{"title":"Dealing with the epidemic of drug use","authors":"Rakesh K. Chadda","doi":"10.25259/ijmr_501_2024","DOIUrl":"https://doi.org/10.25259/ijmr_501_2024","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141922054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advances in TB diagnostics: A critical element for the elimination toolkit","authors":"Ankur Gupta-Wright, Claudia M Denkinger","doi":"10.25259/ijmr_261_2024","DOIUrl":"https://doi.org/10.25259/ijmr_261_2024","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141802239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Frailty is a geriatric syndrome with clinical and public health implications. It represents the state of increased vulnerability. This study aimed to estimate the prevalence of frailty and pre-frailty by demographic characteristics and geographical regions in India. Furthermore, it also aimed to examine the association of this prevalence with selected health outcomes using data from the Longitudinal Ageing Study of India (LASI). This is a secondary analysis of LASI wave-1 data. A total of 26,058 respondents aged ≥60 yr were included for analysis. Frailty was assessed using Fried’s frailty phenotype, including slowness, shrinking, low physical activity, weakness, and low endurance. Descriptive statistics were used to study frailty distribution. The odds ratio (OR) of health events across the frailty categories was computed using ordinal logistic regression. The findings of this study suggest that the prevalence of frailty and pre-frailty was 29.2 and 58.8 per cent, respectively. The prevalence of frailty was higher among women (37.3%), illiterate (37%) and rural residents (31%). It ranged between 14.5 per cent in Uttarakhand and 41.3 per cent in Arunachal Pradesh. Frailty was strongly associated with depression [OR: 2.09, Confidence Interval (CI): 1.98–2.21] and activities of daily living (ADL) difficulty (OR: 1.75, CI: 1.64–1.86). Higher odds were reported for fracture (OR: 1.24, CI: 1.01–1.51) and multimorbidity (OR: 1.18, CI: 1.04–1.33) among frailty. The heterogeneity of frailty prevalence across States indicates the need for population-specific strategies. A sharp age-related increase in prevalence highlights the need for preventive measures. Furthermore, the high prevalence of frailty among women, illiterate and rural residents indicates the target population for receiving preventive interventions. Lastly, a heterogeneity in frailty prevalence across different States indicates the scope for region-specific programmes.
{"title":"Regional variation in prevalence of frailty in India: Evidence from longitudinal ageing study in India (LASI) wave-1","authors":"A. Nagarkar, Amruta Shantaram Kulkarni","doi":"10.25259/ijmr_865_22","DOIUrl":"https://doi.org/10.25259/ijmr_865_22","url":null,"abstract":"\u0000\u0000Frailty is a geriatric syndrome with clinical and public health implications. It represents the state of increased vulnerability. This study aimed to estimate the prevalence of frailty and pre-frailty by demographic characteristics and geographical regions in India. Furthermore, it also aimed to examine the association of this prevalence with selected health outcomes using data from the Longitudinal Ageing Study of India (LASI).\u0000\u0000\u0000\u0000This is a secondary analysis of LASI wave-1 data. A total of 26,058 respondents aged ≥60 yr were included for analysis. Frailty was assessed using Fried’s frailty phenotype, including slowness, shrinking, low physical activity, weakness, and low endurance. Descriptive statistics were used to study frailty distribution. The odds ratio (OR) of health events across the frailty categories was computed using ordinal logistic regression.\u0000\u0000\u0000\u0000The findings of this study suggest that the prevalence of frailty and pre-frailty was 29.2 and 58.8 per cent, respectively. The prevalence of frailty was higher among women (37.3%), illiterate (37%) and rural residents (31%). It ranged between 14.5 per cent in Uttarakhand and 41.3 per cent in Arunachal Pradesh. Frailty was strongly associated with depression [OR: 2.09, Confidence Interval (CI): 1.98–2.21] and activities of daily living (ADL) difficulty (OR: 1.75, CI: 1.64–1.86). Higher odds were reported for fracture (OR: 1.24, CI: 1.01–1.51) and multimorbidity (OR: 1.18, CI: 1.04–1.33) among frailty.