIC 10.1%, UMIC 10.9%, and HIC 5.6%). CONCLUSIONS Conventional risk factors do not fully account for the higher prevalence of diabetes in LIC countries. These findings suggest that other factors are responsible for the higher prevalence of diabetes in LIC countries.
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Affiliation(s)
- Gilles R Dagenais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada
| | - Hertzel C Gerstein
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Xiaohe Zhang
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Matthew McQueen
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Scott Lear
- Faculty of Health Sciences, Simon Fraser University, and Healthy Heart Program, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Prem Mony
- Division of Epidemiology, Biostatistics and Population Health, St. John's Research Institute, Bangalore, India
| | - Rajeev Gupta
- Fortis Escorts Hospital, Malviya Nagar, Jaipur, India
| | - V Raman Kutty
- Health Action by People, Thiruvananthapuram, Kerala, India
| | - Rajesh Kumar
- PGIMER School of Public Health, Chandigarh, India
| | - Omar Rahman
- Independent University, Bangladesh, Bashundhara, Dhaka, Bangladesh
| | - Khalid Yusoff
- Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia UCSI University, Cheras, Selangor, Malaysia
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Aytekin Oguz
- Faculty of Medicine, Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital/Östra, Göteborg, Sweden
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Rafael Diaz
- Estudios Clínicos Latinoamérica, Rosario, Argentina
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, São Paulo, São Paulo, Brazil
| | | | - Annamarie Kruger
- Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Nasheeta Peer
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Jephat Chifamba
- Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine, The Aga Khan University, Karachi, Pakistan
| | - Noorhassim Ismail
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Bai Xiulin
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, FuWai Hospital, Beijing, China
| | - Liu Jiankang
- Jianshe Road Community Health Center, Chengdu City, Sichuan Province, China
| | - Deng Wenqing
- Health Center, Dayicaichang Town, Sichuan Province, China
| | - Yue Gejie
- Qiluhuayuan Hospital, Jinan City, Shandong Province, China
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
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Abstract
Despite various efforts for enhancing women's autonomy in developing countries, many women are deprived of their capacity in decision-making on their household affairs as well as social issues. This paper aimed to examine women's autonomy and its associated factors in the Kapilvastu district of Nepal. We measured women's autonomy using a recently developed women's autonomy measurement scale from June to October 2014. Descriptive statistics, chi-square test and logistic multivariate modeling technique were applied for assessing the association of demographic and socio-economic characteristics of women and their autonomy. Mean score for women's autonomy was 23.34 ± 8.06 out of the possible maximum 48. It was found to be positively associated with higher age difference at marriage, advantaged caste/ethnicity, better employment for the husband, couple's education more than 10 years schooling, and higher economic status of the household. We found strong direct effect of women's education (OR = 8.14, CI = 3.77-17.57), husband's education (OR = 2.63, CI = 1.69-4.10) and economic status of household (OR = 1.42, CI = 1.01-2.03) on women's autonomy. When we adjusted women's education for husband's education, the odds ratio decreased by around 22% {from (OR = 8.14, CI = 3.77-17.57) to (OR = 6.32, CI = 2.77-14.46)} and was a mediator effect. The economic status of household also had mediator effect on women's autonomy through their education. Education status of women is a key predictor of women's autonomy in Kapilvastu district. Husband's education and economic status of the household are other important predictors of women's autonomy which have a mediator effect on women's autonomy. Improving educational status and economic conditions of both women and their husbands may be the best solution to promote women's autonomy.
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Affiliation(s)
- Tulsi Ram Bhandari
- Department of Public Health, School of Health and Allied Sciences, Pokhara University, Lekhnath-12, Kaski, Nepal
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram – 695011, Kerala, India
| | - V. Raman Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram – 695011, Kerala, India
| | - T. K. Sundari Ravindran
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram – 695011, Kerala, India
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24
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Ravindran RM, Kutty VR. Risk Factors for Fall-Related Injuries Leading to Hospitalization Among Community-Dwelling Older Persons: A Hospital-Based Case-Control Study in Thiruvananthapuram, Kerala, India. Asia Pac J Public Health 2015; 28:70S-76S. [PMID: 26463576 DOI: 10.1177/1010539515611229] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study intended to identify the risk factors for injurious falls that led to hospitalization of older persons living in the community. A hospital-based unmatched incident case-control study was done among 251 cases and 250 controls admitted at a tertiary care centre in Kerala. Mean age of cases was 71.6 ± 9.13 years and that of controls was 67.02 ± 6.17 years. Hip fractures were the predominant injury following falls. Falls were mostly a result of intrinsic causes. After adjusting for other variabes, the risk factors for all injuries were age above 70 years (odds ratio [OR] = 2.25; 95% confidence interval [CI] = 1.46-3.46), previous fall history (OR = 2.76; 95% CI = 1.08-7.08), impaired vision (OR = 4.49; 95% CI = 2.77-7.30), not living with spouse (OR = 1.97; 95% CI = 1.31-2.97), door thresholds (OR = 1.52; 95% CI = 1.01-2.29), and slippery floor (OR = 2.37; 95% CI = 1.31-4.32). The risk factors for hip fractures and other injuries were identified separately. Fall prevention strategies among older persons are warranted in Kerala.
