Indian Journal of Medical Research最新文献

Background & objectives The global population is ageing, with an increase in older adults in lower middle-income countries (LMICs). Fragmented data from LMICs indicate the need for the estimation of mental health disorders to guide policies, resource allocation, and sustainable mental health strategies. This systematic review and meta-analysis calculated the overall prevalence of depressive, anxiety, sleep and substance use disorders in older adults aged ≥60 yr in LMICs. Methods The protocol was registered in PROSPERO (CRD42024503470). A systematic search across PubMed, Scopus, and Cochrane Central was conducted (Dec 2023-Jan 2024), focusing on cross-sectional studies published in English. Quality assessments were conducted using the AXIS tool. A random-effects model was used to estimate pooled prevalence; heterogeneity was calculated using I2 statistics. Results Out of 4,204 articles, 92 studies were included, with the majority from India (n=29), Iran (n=11) and Nigeria (n=9). Pooled prevalence of depressive disorders was 38.76 per cent [95% confidence interval (CI): 34.25-43.28%; n=76; I2=96.89%], sleep disorders 33.58 per cent (95% CI: 27.03-40.14%; n=20; I2=95.76%), anxiety disorders 27.76 per cent (95% CI: 13.74-41.79%; n=13; I2=96.62%), and substance use disorders 26.36 per cent (95% CI: 14.23-38.49%; n=9; I2=96.86%). Depressive disorders were the highest in Africa, while sleep, anxiety, and substance use disorders were at higher rates in Asia. Interpretation & conclusions The findings emphasise the high burden of mental health disorders among older adults in LMICs, which indicate the need for strategic management. Early diagnosis, treatment, and integration of mental health into primary care, along with capacity building of the health care workers, are urgently needed.

Background & objectives Hypertension, traditionally a significant health issue among adults, is now increasingly being observed in the paediatric population posing long-term cardiovascular risks. This study evaluated a school-based hypertension education intervention for adolescents and its impact on their hypertensive family members. Objectives included assessing adolescents' knowledge retention, knowledge transfer to adults, and the effects of child-led monitoring on adult compliance. Methods The study was conducted in two phases. In Phase 1, the study involved adolescents from classes 6-10 (n=423). Phase 1 assessed hypertension knowledge changes post-intervention from baseline scores across 6 interval points through 91 days using hypertension knowledge test (HKT). In Phase 2, adolescents and their hypertensive family members (n=181) were recruited in pairs. Changes in HKT, hypertension compliance (hypertension compliance scale: HyCompS), and mean arterial pressure (MAP) were analysed pre- and post-intervention using paired t-tests. Adolescents tracked adult adherence via daily monitoring diaries, analysed descriptively. Results In Phase 1, adolescents showed significant and sustained improvements in hypertension knowledge despite minor dips on the 35th and 63rd days. In Phase 2, adults' knowledge improved significantly in overall and general awareness domains. Compliance increased, particularly for medication and lifestyle monitoring, with significant reduction in MAP. Children recorded high monitoring adherence-medication (77.6%), exercise (72%), and diet (66%). Interpretation & conclusions Adolescents can effectively serve as health advocates, promoting hypertension awareness and compliance within families. Structured school interventions may improve both adolescent and adult health outcomes. Longitudinal studies with larger samples are recommended.

Background & objectives Extreme heat in cities poses significant health risks especially to vulnerable populations. Climate change has led to heatwaves in India increasing in frequency and duration. To address the heat-health challenges, heat action plans (HAPs) are a key instrument for heat governance. The objective of this study is to critically assess city level HAPs from India, in terms of the eight core elements identified by the World Health Organization guidance on heat-health action. Methods The study uses a benchmarking approach in mapping the representation of core elements across eight city-level HAPs, to assess the plan's coverage and extent of development for each element and its sub-elements. Supportive text analysis was conducted using R software to study the frequency of use of words in the HAPs and key words corresponding to core elements. Results The HAPs varied in design and scope, with core elements that require long-term institutional and/or intersectoral planning and implementation receiving least attention. These elements included care for vulnerable populations, health system preparedness, long-term urban planning, and surveillance of health outcomes. The study identifies the dominant framing of the issue of heat as a time-limited disaster event (namely, a heatwave) as a significant barrier in designing HAPs that are responsive to local contexts and calls for long-term measures required to shape structural drivers of differential vulnerabilities. Interpretation & conclusions A paradigm shift from solely top-down disaster management to coupling with decentralised, community-informed management and long-term measures is essential to effectively address heat-related health risks in both the immediate and the long-term.

Background & objectives Quality of life (QoL) is a highly underrated yet an extremely crucial measure of the functional outcomes of any therapy. Reduction of intraocular pressure solely cannot determine the success of antiglaucoma therapy. This study was conducted to compare the QoL in patients with moderate to severe glaucoma on medical and surgical therapy, using glaucoma quality of life -15 (GQL-15) questionnaire. Methods A prospective observational study was conducted on 54 eyes of 46 individuals from October 2022 to December 2023. Normative values of the GQL-15 scores were obtained from a control group comprising 30 eyes of 15 age and sex-matched healthy individuals (non-glaucoma). The questionnaire was filled pre-operatively when participants were on medical management and at six months follow up after trabeculectomy i.e., on surgical management. GQL-15 scores were then compared among three groups in the study: controls, medical management and surgical management. Results The study showed poorer quality of life in individuals with glaucoma than in the control group. The GQL-15 scores significantly improved after trabeculectomy (32.1±10.3) compared to the medical management group (36.3±11), (P<0.001). A significant difference was observed for all questionnaire domains, including central and near vision, peripheral vision, dark adaptation and glare, and outdoor mobility (P<0.001) for all. Scores varied by glaucoma severity, with severe cases showing the poorest QoL. Interpretations & conclusions Surgical therapy may improve QoL in patients with moderate to severe glaucoma, suggesting a potential role for trabeculectomy over medical management.