\u0000\u0000\u0000\u0000The heterogeneity of frailty prevalence across States indicates the need for population-specific strategies. A sharp age-related increase in prevalence highlights the need for preventive measures. Furthermore, the high prevalence of frailty among women, illiterate and rural residents indicates the target population for receiving preventive interventions. Lastly, a heterogeneity in frailty prevalence across different States indicates the scope for region-specific programmes.\u0000","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141798852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nobhojit Roy, M. Khajanchi, Isaac G. Alty, Radzi Hamzah, Anna Aroke, Niladri Banerjee, Sanjeev Bhoi, Shamita Chatterjee, K. Soni, A. Gadgil, Gopalkrishna Gururaj, J. Jagnoor, Anip Joshi, M. Joshipura, Jyoti Kamble, Ajai K. Malhotra, Sarosh Mehta, Charles N. Mock, Rajashekar Mohan, Priyansh Nathani, Roopa Rawat, B. Sarang, Mohan Raj Sharma, Naveen Sharma, T. Sinha, P. Tewari, Carolina Torres Perez-Iglesias, Isita Tripathi, P. T. Leitz, Nakul P. Raykar
Injuries profoundly impact global health, with substantial deaths and disabilities, especially in low- and middle-income countries (LMICs). This paper presents strategic consensus from the Transdisciplinary Research, Advocacy, and Implementation Network for Trauma in India (TRAIN Trauma India) symposium, advocating for enhanced, system-level trauma care to address this challenge. Five working groups conducted separate literature reviews on pre-hospital trauma care, in-hospital trauma resuscitation and training, trauma systems, trauma registries, and India’s Towards Improving Trauma Care Outcomes (TITCO) registry. Using a Delphi approach, the TRAIN Trauma India Symposium generated consensus statements and recommendations for interventions to streamline trauma care and reduce preventable trauma mortality in India and LMICs. Experts prioritized interventions based on cost and difficulty. An expert panel agreed on four pre-hospital consensus statements, eight hospital resuscitation consensus statements, six system-level consensus statements, and six trauma registry consensus statements. The expert panel recommended six pre-hospital interventions, four hospital resuscitation interventions, nine system-level interventions, and seven trauma registry interventions applicable to the Indian context. Of these, 14 interventions were ranked as low cost/low difficulty, five high cost/low difficulty, five low cost/high difficulty, and three high cost/high difficulty. This consensus underscores the urgent need for integrated and efficient trauma systems to reduce preventable mortality, emphasizing the importance of comprehensive care that includes community engagement and robust pre-hospital and acute hospital trauma care pathways. It highlights the critical role of inclusive, system-wide approaches, from enhancing pre-hospital care and in-hospital resuscitation to implementing effective trauma registries to improve outcomes and streamline care across contexts.
{"title":"Consensus recommendations for acute trauma care & outcomes in LMICs from the transdisciplinary research, advocacy & implementation network for trauma in India","authors":"Nobhojit Roy, M. Khajanchi, Isaac G. Alty, Radzi Hamzah, Anna Aroke, Niladri Banerjee, Sanjeev Bhoi, Shamita Chatterjee, K. Soni, A. Gadgil, Gopalkrishna Gururaj, J. Jagnoor, Anip Joshi, M. Joshipura, Jyoti Kamble, Ajai K. Malhotra, Sarosh Mehta, Charles N. Mock, Rajashekar Mohan, Priyansh Nathani, Roopa Rawat, B. Sarang, Mohan Raj Sharma, Naveen Sharma, T. Sinha, P. Tewari, Carolina Torres Perez-Iglesias, Isita Tripathi, P. T. Leitz, Nakul P. Raykar","doi":"10.25259/ijmr_2417_23","DOIUrl":"https://doi.org/10.25259/ijmr_2417_23","url":null,"abstract":"\u0000\u0000Injuries profoundly impact global health, with substantial deaths and disabilities, especially in low- and middle-income countries (LMICs). This paper presents strategic consensus from the Transdisciplinary Research, Advocacy, and Implementation Network for Trauma in India (TRAIN Trauma India) symposium, advocating for enhanced, system-level trauma care to address this challenge.