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Affiliation(s)
| | - V Raman Kutty
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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25
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Sreelakshmi PR, Nair S, Soman B, Alex R, Vijayakumar K, Kutty VR. Maternal and neonatal outcomes of gestational diabetes: A retrospective cohort study from Southern India. J Family Med Prim Care 2015; 4:395-8. [PMID: 26288780 PMCID: PMC4535102 DOI: 10.4103/2249-4863.161331] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: The prevalence of gestational diabetes is on the rise. Understanding the various outcomes of it is necessary to face this challenge. Objectives: To study the frequency of occurrence of various maternal and fetal outcomes among gestational diabetes patients. Methods: This is a retrospective cohort study conducted in rural Kerala, a southern state of India. The study participants were followed up for a period of 4 years, from 2007 to 2011. The participants included 60 women with gestational diabetes and 120 women without gestational diabetes. Gestational diabetes was the major exposure variable. The frequencies of various outcomes were computed. Multivariable logistic regression was done to compute the risk for various outcomes in gestational diabetes. Results: The major outcomes included termination of pregnancy by caesarean section, long-term progression to type 2 diabetes, in-born nursery (IBN) admissions and increased neonatal birth weight. The maximum adjusted RR [13.2 (1.5-116.03)] was for the development of type 2 DM later. Conclusion: Gestational diabetes can result in significant feto-maternal outcomes; so better facilities are needed to manage gestational diabetes.
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Affiliation(s)
- P R Sreelakshmi
- Department of Community Medicine, Sree Uthradam Thirunal Academy of Medical Sciences, Vattapara, India
| | - Sanjeev Nair
- Department of Respiratory Medicine, Government Medical College, Karakonam, Thiruvananthapuram, India
| | - Biju Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Karakonam, Thiruvananthapuram, India
| | - Rani Alex
- Department of Community Medicine, Sree Uthradam Thirunal Academy of Medical Sciences, Vattapara, India
| | - K Vijayakumar
- Department of Community Medicine, SMCSI Medical College, Karakonam, Thiruvananthapuram, India
| | - V Raman Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Karakonam, Thiruvananthapuram, India
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26
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Rosengren A, Teo K, Rangarajan S, Kabali C, Khumalo I, Kutty VR, Gupta R, Yusuf R, Iqbal R, Ismail N, Altuntas Y, Kelishadi R, Diaz R, Avezum A, Chifamba J, Zatonska K, Wei L, Liao X, Lopez-Jaramillo P, Yusufali A, Seron P, Lear SA, Yusuf S. Psychosocial factors and obesity in 17 high-, middle- and low-income countries: the Prospective Urban Rural Epidemiologic study. Int J Obes (Lond) 2015; 39:1217-23. [PMID: 25869608 PMCID: PMC4766924 DOI: 10.1038/ijo.2015.48] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/21/2014] [Accepted: 11/23/2014] [Indexed: 02/05/2023]
Abstract
Background/Objectives: Psychosocial stress has been proposed to contribute to obesity, particularly abdominal, or central obesity, through chronic activation of the neuroendocrine systems. However, these putative relationships are complex and dependent on country and cultural context. We investigated the association between psychosocial factors and general and abdominal obesity in the Prospective Urban Rural Epidemiologic study. Subjects/Methods: This observational, cross-sectional study enrolled 151 966 individuals aged 35–70 years from 628 urban and rural communities in 17 high-, middle- and low-income countries. Data were collected for 125 290 individuals regarding education, anthropometrics, hypertension/diabetes, tobacco/alcohol use, diet and psychosocial factors (self-perceived stress and depression). Results: After standardization for age, sex, country income and urban/rural location, the proportion with obesity (body mass index ⩾30 kg m−2) increased from 15.7% in 40 831 individuals with no stress to 20.5% in 7720 individuals with permanent stress, with corresponding proportions for ethnicity- and sex-specific central obesity of 48.6% and 53.5%, respectively (P<0.0001 for both). Associations between stress and hypertension/diabetes tended to be inverse. Estimating the total effect of permanent stress with age, sex, physical activity, education and region as confounders, no relationship between stress and obesity persisted (adjusted prevalence ratio (PR) for obesity 1.04 (95% confidence interval: 0.99–1.10)). There was no relationship between ethnicity- and sex-specific central obesity (adjusted PR 1.00 (0.97–1.02)). Stratification by region yielded inconsistent associations. Depression was weakly but independently linked to obesity (PR 1.08 (1.04–1.12)), and very marginally to abdominal obesity (PR 1.01 (1.00–1.03)). Conclusions: Although individuals with permanent stress tended to be slightly more obese, there was no overall independent effect and no evidence that abdominal obesity or its consequences (hypertension, diabetes) increased with higher levels of stress or depression. This study does not support a causal link between psychosocial factors and abdominal obesity.
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Affiliation(s)
- A Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - K Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - S Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - C Kabali
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - I Khumalo
- North-West University, Optentia Research Programme, Faculty of Humanities, Vanderbilpark, South Africa
| | - V R Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - R Gupta
- Fortis Escorts Hospital, JLN Marg, Jaipur, Rajasthan, India
| | - R Yusuf
- Independent University Bangladesh, Dhaka, Bangladesh
| | - R Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - N Ismail
- Department of Community Health, Universiti Kebangsaan, Kuala Lumpur, Malaysia
| | - Y Altuntas
- SB Pediatric Endocrinology and Metabolism, Training and Research Hospital, Istanbul, Turkey
| | - R Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - R Diaz
- Estudios Clinicos Latinoamerica ECLA, Rosario, Santa Fe, Argentina
| | - A Avezum
- Dante Pazzanese Institute of cardiology, Sao Paulo, Brazil
| | - J Chifamba
- Physiology Department, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - K Zatonska
- Department of Social Medicine, Medical University of Wrocław, Wrocław, Poland
| | - L Wei
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - X Liao
- Sichuan University West China Hospital, Chengdu, Sichuan Province, China
| | - P Lopez-Jaramillo
- Fundacion Oftalmologica de Santander (FOSCAL) and Medical School, Universidad de Santander (UDES), Santander, Colombia
| | | | - P Seron
- Universidad de La Frontera, Temuco, Chile
| | - S A Lear
- Faculty of Health Sciences, Simon Fraser University and Division of Cardiology, Providence Health Care, Vancouver, BC, Canada
| | - S Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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27
