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Variability in addictive and carcinogenic potential of smokeless tobacco products marketed in Mumbai, India: a surveillance study 印度孟买市场上销售的无烟烟草制品致瘾和致癌潜力的差异:一项监测研究
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-23 DOI: 10.1016/j.lansea.2024.100457
Sampada S. Nikam , Vikram Gota , Prakash C. Gupta , Namrata Puntambekar , Arjun Singh , Pankaj Chaturvedi , Peter W. Villalta , Dorothy K. Hatsukami , Jasjit S. Ahluwalia , Saonli Basu , Samir S. Khariwala , Irina Stepanov

Background

India has the highest incidence worldwide of smokeless tobacco (SLT)-associated oral cancer, accounting for nearly 70% of all SLT users globally. Nicotine and tobacco-specific N-nitrosamines (TSNA) play critical roles in the addictive and carcinogenic potential, respectively, of SLT products. Our group has previously reported substantial variability in nicotine and TSNA levels across a small SLT product sample in India, calling for systematic surveillance. However, there is no information available on the current levels of these constituents in Indian SLT.

Methods

We analysed 321 samples representing 57 brands of eight popular types of manufactured SLT products purchased from five local markets in Mumbai, India between August, and September 2019. The sampling locations were Mumbai Central, Kurla, Thane, Vashi, and Airoli. Product pH, moisture content, total and unprotonated (biologically available) nicotine, and TSNA levels were measured at the Advanced Centre for Treatment, Research, and Education in Cancer (ACTREC) in Mumbai.

Findings

Total nicotine content ranged from 0.45 to 35.1 mg/g across products. The unprotonated nicotine fraction contributed 0.1–100% of the total nicotine content. The carcinogenic TSNA levels ranged 0.06–76 ug/g for N′-nitrosonornicotine (NNN), 0.02–19.2 ug/g for 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), and 0.01–6.51 ug/g for 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). Consistent with our previous study, we observed substantial variations across different brands of the same product type.

Interpretation

This is the most extensive and the first within-country study to report brand-specific nicotine and TSNA levels in SLT products marketed in Mumbai, India. Our results show that levels of these constituents remain extremely variable across Indian SLT and are strikingly high in many products. Enhanced public education and continued efforts to reduce SLT use prevalence in India are critical for reducing the global burden of SLT-associated morbidity and mortality. Regulation of nicotine and TSNA levels in SLT products should be considered.

Funding

This work was supported by the National Institutes of Health (USA) grant R01-TW010651 and, in part, by grants R01-CA180880 and R50-CA211256. The LC-MS/MS analysis was supported in part by XII Plan project funding from the Department of Atomic Energy, Government of India.

背景印度是全球无烟烟草(SLT)相关口腔癌发病率最高的国家,占全球无烟烟草使用者总数的近 70%。尼古丁和烟草特异性 N-亚硝胺(TSNA)分别在无烟烟草产品的成瘾性和致癌性方面发挥着关键作用。我们的研究小组以前曾报告过印度一小部分 SLT 产品样本中尼古丁和 TSNA 含量的巨大差异,呼吁进行系统监测。我们分析了 2019 年 8 月至 9 月期间从印度孟买五个当地市场购买的 321 个样品,这些样品代表了八种流行的 SLT 制品的 57 个品牌。取样地点为孟买市中心、库尔勒、塔内、瓦什和艾罗利。孟买癌症治疗、研究和教育高级中心(ACTREC)对产品的pH值、水分含量、总尼古丁和非质子(生物可用)尼古丁以及TSNA水平进行了测量。非质子化尼古丁部分占尼古丁总含量的 0.1%-100%。N′-亚硝基烟碱(NNN)的致癌 TSNA 含量为 0.06-76 微克/克,4-(甲基亚硝基氨基)-1-(3-吡啶基)-1-丁酮(NNK)的致癌 TSNA 含量为 0.02-19.2 微克/克,4-(甲基亚硝基氨基)-1-(3-吡啶基)-1-丁醇(NNAL)的致癌 TSNA 含量为 0.01-6.51 微克/克。与我们之前的研究一致,我们观察到同一类型产品的不同品牌之间存在很大差异。解释 这是报告印度孟买市场上 SLT 产品中特定品牌尼古丁和 TSNA 含量的最广泛和首个国内研究。我们的研究结果表明,印度 SLT 产品的尼古丁和 TSNA 含量差异极大,许多产品的尼古丁和 TSNA 含量都非常高。加强公众教育,继续努力降低印度 SLT 的使用率,对于减轻 SLT 相关发病率和死亡率的全球负担至关重要。应考虑对 SLT 产品中的尼古丁和 TSNA 水平进行监管。LC-MS/MS 分析部分得到了印度政府原子能部 XII 计划项目资金的支持。
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引用次数: 0
The value of CT coronary angiography for a comprehensive assessment of left circumflex artery in Kawasaki disease: 9 years of experience from a tertiary center CT 冠状动脉造影对川崎病左侧环状动脉综合评估的价值:一家三级医疗中心的九年经验
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-23 DOI: 10.1016/j.lansea.2024.100471
Manphool Singhal , Rakesh Kumar Pilania , Abarna Thangaraj , Himanshi Chaudhary , Anjani Gummadi , Raghuraman Soundararajan , Sathish Loganathan , Arun Sharma , Aman Gupta , Sagar Bhattad , Ankur Kumar Jindal , Pandiarajan Vignesh , Deepti Suri , Manavjit Singh Sandhu , Surjit Singh