\u0000\u0000\u0000\u0000Five working groups conducted separate literature reviews on pre-hospital trauma care, in-hospital trauma resuscitation and training, trauma systems, trauma registries, and India’s Towards Improving Trauma Care Outcomes (TITCO) registry. Using a Delphi approach, the TRAIN Trauma India Symposium generated consensus statements and recommendations for interventions to streamline trauma care and reduce preventable trauma mortality in India and LMICs. Experts prioritized interventions based on cost and difficulty.\u0000\u0000\u0000\u0000An expert panel agreed on four pre-hospital consensus statements, eight hospital resuscitation consensus statements, six system-level consensus statements, and six trauma registry consensus statements. The expert panel recommended six pre-hospital interventions, four hospital resuscitation interventions, nine system-level interventions, and seven trauma registry interventions applicable to the Indian context. Of these, 14 interventions were ranked as low cost/low difficulty, five high cost/low difficulty, five low cost/high difficulty, and three high cost/high difficulty.\u0000\u0000\u0000\u0000This consensus underscores the urgent need for integrated and efficient trauma systems to reduce preventable mortality, emphasizing the importance of comprehensive care that includes community engagement and robust pre-hospital and acute hospital trauma care pathways. It highlights the critical role of inclusive, system-wide approaches, from enhancing pre-hospital care and in-hospital resuscitation to implementing effective trauma registries to improve outcomes and streamline care across contexts.\u0000","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141821602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Implementation science in health & the proverbial slip between the cup & the lips","authors":"Samiran Panda","doi":"10.25259/ijmr_348_2024","DOIUrl":"https://doi.org/10.25259/ijmr_348_2024","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141822794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anupam Datta Gupta, Koninika Datta Gupta, T. Kleinig
India is home to one-fifth of the world’s population and is currently the fastest-growing economy. As the health industry is growing, India needs to develop robust implementation of evidence-based health care addressing the major public health issues. Two of such issues India is grappling with are the establishment of stroke care and the reduction of road accidents. Australia has achieved notable success in implementing stroke care and reducing road accidents. In stroke, Australian initiatives include dedicated stroke units, the development of clinical guidelines, the implementation of acute interventions, the establishment of a national stroke foundation, and the stroke registry. As a result, the combined, primary, and secondary prevention measures, acute treatment, and rehabilitation have reduced the total disease burden of stroke from 2003 to 2023 by 53 per cent, from 7.4 to 3.5 Disability Adjusted Life Years (DALYS) per 1,000 population, which is a 56 per cent decline in fatal burden and 23 per cent decline in non-fatal burden. For road safety, Australia implemented evidence-based practices such as education, legislation including mandatory use of seat belts, and other road safety initiatives. Data show that seat belt use reached 98 per cent in Australia in 2023. Furthermore, about 20 per cent of drivers as well as passengers who were killed in crashes in 2024 did not wear seat belts. The reduction of speed limits in built-up areas, the adoption of monitoring technology, and the clever use of infrastructure are proving to be effective in reducing fatalities and serious injuries. Australia’s implementation research can provide valuable insights into the efforts of mitigating the impact of stroke and enhancing road safety in India.