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Pappachan JM, Raskauskiene D, Kutty VR, Clayton RN. Excess mortality associated with hypopituitarism in adults: a meta-analysis of observational studies. J Clin Endocrinol Metab 2015; 100:1405-11. [PMID: 25658016 DOI: 10.1210/jc.2014-3787] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT Several previous observational studies showed an association between hypopituitarism and excess mortality. Reports on reduction of standard mortality ratio (SMR) with GH replacement have been published recently. OBJECTIVE This meta-analysis assessed studies reporting SMR to clarify mortality risk in hypopituitary adults and also the potential benefit conferred by GH replacement. DATA SOURCES A literature search was performed in Medline, Embase, and Cochrane library up to March 31, 2014. ELIGIBILITY CRITERIA Studies with or without GH replacement reporting SMR with 95% confidence intervals (95% CI) were included. DATA EXTRACTION AND ANALYSIS Patient characteristics, SMR data, and treatment outcomes were independently assessed by two authors, and with consensus from third author, studies were selected for analysis. Meta-analysis was performed in all studies together, and those without and with GH replacement separately, using the statistical package metafor in R. RESULTS Six studies reporting a total of 19 153 hypopituiatary adults with a follow-up duration of more than 99,000 person years were analyzed. Hypopituitarism was associated with an overall excess mortality (weighted SMR, 1.99; 95% CI, 1.21-2.76) in adults. Female hypopituitary adults showed higher SMR compared with males (2.53 vs 1.71). Onset of hypopituitarism at a younger age was associated with higher SMR. GH replacement improved the mortality risk in hypopituitary adults that is comparable to the background population (SMR with GH replacement, 1.15; 95% CI, 1.05-1.24 vs SMR without GH, 2.40; 95% CI, 1.46-3.34). GH replacement conferred lower mortality benefit in hypopituitary women compared with men (SMR, 1.57; 95% CI, 1.38-1.77 vs 0.95; 95% CI, 0.85-1.06). LIMITATIONS There was a potential selection bias of benefit of GH replacement from a post-marketing data necessitating further evidence from long-term randomized controlled trials. CONCLUSIONS Hypopituitarism may increase premature mortality in adults. Mortality benefit from GH replacement in hypopituitarism is less pronounced in women than men.
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Affiliation(s)
- Joseph M Pappachan
- Department of Endocrinology (J.M.P., D.R.), Walsall Manor Hospital, West Midlands, WS2 9PS, United Kingdom; Achutha Menon Centre for Health Science Studies (V.R.K.), Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India 695011; and Keele University Medical School & University Hospital of North Staffordshire (R.N.C.), Stoke-on-Trent, Staffordshire ST4 6QG, United Kingdom
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28
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Varghese J, Kutty VR, Paina L, Adam T. Advancing the application of systems thinking in health: understanding the growing complexity governing immunization services in Kerala, India. Health Res Policy Syst 2014; 12:47. [PMID: 25160531 PMCID: PMC4245198 DOI: 10.1186/1478-4505-12-47] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 07/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Governing immunization services in a way that achieves and maintains desired population coverage levels is complex as it involves interactions of multiple actors and contexts. In one of the Indian states, Kerala, after routine immunization had reached high coverage in the late 1990s, it started to decline in some of the districts. This paper describes an application of complex adaptive systems theory and methods to understand and explain the phenomena underlying unexpected changes in vaccination coverage. METHODS We used qualitative methods to explore the factors underlying changes in vaccination coverage in two districts in Kerala, one with high and one with low coverage. Content analysis was guided by features inherent to complex adaptive systems such as phase transitions, feedback, path dependence, and self-organization. Causal loop diagrams were developed to depict the interactions among actors and critical events that influenced the changes in vaccination coverage. RESULTS We identified various complex adaptive system phenomena that influenced the change in vaccination coverage levels in the two districts. Phase transition describes how initial acceptability to vaccination is replaced by a resistance in northern Kerala, which involved new actors; actors attempting to regain acceptability and others who countered it created several feedback loops. We also describe how the authorities have responded to declining immunization coverage and its impact on vaccine acceptability in the context of certain highly connected actors playing disproportionate influence over household vaccination decisions.Theoretical exposition of our findings reveals the important role of trust in health workers and institutions that shape the interactions of actors leading to complex adaptive system phenomena. CONCLUSIONS As illustrated in this study, a complex adaptive system lens helps to uncover the 'real' drivers for change. This approach assists researchers and decision makers to systematically explore the driving forces and factors in each setting and develop appropriate and timely strategies to address them. The study calls for greater consideration of dynamics of vaccine acceptability while formulating immunization policies and program strategies. The analytical approaches adopted in this study are not only applicable to immunization or Kerala but to all complex interventions, health systems problems, and contexts.
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Affiliation(s)
- Joe Varghese
- Centre for Chronic Disease Control and Governance Hub, Public Health Foundation of India, Delhi NCR, Plot No, 47, Sector 44, Gurgaon 122002, India.
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James TT, Kutty VR. Assessment of Internalized Stigma Among Patients With Mental Disorders in Thiruvananthapuram District, Kerala, India. Asia Pac J Public Health 2014; 27:439-49. [DOI: 10.1177/1010539514545645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to compare the prevalence of high internalized stigma of mental illness among patients attending community-based and psychiatric hospital–based care in Thiruvananthapuram district, Kerala, India and to examine the factors associated with high internalized stigma. A cross-sectional survey was conducted among 290 patients, mean age 45 years, 38.2% and 61.8% female. A Malayalam version of the Internalized Stigma of Mental Illness inventory was used for assessing internalized stigma. A multistage random sampling method was adopted. The prevalence of high internalized stigma was higher among patients from community-based care (44.7%) as compared with those from psychiatric hospital–based care (34.1%). Apart from treatment in community-based care, age ≤45 years, unemployment, absence of long-term friendships, no hope of cure with medication, presence of other illnesses, and substance use were significantly associated with high internalized stigma. More than one third of the subjects had high internalized stigma.