{"title":"Implementation of stroke care & road safety in India: Lessons from Australia","authors":"Anupam Datta Gupta, Koninika Datta Gupta, T. Kleinig","doi":"10.25259/ijmr_274_2024","DOIUrl":"https://doi.org/10.25259/ijmr_274_2024","url":null,"abstract":"India is home to one-fifth of the world’s population and is currently the fastest-growing economy. As the health industry is growing, India needs to develop robust implementation of evidence-based health care addressing the major public health issues. Two of such issues India is grappling with are the establishment of stroke care and the reduction of road accidents. Australia has achieved notable success in implementing stroke care and reducing road accidents. In stroke, Australian initiatives include dedicated stroke units, the development of clinical guidelines, the implementation of acute interventions, the establishment of a national stroke foundation, and the stroke registry. As a result, the combined, primary, and secondary prevention measures, acute treatment, and rehabilitation have reduced the total disease burden of stroke from 2003 to 2023 by 53 per cent, from 7.4 to 3.5 Disability Adjusted Life Years (DALYS) per 1,000 population, which is a 56 per cent decline in fatal burden and 23 per cent decline in non-fatal burden. For road safety, Australia implemented evidence-based practices such as education, legislation including mandatory use of seat belts, and other road safety initiatives. Data show that seat belt use reached 98 per cent in Australia in 2023. Furthermore, about 20 per cent of drivers as well as passengers who were killed in crashes in 2024 did not wear seat belts. The reduction of speed limits in built-up areas, the adoption of monitoring technology, and the clever use of infrastructure are proving to be effective in reducing fatalities and serious injuries. Australia’s implementation research can provide valuable insights into the efforts of mitigating the impact of stroke and enhancing road safety in India.","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141822517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria P. Cote, Radzi Hamzah, Isaac G. Alty, Isita Tripathi, Adriana Montalvan, Sophia M. Leonard, Jyoti Kamble, Saad Javed, Sabrina Asturias, M. Khajanchi, Nakul P. Raykar
Many low- and middle- income countries (LMICs) have attempted to implement trauma registries with varying degrees of success. This study aimed to understand the registry implementation mechanism in LMICs better. Study objectives include assessment of the current use of trauma registries in LMICs, identification of barriers to the process and potential areas for intervention, and investigation of the registry implementation experience of key stakeholders in LMICs. An initial narrative review of articles on trauma registry use in LMICs published in English between January 2017 and September 2023 was conducted. Key findings identified in this review were used to establish a theoretical framework from which an interview guide was subsequently developed. Expert consultation with key stakeholders in trauma registry implementation in two LMICs was conducted to assess the experience of registry implementation further. The presence of trauma registries in LMICs is limited. Key implementation barriers include funding concerns, uncoordinated administrative efforts, lack of human and physical resources (i.e., technology, equipment), and challenges in data management, analysis, and quality. Stakeholder interviews highlighted the importance of trauma registry development but echoed some obstacles, notably funding and data collection barriers. Barriers to registry implementation are ubiquitous and may contribute to the low uptake of registries in LMICs. One potential solution to these challenges is the application of the WHO International Registry for Trauma and Emergency Care. Future studies examining context-specific challenges to registry implementation and sustained utilization are required.
{"title":"Current status of implementation of trauma registries’ in LMICs & facilitators to implementation barriers: A literature review & consultation","authors":"Maria P. Cote, Radzi Hamzah, Isaac G. Alty, Isita Tripathi, Adriana Montalvan, Sophia M. Leonard, Jyoti Kamble, Saad Javed, Sabrina Asturias, M. Khajanchi, Nakul P. Raykar","doi":"10.25259/ijmr_2420_23","DOIUrl":"https://doi.org/10.25259/ijmr_2420_23","url":null,"abstract":"\u0000\u0000Many low- and middle- income countries (LMICs) have attempted to implement trauma registries with varying degrees of success. This study aimed to understand the registry implementation mechanism in LMICs better. Study objectives include assessment of the current use of trauma registries in LMICs, identification of barriers to the process and potential areas for intervention, and investigation of the registry implementation experience of key stakeholders in LMICs.\u0000\u0000\u0000\u0000An initial narrative review of articles on trauma registry use in LMICs published in English between January 2017 and September 2023 was conducted. Key findings identified in this review were used to establish a theoretical framework from which an interview guide was subsequently developed. Expert consultation with key stakeholders in trauma registry implementation in two LMICs was conducted to assess the experience of registry implementation further.\u0000\u0000\u0000\u0000The presence of trauma registries in LMICs is limited. Key implementation barriers include funding concerns, uncoordinated administrative efforts, lack of human and physical resources (i.e., technology, equipment), and challenges in data management, analysis, and quality. Stakeholder interviews highlighted the importance of trauma registry development but echoed some obstacles, notably funding and data collection barriers.\u0000\u0000\u0000\u0000Barriers to registry implementation are ubiquitous and may contribute to the low uptake of registries in LMICs. One potential solution to these challenges is the application of the WHO International Registry for Trauma and Emergency Care. Future studies examining context-specific challenges to registry implementation and sustained utilization are required.\u0000","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141820665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Aroke Anthony, Khushboo Panchal, Fleming Mathew, K. Soni, Ajai K. Malhotra