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Affiliation(s)
- Tintu T. James
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - V. Raman Kutty
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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Bhandari TR, Dangal G, Sarma PS, Kutty VR. Construction and Validation of a Women's Autonomy Measurement Scale with Reference to Utilization of Maternal Health Care Services in Nepal. JNMA J Nepal Med Assoc 2014; 52:925-934. [PMID: 26982668] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Women's autonomy is one of the predictors of maternal health care service utilization. This study aimed to construct and validate a scale for measuring women's autonomy with relevance to developing countries. METHODS We conducted a study for construction and validation of a scale in Rupandehi and further validated in Kapilvastu districts of Nepal. Initially, we administered a 24-item preliminary scale and finalized a 23-item scale using psychometric tests. After defining the construct of women's autonomy, we pooled 194 items and selected 24 items to develop a preliminary scale. The scale development process followed different steps i.e. definition of construct, generation of items pool, pretesting, analysis of psychometric test and further validation. RESULTS The new scale was strongly supported by Cronbach's Alpha value (0.84), test-retest Pearson correlation (0.87), average content validity ratio (0.8) and overall agreement- Kappa value of the items (0.83) whereas all values were found satisfactory. From factor analysis, we selected 23 items for the final scale which show good convergent and discriminant validity. From preliminary draft, we removed one item; the remaining 23 items were loaded in five factors. All five factors had single loading items by suppressing absolute coefficient value less than 0.45 and average coefficient was more than 0.60 of each factor. Similarly, the factors and loaded items had good convergent and discriminant validity which further showed strong measurement capacity of the scale. CONCLUSIONS The new scale is a reliable tool for assessing women's autonomy in developing countries. We recommend for further use and validation of the scale for ensuring the measurement capacity.
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Affiliation(s)
- T R Bhandari
- Department of Public Health, School of Health and Allied Sciences, Pokhara University, Kaski, Nepal. and Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - G Dangal
- Department of Obstetrics and Gynaecology, Kathmandu Model Hospital, Kathmandu, Nepal
| | - P S Sarma
- Department of Obstetrics and Gynaecology, Kathmandu Model Hospital, Kathmandu, Nepal
| | - V R Kutty
- Department of Biology, Faculty of Natural and Life Sciences, Djillali Liabes University, Sidi-bel-Abbes, Algeria
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Gupta R, Islam S, Mony P, Kutty VR, Mohan V, Kumar R, Thakur JS, Shankar VK, Mohan D, Vijayakumar K, Rahman O, Yusuf R, Iqbal R, Shahid M, Mohan I, Rangarajan S, Teo KK, Yusuf S. Socioeconomic factors and use of secondary preventive therapies for cardiovascular diseases in South Asia: The PURE study. Eur J Prev Cardiol 2014; 22:1261-71. [DOI: 10.1177/2047487314540386] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/30/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Rajeev Gupta
- Department of Medicine, Fortis Escorts Hospital, India
| | - Shofiqul Islam
- Population Health Research Institute and Hamilton Health Sciences, McMaster University, Canada
| | - Prem Mony
- St John’s Research Institute, St John’s Medical College, India
| | | | | | - Rajesh Kumar
- School of Public Health, Postgraduate Institute of Medical Education and Research, India
| | - JS Thakur
- School of Public Health, Postgraduate Institute of Medical Education and Research, India
| | | | | | | | - Omar Rahman
- Department of Public Health, Independent University, Bangladesh
| | - Rita Yusuf
- Department of Public Health, Independent University, Bangladesh
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Pakistan
| | | | - Indu Mohan
- Department of Medicine, Fortis Escorts Hospital, India
| | - Sumathy Rangarajan
- Population Health Research Institute and Hamilton Health Sciences, McMaster University, Canada
| | - Koon K Teo
- Population Health Research Institute and Hamilton Health Sciences, McMaster University, Canada
| | - Salim Yusuf
- Population Health Research Institute and Hamilton Health Sciences, McMaster University, Canada
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Lear SA, Teo K, Gasevic D, Zhang X, Poirier PP, Rangarajan S, Seron P, Kelishadi R, Tamil AM, Kruger A, Iqbal R, Swidan H, Gómez-Arbeláez D, Yusuf R, Chifamba J, Kutty VR, Karsıdag K, Kumar R, Li W, Szuba A, Avezum A, Diaz R, Anand SS, Rosengren A, Yusuf S. The association between ownership of common household devices and obesity and diabetes in high, middle and low income countries. CMAJ 2014; 186:258-66. [PMID: 24516093 DOI: 10.1503/cmaj.131090] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake. METHODS We performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153,996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels. RESULTS Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32-1.55; diabetes: OR 1.38, 95% CI 1.28-1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29-1.49) and diabetes (OR 1.33, 95% CI 1.23-1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33-4.25; diabetes: OR 1.97, 95% CI 1.53-2.53) and decreased through country income levels such that we did not detect an association in high income countries. INTERPRETATION The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With increasing ownership of household devices in developing countries, societal interventions are needed to mitigate their effects on poor health.
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Ramachandran S, Venugopal A, Kutty VR, A V, G D, Chitrasree V, Mullassari A, Pratapchandran NS, Santosh KR, Pillai MR, Kartha CC. Plasma level of cyclophilin A is increased in patients with type 2 diabetes mellitus and suggests presence of vascular disease. Cardiovasc Diabetol 2014; 13:38. [PMID: 24502618 PMCID: PMC3922405 DOI: 10.1186/1475-2840-13-38] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 02/05/2014] [Indexed: 11/30/2022] Open
Abstract
Aims/hypothesis Cyclophilin A, an immunophilin is secreted from human monocytes activated by high glucose. Given its role as an inflammatory mediator of vascular tissue damage associated with inflammation and oxidative stress, we examined plasma levels of cyclophilin A in normal healthy volunteers and patients with type 2 diabetes (DM), with or without coronary artery disease (CAD). Methods Study subjects comprised of 212 patients with DM and CAD,101 patients with diabetes, 122 patients with CAD and 121 normal healthy volunteers. Diabetes was assessed by HbA1c levels while coronary artery disease was established by a positive treadmill test and/or coronary angiography. Plasma cyclophilin A was measured using a cyclophilin A ELISA Kit. Relationship of plasma cyclophilin A levels with blood markers of type 2 diabetes, blood lipid levels and medication for diabetes and coronary artery disease were also explored. Results Plasma Cyclophilin levels were higher in diabetes patients with or without CAD compared to normal subjects (P < 0.001). Age, fasting blood sugar levels and HbA1C levels were positively associated with increased plasma cyclophilin. Patients using metformin had reduced levels of plasma cyclophilin (p < 0.001).Serum levels of total cholesterol, LDL cholesterol and triglycerides had no significant association with plasma cyclophilin levels. In patients with increased serum CRP levels, plasma cyclophilin A was also elevated (p = 0.016). Prevalence odds for DM, DM + CAD and CAD are higher in those with high cyclophilin values, compared to those with lower values, after adjusting for age and sex, indicating strong association of high cyclophilin values with diabetes and vascular disease. Conclusions/interpretations Our study demonstrates that patients with type 2 diabetes have higher circulating levels of cyclophilin A than the normal population. Plasma cyclophilin levels were increased in patients with diabetes and coronary artery disease suggesting a role of this protein in accelerating vascular disease in type 2 diabetes. Considering the evidence that Cyclophilin A is an inflammatory mediator in atherogenesis, the mechanistic role of cyclophilin A in diabetic vascular disease progression deserves detailed investigation.
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Affiliation(s)
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- Cardiovascular Disease Biology, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, India.
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Raman Kutty V. Cohorts in chronic disease research: experiences from the PRO-LIFE cohort, Varkala, South India. BMC Proc 2013. [PMCID: PMC3892173 DOI: 10.1186/1753-6561-7-s5-o7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Sensarma P, Bhandari S, Kutty VR. Barriers to immunization among children of HIV-infected mothers in Kolkata, India: a qualitative study. Asia Pac J Public Health 2013; 27:NP1362-71. [PMID: 23666833 DOI: 10.1177/1010539513486177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
More than one fourth of children of HIV-infected mothers living in Kolkata city are not completely immunized by 12 months of age. This qualitative study aims to explore the barriers to immunization of these children as perceived by their caregivers and the local health care service providers. In-depth interviews were conducted after obtaining written informed consent. Audio recording and hand-recorded notes were used with permission. The transcripts were coded and analyzed using grounded theory. Deteriorating socioeconomic status, tightening of time schedule of caregivers due to illness in the family, stigma, discrimination, and lack of awareness about immunization prove to be major barriers for immunization of the HIV-exposed children. Interplay of these factors coupled with harassment and negative attitudes of service providers toward HIV-affected/HIV-infected people also impede immunization. The intervention efforts need to address these social barriers and adverse life events to improve immunization coverage.
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Affiliation(s)
- Pinaki Sensarma
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Subhasis Bhandari
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - V Raman Kutty
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Varghese J, Raman Kutty V, Ramanathan M. The interactions of ethical notions and moral values of immediate stakeholders of immunisation services in two Indian states: a qualitative study. BMJ Open 2013; 3:bmjopen-2012-001905. [PMID: 23457322 PMCID: PMC3612786 DOI: 10.1136/bmjopen-2012-001905] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study examines the existing norms regarding immunisation within the communities and the ethical notions that govern the actions of different health professionals and their collective synergistic or conflicting effects on the governance of the programme. DESIGN We used descriptive and analytical qualitative methods as it suited the research question. SETTING The data were collected from areas under 16 primary health centres in Kerala and Tamil Nadu identified through a three-step sampling process. PARTICIPANTS This involved in-depth interviews with stakeholders including providers, beneficiaries and other stakeholders, focus group discussions with mothers of under-five children and participant and non-participant observations of vaccination-related activities. RESULTS Unlike most other ethical analyses that look at the ethics of vaccination policies, the interactions of normative principles and notions are analysed in this article. Moral obligation of parents towards their children, beneficence of healthcare providers and the utilitarian aspirations of the state are the key normative principles involved. Our analysis points to the interplay of both synergy and conflict in ethical notions and moral values in the context of immunisation services. Paternalistic interventions like special immunisation campaigns against polio and Japanese encephalitis are a case in point: they generate conflict at the normative level and create mistrust. CONCLUSIONS Analysis of vaccination policies and programmes needs to go beyond factors that assess monetary benefits or herd immunity. Understanding the interactions of normative notions that shape the social organisation of the providers and the users of vaccination is important in creating a sustainable environment for the programme.
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Affiliation(s)
- Joe Varghese
- Centre for Chronic Disease Control, New Delhi, India
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - V Raman Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Mala Ramanathan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
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Kutty VR, Shah P, Modi D, Shah S, Ramanathan M, Archana AR. Reducing neonatal mortality in Jhagadia Block, Gujarat: we need to go beyond promoting hospital deliveries. J Trop Pediatr 2013; 59:49-53. [PMID: 22964552 DOI: 10.1093/tropej/fms043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND METHODS We examined data from a cohort of births that occurred in the period 2004-08 in the SEWA-Rural project area, covering a population of ∼175000, in Gujarat, India, to assess the trends and risk factors for neonatal mortality. RESULTS In this population living in 168 villages, there has been a significant declining trend in infant and neonatal mortality, more marked in the tribal population, in whom this paralleled a rise in the proportion of women delivering in hospitals. The more important risk factors for neonatal mortality risk to emerge from multivariate analysis are low birth weight, prematurity, young age of mother, older mother and high birth order. CONCLUSION Although community based interventions along with promotion of hospital birth has an impact in reducing neonatal deaths in this community, sustaining this momentum may demand more long-term policy interventions to promote better living standards and better reproductive health.
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Affiliation(s)
- V Raman Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India 695011.