Trauma is one of the leading causes of disability and death, worldwide. Ninety per cent of trauma related mortality occurs in low- and middle-income countries (LMICs). Despite this, there is paucity of literature emanating from LMICs with studies that present and/or evaluate feasible interventions that can have a measurable impact on outcomes after injury, primarily mortality. The current article aims at developing such interventions key elements of implementation and measures of compliance and impact. A literature review was conducted to evaluate the status of injury care among LMICs worldwide. Based on this review, interventions were identified/developed, that (i) were feasible to implement within the constraints of available resources; (ii) could be implemented within a two year timespan; and (iii) would improve outcomes primarily, mortality. These interventions were then discussed at a symposium of experts and stakeholders from around the world. The literature review identified gaps across the entire spectrum of injury care at all levels – primary, secondary and tertiary prevention. Additionally, lack of data systems capable of ensuring quality of care and driving performance improvement was identified. Utilizing the review as the basis and focusing on hospital level interventions, one policy intervention, five in-hospital interventions and one major research question were identified/developed that met the defined criteria. Gaps in trauma care in LMICs at every level and in data systems were identified. Feasible interventions that can be implemented within the resource constraints of LMICs in a reasonable timeframe and that can have a measurable impact on injury related mortality were developed and are presented.
{"title":"Hospital level interventions to improve outcomes after injury in India, a LMIC","authors":"Anna Aroke Anthony, Khushboo Panchal, Fleming Mathew, K. Soni, Ajai K. Malhotra","doi":"10.25259/ijmr_2398_23","DOIUrl":"https://doi.org/10.25259/ijmr_2398_23","url":null,"abstract":"\u0000\u0000Trauma is one of the leading causes of disability and death, worldwide. Ninety per cent of trauma related mortality occurs in low- and middle-income countries (LMICs). Despite this, there is paucity of literature emanating from LMICs with studies that present and/or evaluate feasible interventions that can have a measurable impact on outcomes after injury, primarily mortality. The current article aims at developing such interventions key elements of implementation and measures of compliance and impact.\u0000\u0000\u0000\u0000A literature review was conducted to evaluate the status of injury care among LMICs worldwide. Based on this review, interventions were identified/developed, that (i) were feasible to implement within the constraints of available resources; (ii) could be implemented within a two year timespan; and (iii) would improve outcomes primarily, mortality. These interventions were then discussed at a symposium of experts and stakeholders from around the world.\u0000\u0000\u0000\u0000The literature review identified gaps across the entire spectrum of injury care at all levels – primary, secondary and tertiary prevention. Additionally, lack of data systems capable of ensuring quality of care and driving performance improvement was identified. Utilizing the review as the basis and focusing on hospital level interventions, one policy intervention, five in-hospital interventions and one major research question were identified/developed that met the defined criteria.\u0000\u0000\u0000\u0000Gaps in trauma care in LMICs at every level and in data systems were identified. Feasible interventions that can be implemented within the resource constraints of LMICs in a reasonable timeframe and that can have a measurable impact on injury related mortality were developed and are presented.\u0000","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141820806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Globally, vitamin D deficiency has been incriminated in poor bone health and growth retardation in children, impaired adult musculoskeletal health (classically described), increased risk of cardiovascular events, immune dysfunction, neurologic disorders, insulin resistance and its multiple sequelae, polycystic ovary syndrome (PCOS) and certain cancers. This review intends to holistically highlight the burden of vitamin D deficiency among children in India, the public health importance, and potential therapeutic and preventive options, utilizing the concept of implementation research. A systematic search was carried out on PubMed, Embase, China National Knowledge Infrastructure (CNKI) and Cochrane database, clinicaltrials.gov, Google Scholar, and ctri.nic.in with the keywords or MeSH terms namely ‘vitamin D’, ‘cholecalciferol’, ‘ergocalciferol’, ‘children’, connected with appropriate boolean operators. Vitamin D deficiency/insufficiency prevalence varies from 70-90 per cent in Indian children. Rickets, stunting, impaired bone mineral health, and dental health are common problems in these children. Serum 25-hydroxy vitamin D (25(OH)D) should be maintained >20 ng/ml in children. Oral vitamin D supplementation has a high therapeutic window (1200-10,000 IU/d well tolerated). Fortification of grains, cereal, milk, bread, fruit juice, yogurt, and cheese with vitamin D has been tried in different countries across the globe. From Indian perspective, fortification of food items which is virtually used by everyone would be ideal like fortified milk or cooking oil. Fortification of “laddus” made from “Bengal gram” with vitamin D as a part of a mid-day meal programme for children can be an option. There is enough evidence from India to suggest the importance and utility of food fortification with vitamin D to address the epidemic of vitamin D deficiency/insufficiency in children.