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Abstract
World Health Organization and United Nations International Children's Emergency Fund have strongly recommended a sustained coverage of universal immunisation among all children against tuberculosis, polio, diphtheria, pertussis, tetanus and measles. In India, these vaccines under the universal immunisation programme are made available absolutely free of cost to all children through the public health system. Information regarding immunisation coverage among HIV exposed children in India is still very limited. The objective of this study was to estimate the proportion of children of people living with HIV who had been completely immunised by the age of 12 months and to find predictors of complete immunisation. A community-based cross-sectional survey was conducted in the Kolkata Metropolitan Area between 15 June and 14 September 2009 using a pre-structured interview schedule. Data were analysed from 256 care-givers of children (85.5% response rate) whose parents were randomly selected from the Bengal Network of HIV-positive people. Multiple logistic regression was used to estimate and test associations of predictors with complete immunisation. The percentage of children of people living with HIV completely immunised at the age of 12 months was 73.0% (67.3% to 78.1%), which was not significantly different from that for all children at 12 months. Mothers having received antenatal care [OR (odds ratio): 7.29; 95% confidence intervals (CI): 2.39-22.25], mothers having postprimary education (OR: 3.37; 95% CI: 1.45-7.81), children of Hindu and Christian religion (OR: 3.74; 95% CI: 1.63-8.62), children not belonging to scheduled castes, tribes and 'other backward classes' (OR: 2.08; 95% CI: 1.02-4.25) were significant independent predictors of complete immunisation status of these children. This emphasises the imperative need for up-scaling of antenatal care among the pregnant mothers to ensure complete immunisation among their children. A special focus on girl child education should also be implemented to empower future mothers for a sustained improvement of child immunisation in the long-run. The current national immunisation programme should focus on the children from the Muslim community and those belonging to scheduled castes, tribes and other backward classes to improve coverage.
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Affiliation(s)
- Pinaki Sensarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Abstract
BACKGROUND The dominant theoretical basis of our public health practice originates from a positivist or reductionist paradigm. It fails to take into account the complexity emerging out of public health's multiple influences originating from biological and social worlds. A deeper understanding of the interaction of elements that characterize the implementation of public health functions will enhance our ability to generate evidence and learn further. OBJECTIVE The "interactive governance theory" by Jan Kooiman introduced here offers an analytical framework that uses the concept of "governability." It is a measure of how governable a particular social system is that takes care of a public function. Assessment is facilitated by breaking down and describing the social system into constituent parts and by exploring the properties, qualities, and the way in which they interact with each other. Further, by deliberating a complex public health function such as immunization services in the context of developing countries, we explore the application of the interactive governance theory and governability. CONCLUSION The theory offers new insights into how interactive and holistic approaches can be integrated into public health practice. The advantage of the concept of "governability" is that it enables us to explore why some governance systems deliver what they are expected to, while others do not. This might help us to identify areas where governance can be improved.
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Affiliation(s)
- Joe Varghese
- Community Health Department, Christian Medical Association of India, New Delhi, India.
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Abstract
The authors developed a scale for positive mental health (PMH), which encompasses positive state of mind and positive functioning. The existing tools are inadequate to measure the construct, especially in a community where the self-statement format of a scale is difficult to internalize. The authors constructed a tool from an initial item pool with the help of experts and validated it in a sample of 326 young people in the state of Kerala, India. Factor analysis gave 4 underlying factors for the construct of PMH. The scale (mean = 67.41 ± 9.49) has Cronbach's α value of .76 and test-retest correlation of .84. Convergent validity with the PMH Inventory is .864; discriminant validity with the Mental Health Inventory is .422. The findings prove that the scale, named the Achutha Menon Centre Positive Mental Health Scale, is reliable and valid and can be used in both individual- and population-based studies for measuring PMH.
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Affiliation(s)
- Nima S Ganga
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - V Raman Kutty
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Abstract
BACKGROUND AND OBJECTIVE Recent studies have presented evidence that periodontal disease in pregnant women may be a determining factor for preterm delivery. However, this finding has not been consistently observed. The present investigation was carried out to explore the association between maternal periodontal disease and preterm delivery in the state of Kerala, India. MATERIAL AND METHODS The case-control study had a sample of 300 (100 cases and 200 controls) postpartum women over 18 years of age. Cases were women who had undergone spontaneous preterm delivery (< 37 wk of gestation) and controls were women who delivered at term (≥ 37 wk of gestation). Standard, clinical and periodontal examinations were performed at the maternity wards, and the existence of an association between periodontal disease and preterm delivery was evaluated by means of a multivariate logistic regression model that also considered other risk factors for preterm delivery. RESULTS Periodontitis was diagnosed in 25% of the mothers in the case group and in 14.5% of the mothers in the control group. Logistic regression analysis indicated a risk of nearly threefold for preterm delivery in mothers with periodontitis [adjusted odds ratio (OR(a) ) = 2.72; 95% confidence interval (CI): 1.68-6.84]. The other factors significantly associated with preterm birth were physical exertion (OR(a) = 2.80; 95% CI: 1.18-6.65), a previous history of preterm birth (OR(a) = 2.65; 95% CI: 1.20-5.83) and previous abortion/death of infant (OR(a) = 4.08; 95% CI: 1.56-10.65). CONCLUSION Periodontal disease is a possible risk factor for preterm delivery in this population.
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Affiliation(s)
- J K Baskaradoss
- Achutha Menon Centre for Health Science Studies (AMCHSS), Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India.
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Kutty VR. The draft National Health Research Policy. Indian J Med Ethics 2011; 8:93-94. [PMID: 22106617 DOI: 10.20529/ijme.2011.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- V Raman Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology,Thiruvananthapuram 695 011 India.