在全球范围内，维生素 D 缺乏导致儿童骨骼健康不良和生长迟缓、成人肌肉骨骼健康受损（经典描述）、心血管事件风险增加、免疫功能障碍、神经系统疾病、胰岛素抵抗及其多种后遗症、多囊卵巢综合征（PCOS）和某些癌症。本综述旨在利用实施研究的概念，全面强调印度儿童维生素 D 缺乏症的负担、对公共卫生的重要性以及潜在的治疗和预防方案。gov、Google Scholar 和 ctri.nic.in，关键词或 MeSH 术语为 "维生素 D"、"胆钙化醇"、"麦角钙化醇"、"儿童"，并使用适当的布尔运算符连接。佝偻病、发育迟缓、骨骼矿物质健康受损和牙齿健康是这些儿童的常见问题。儿童血清 25- 羟基维生素 D（25(OH)D）应保持在 20 纳克/毫升以上。口服维生素 D 补充剂具有较高的治疗窗口期（1200-10000 IU/天，耐受性良好）。全球不同国家已尝试在谷物、麦片、牛奶、面包、果汁、酸奶和奶酪中添加维生素 D。从印度的角度来看，强化牛奶或食用油等人人都会食用的食品是理想的选择。印度有足够的证据表明，添加维生素 D 的食品强化剂对解决儿童维生素 D 缺乏/不足流行病的重要性和实用性。
{"title":"Strategies to build stronger bones in Indian children: Challenges for implementation","authors":"S. Mukhopadhyay, D. Dutta","doi":"10.25259/ijmr_233_2024","DOIUrl":"https://doi.org/10.25259/ijmr_233_2024","url":null,"abstract":"\u0000\u0000Globally, vitamin D deficiency has been incriminated in poor bone health and growth retardation in children, impaired adult musculoskeletal health (classically described), increased risk of cardiovascular events, immune dysfunction, neurologic disorders, insulin resistance and its multiple sequelae, polycystic ovary syndrome (PCOS) and certain cancers. This review intends to holistically highlight the burden of vitamin D deficiency among children in India, the public health importance, and potential therapeutic and preventive options, utilizing the concept of implementation research.\u0000\u0000\u0000\u0000A systematic search was carried out on PubMed, Embase, China National Knowledge Infrastructure (CNKI) and Cochrane database, clinicaltrials.gov, Google Scholar, and ctri.nic.in with the keywords or MeSH terms namely ‘vitamin D’, ‘cholecalciferol’, ‘ergocalciferol’, ‘children’, connected with appropriate boolean operators.\u0000\u0000\u0000\u0000Vitamin D deficiency/insufficiency prevalence varies from 70-90 per cent in Indian children. Rickets, stunting, impaired bone mineral health, and dental health are common problems in these children. Serum 25-hydroxy vitamin D (25(OH)D) should be maintained >20 ng/ml in children. Oral vitamin D supplementation has a high therapeutic window (1200-10,000 IU/d well tolerated). Fortification of grains, cereal, milk, bread, fruit juice, yogurt, and cheese with vitamin D has been tried in different countries across the globe. From Indian perspective, fortification of food items which is virtually used by everyone would be ideal like fortified milk or cooking oil. Fortification of “laddus” made from “Bengal gram” with vitamin D as a part of a mid-day meal programme for children can be an option.\u0000\u0000\u0000\u0000There is enough evidence from India to suggest the importance and utility of food fortification with vitamin D to address the epidemic of vitamin D deficiency/insufficiency in children.\u0000","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141820807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Asadullah, R. Amarchand, Ambuj Roy, Rohit Bhatia, Rakesh Kumar, Anand Krishnan
Improving access to acute cardiac care requires remodelling of existing health systems into a service delivery network with an anchor establishment (Hub) offering a full array of services, complemented by spoke establishments that offer limited services. We assessed the availability of cardiac services in the district of Faridabad in the northern State of Haryana, India and explored the feasibility and challenges of implementing a hub-and-spoke model. In 2019-2020, we listed all the facilities in private and public sectors in the study-district and mapped their geocoordinates with the help of QGIS (Quantum Geographic Information System) software version 