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Abstract
BACKGROUND Studies from Tamil Nadu, South India, have reported the world's highest suicide rates. As per official reports, Kerala, another South Indian state has the highest suicide rate among the major states in India. OBJECTIVE The purpose of this analysis is to estimate the rates and age-specific incidence of suicide in a rural community in Kerala, under continuous observation for the last five years. SETTINGS AND DESIGN The study setting comprised of seven contiguous panchayats constituting a development block in Kerala. A prospective cohort study design was used. MATERIALS AND METHODS Through regular home visits, every death that occurred in the community was captured by local resident health workers and the cause of death assigned. STATISTICAL ANALYSIS Suicide rates by age and sex and relative share of suicide deaths to all-cause deaths in men and women were calculated. RESULTS During the five-year period from 2002 to 2007, 284 cases of suicide were reported. The suicide rates were 44.7/100,000 for males and 26.8/100,000 for females. Male to female suicide ratio was 1.7. Among females aged between 15 and 24, suicides constituted more than 50% of all deaths. Male to female ratio of suicide varied from 0.4 in children aged 14 years or less to 4.5 in the 45-54 year age group. CONCLUSION Our analysis shows that the level of under-reporting of suicides in rural Kerala is much less than that reported in Tamil Nadu.
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Affiliation(s)
- C R Soman
- Health Action by People, TC 7/1724, Temple Road, Kochulloor, Trivandrum, Kerala - 695 011, India
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Vijayakumar G, Arun R, Kutty VR. High prevalence of type 2 diabetes mellitus and other metabolic disorders in rural Central Kerala. J Assoc Physicians India 2009; 57:563-567. [PMID: 20209716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Within India, inter-regional disparities in burden of type 2 diabetes mellitus (DM) are expected because of varying lifestyles and demographic patterns. Hence, to estimate the prevalence of DM and impaired fasting glycaemia (IFG), and to explore the predictors of DM, a study was conducted in rural Kerala. METHODS In 2007, a cross-sectional survey was conducted among 1990 adults (women: 1149; men: 841) of two Panchayat Wards in Venmony Panchayat, Chengannur Taluk, Kerala, India. Those who were already on drugs for DM and/or having fasting plasma glucose (FBS) > or = 126 mg/dL were considered as DMs; those with FBS 100 -125 mg/dL were considered as IFGs. Pearson's Chi-Square test and multiple logistic regression were used for statistical analysis. RESULTS The response rate was 82.7 percent. The crude- and age-adjusted prevalence of DM was 14.6 percent and 12.5 percent respectively, and that of IFG was 5.1 percent and 4.6 percent respectively. The crude prevalence of hypertension (BP > or = 140/90), hypercholesterolemia (fasting total serum cholesterol > or = 200 mg/dL) and central obesity (WHR > or = 0.80 [women] and > or = 0.90 [men]) was 36.1 percent, 37.0 percent and 85.6 percent respectively. Adjusted for age and sex, DM was significantly associated with positive family history of DM [Odds ratio: 2.81; 95% CI (2.04-3.86)], high socioeconomic status [1.43; (1.04-1.95)], central obesity [3.91; (1.77-8.64)], hypercholesterolemia [1.93; (1.42-2.62)], and hypertension [1.71; (1.24-2.37)]. CONCLUSION High prevalence of DM even in rural community validates the pandemic trend of DM. The coexistence of other non-communicable diseases amplifies the burden of DM. The impact of socioeconomic transition on the occurrence of DM needs to be explored further.
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Affiliation(s)
- G Vijayakumar
- MedicalTrust Hospital and Diabetes Care Centre, Kulanada, Pathanamthitta-689 573, Kerala, India
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Abstract
This survey of obstetricians' knowledge and practices in two districts in Kerala, India, finds a number of unethical practices: most providers are unaware of the value of the rapid screening test for HIV, they do not give pregnant women the option to refuse testing; testing is done without counselling, private doctors refer pregnant women who test positive to government hospitals, and some health services have separate facilities for pregnant women who test positive.
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Lipska K, Sylaja PN, Sarma PS, Thankappan KR, Kutty VR, Vasan RS, Radhakrishnan K. Risk factors for acute ischaemic stroke in young adults in South India. J Neurol Neurosurg Psychiatry 2007; 78:959-63. [PMID: 17220290 PMCID: PMC2117871 DOI: 10.1136/jnnp.2006.106831] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Stroke is a leading cause of death and disability in developing countries, afflicting individuals at a young age. The contribution of established vascular risk factors to ischaemic stroke in young adults has not been evaluated systematically in Indians. METHODS We conducted a case control study in 214 South Indian patients with first acute ischaemic stroke that occurred between the ages of 15 and 45 years, 99 age and sex matched hospital controls and 96 community controls. We compared the prevalence of the following risk factors: smoking, elevated blood pressure, high fasting blood glucose and abnormal lipids. RESULTS Compared with community controls, stroke patients had a higher prevalence of smoking (multivariable adjusted odds ratio (OR) 7.77, 95% CI 1.93 to 31.27), higher systolic blood pressure (OR per SD increment of 1.88, 95% CI 1.01 to 3.49) and fasting blood glucose (OR per SD increment of 4.55, 95% CI 1.63 to 12.67), but lower high density lipoprotein (HDL) cholesterol (OR per SD increment of 0.17, 95% CI 0.09 to 0.30). Compared with hospital controls, stroke patients had a higher prevalence of smoking (OR 3.95, 95% CI 1.61 to 9.71) and lower HDL cholesterol (OR per SD increment 0.27, 95% CI 0.17 to 0.44). The presence of > or = 3 metabolic syndrome components was associated strongly with stroke (OR 4.76, 95% CI 1.93 to 11.76; OR 2.09, 95% CI 1.06 to 4.13) compared with community and hospital controls. CONCLUSIONS Key components of the metabolic syndrome and smoking are associated with ischaemic stroke in young South Indian adults. Our observations underscore the importance of targeting adolescents and young adults for screening and prevention to reduce the burden of ischaemic stroke in young adults.