3.20. After consent, we assessed the availability of specific cardiac care-related inputs (medicines, technologies and staff) using a checklist by enquiring from the hospital staff. Each facility was classified as L1 (No ECG) to L5 (cardiac catheterization) as per the national guidelines for the management of ST-elevation myocardial infarction (STEMI). There were 109 health facilities (66% private) in the district, 1.6 cardiologists and 5.4 coronary care unit beds per 100,000 population (94% private). Only one district hospital running in a public-private partnership mode at the L5 level provided any cardiac services. Private facilities were providing a range of services with a considerable number of them functional at L5. The higher-level facilities were concentrated in the central and urban parts of the district. Only 46 per cent of the ambulances had oxygen cylinders and 14.7 per cent had defibrillators. Implementation of a hub-and-spoke model for cardiac care in Faridabad district will require significant strengthening of public health services, development of a private-sector participation model, and strengthening of ambulance services.
{"title":"Strengthening cardiac services in Faridabad District: A facility mapping exercise to explore implementation of a hub-and-spoke model","authors":"Muhammad Asadullah, R. Amarchand, Ambuj Roy, Rohit Bhatia, Rakesh Kumar, Anand Krishnan","doi":"10.25259/ijmr_1789_23","DOIUrl":"https://doi.org/10.25259/ijmr_1789_23","url":null,"abstract":"\u0000\u0000Improving access to acute cardiac care requires remodelling of existing health systems into a service delivery network with an anchor establishment (Hub) offering a full array of services, complemented by spoke establishments that offer limited services. We assessed the availability of cardiac services in the district of Faridabad in the northern State of Haryana, India and explored the feasibility and challenges of implementing a hub-and-spoke model.\u0000\u0000\u0000\u0000In 2019-2020, we listed all the facilities in private and public sectors in the study-district and mapped their geocoordinates with the help of QGIS (Quantum Geographic Information System) software version 3.20. After consent, we assessed the availability of specific cardiac care-related inputs (medicines, technologies and staff) using a checklist by enquiring from the hospital staff. Each facility was classified as L1 (No ECG) to L5 (cardiac catheterization) as per the national guidelines for the management of ST-elevation myocardial infarction (STEMI).\u0000\u0000\u0000\u0000There were 109 health facilities (66% private) in the district, 1.6 cardiologists and 5.4 coronary care unit beds per 100,000 population (94% private). Only one district hospital running in a public-private partnership mode at the L5 level provided any cardiac services. Private facilities were providing a range of services with a considerable number of them functional at L5. The higher-level facilities were concentrated in the central and urban parts of the district. Only 46 per cent of the ambulances had oxygen cylinders and 14.7 per cent had defibrillators.\u0000\u0000\u0000\u0000Implementation of a hub-and-spoke model for cardiac care in Faridabad district will require significant strengthening of public health services, development of a private-sector participation model, and strengthening of ambulance services.\u0000","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141821888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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