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Affiliation(s)
- K Lipska
- Department of Medicine, Brigham and Women's Hospital, Boston University School of Medicine, Boston, Massachusetts, USA
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Kutty VR. Just and Lasting Change. When Communities Own Their Futures. Int J Epidemiol 2002. [DOI: 10.1093/ije/31.6.1281] [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: 11/13/2022] Open
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Kutty VR, Soman CR, Joseph A, Kumar KV, Pisharody R. Random capillary blood sugar and coronary risk factors in a south Kerala population. J Cardiovasc Risk 2002; 9:361-7. [PMID: 12478206 DOI: 10.1097/01.hjr.0000049241.21319.7c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND High prevalence of type 2 diabetes in one subdivision of a district in south India prompted us to look at the prevalence of other major coronary risk factors, and relate these to random blood sugar values. DESIGN Cross-sectional survey of all adult residents of four wards (clusters of households) of a subdivision. Detailed investigation for diabetes and blood lipids in a selected subsample with random blood sugar (RBS) >109 mg/dl by glucometer. METHODS From the selected wards, we conducted a standard oral glucose tolerance test and serum lipids in all those who had RBS above 109 mg/dl by glucometer. Risk factors such as smoking, obesity (body mass index > 29.9), high blood pressure (systolic pressure > 139; diastolic pressure > 89 mmHg) and sedentary habits were assessed in all irrespective of RBS. RESULTS Prevalence of all risk factors increases with age. Mean RBS ranges from 92.9 +/- 15.7 to 108.8 +/- 35.7 mg/dl in males and 88.6 +/- 16.0 to 117.3 +/- 61.6 mg/dl in females, between the age groups 20-29 to > 69. Risk factor prevalence varied with area of residence, with urban population reporting highest prevalence for type 2 diabetes and obesity, and coastal population for hypertension. For increasing levels of fasting plasma glucose (FPG < 100, 100-124 and > 125 mg/dl), serum total cholesterol values were 5.21 +/- 1.08 mM/l, 5.38 +/- 0.86 mM/l and 5.63 +/- 1.37 mM/l for males. For females, corresponding values were 5.23 +/- 1.11 mM/l, 5.54 +/- 1.15 mM/l, and 5.49 +/- 1.10 mM/l respectively. CONCLUSIONS Risk factor prevalence varies with area of residence within the study population. Mean plasma lipid levels are high among both sexes, tending to rise with increasing mean fasting plasma glucose levels.
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Rajasree S, Rajpal K, Kartha CC, Sarma PS, Kutty VR, Iyer CS, Girija G. Serum 25-hydroxyvitamin D3 levels are elevated in South Indian patients with ischemic heart disease. Eur J Epidemiol 2002; 17:567-71. [PMID: 11949730 DOI: 10.1023/a:1014559600042] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Several lines of evidence point to a possible relationship between vitamin D and cardiovascular disease. Animal experiments and observational studies in humans suggest vitamin D to be arteriotoxic and an association of high intake of vitamin D with increased incidence of ischemic heart disease (IHD). The major source of vitamin D in adults is vitamin D synthesized in the skin through exposure to the sun. In tropical environment there is a possibility of high level of solar exposure and enhanced serum levels of vitamin D in the population. We explored the relation between serum level of 25-hydroxyvitamin D3 and IHD in a case-control study involving 143 patients with either angiographic evidence of coronary artery disease or patients with acute myocardial infarction and 70 controls, all men in the age group of 45-65 years. Fasting blood samples were collected, serum separated and serum levels of 25-hydroxyvitamin D3 was measured by protein binding radioligand assay. Serum levels of cholesterol, triglyceride, calcium, magnesium and inorganic phosphate were also determined. Prevalences of diabetes, hypertension and smoking history were noted. Statistical comparisons of variables between cases and controls were done using chi2-tests. Multivariate logistic regression analysis was done to examine the association of IHD with serum levels of 25-hydroxyvitamin D3 controlling for selected variables. Serum levels of 25-hydroxyvitamin D3, calcium, inorganic phosphate, total cholesterol, low density lipoprotein and triglycerides were elevated in a higher proportion of patients, compared to controls. Serum levels of 25-OH-D3 above 222.5 nmol/l (89 ng/ml) was observed in 59.4% of cases compared to 22.1% in controls (p < 0.001; unadjusted odds ratio (OR): 5.17; 95% confidence interval (CI): 2.62-10.21). When controlled for age and selected variables using the multivariate logistic regression, the adjusted OR relating elevated serum 25-hydroxyvitamin D3 levels (> or = 222.5 nmol/l, > or = 89 ng/ml) and IHD is 3.18 (95% CI: 1.31-7.73). Given the evidences for the arteriotoxicity of vitamin D, further investigations are warranted to probe whether the elevated serum levels of 25-hydroxyvitamin D3 observed in patients with IHD in a tropical environment has any pathogenic significance.
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Affiliation(s)
- S Rajasree
- Department of Cardiology and Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Sivan YS, Alwin Jayakumar Y, Arumughan C, Sundaresan A, Jayalekshmy A, Suja KP, Soban Kumar DR, Deepa SS, Damodaran M, Soman CR, Raman Kutty V, Sankara Sarma P. Impact of vitamin A supplementation through different dosages of red palm oil and retinol palmitate on preschool children. J Trop Pediatr 2002; 48:24-8. [PMID: 11871368 DOI: 10.1093/tropej/48.1.24] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Red palm oil (5 ml and 10 ml), ground nut oil fortified with 400 and 800 retinol equivalent retinol palmitate, and ground nut oil (5 and 10 ml), were administered to six groups of preschool children (four experimental and two control groups) in randomly assigned balwadis of Ramanathapuram District of Tamil Nadu for a period of 7 months, to monitor the difference in the efficacy of the mode of supplementation and the optimum dose for improving vitamin A status. Results show that red palm oil groups recorded more gain in retinol and beta-carotene levels compared to other dosage groups, and that administration of 10 ml did not offer any substantial improvement over the 5-ml daily dose.
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Affiliation(s)
- Y S Sivan
- Regional Research Laboratory, Council of Scientific & Industrial Research, Trivandrum, India
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