Background

Transthoracic echocardiography (TTE) has traditionally been the primary method for coronary imaging in children with Kawasaki disease (KD). We aimed to evaluate coronary artery lesions (CALs) of the left circumflex artery (LCx) in KD on computed tomography coronary angiography (CTCA).

Methods

Over a 9-year period (November 2013–December 2022), 225 children with KD underwent radiation-optimized CTCA on a 128-slice dual-source platform. TTE was performed on the same day, or a day prior or after CTCA.

Findings

On CTCA, LCx CALs were seen in 41/225 (18.2%) patients. However, TTE detected CALs in only one third of these patients [15/41 (36.6%)]. CTCA showed 47 LCx CALs in 41 patients–aneurysms in 39 patients (40 fusiform, 2 saccular; 7 giant aneurysms), stenoses in 3, and thrombosis in 2. Thromboses and stenoses were both missed on TTE. Proximal LCx aneurysms were seen in 39 patients–of these, 12 had distal extension. Six patients had distal LCx aneurysms without proximal involvement and 2 non-contiguous multiple aneurysms. Four (9.75%) patients had isolated LCx involvement. Based on CTCA findings, treatment protocols had to be modified in 3/41 (7.3%) patients.

Interpretation

This study highlights anatomical findings of LCx involvement in KD. Isolated LCx CALs were noted in 4/41 (9.75%) patients. TTE alone proved inadequate for LCx assessment in children with KD. With abnormalities detected in 18.2% of cases, including those missed by TTE, CTCA emerges as an essential imaging modality. The findings have implications for treatment planning and follow-up strategies in children with KD.

Funding

None.

背景传统上,胸超声心动图(TTE)是川崎病(KD)患儿冠状动脉成像的主要方法。我们旨在通过计算机断层扫描冠状动脉造影术(CTCA)评估川崎病儿童左侧环状动脉(LCx)的冠状动脉病变(CALs)。结果在 CTCA 上,41/225(18.2%)例患者出现 LCx CAL。然而,TTE 仅在三分之一的患者中检测到 CAL [15/41(36.6%)]。CTCA 在 41 位患者中发现了 47 个 LCx CAL,其中 39 位为动脉瘤(40 个纺锤形动脉瘤,2 个囊状动脉瘤;7 个巨大动脉瘤),3 位为狭窄,2 位为血栓形成。39 名患者的 LCx 近端出现动脉瘤,其中 12 名患者的动脉瘤向远端延伸。6 名患者的 LCx 远端动脉瘤未累及近端,2 名患者的动脉瘤为不连续的多发性动脉瘤。有 4 名患者(9.75%)的 LCx 单独受累。根据 CTCA 检查结果,3/41(7.3%)例患者的治疗方案需要修改。4/41(9.75%)例患者出现孤立的 LCx CAL。事实证明,仅靠 TTE 无法对 KD 儿童的 LCx 进行评估。在18.2%的病例中发现了异常,包括TTE漏诊的病例,因此CTCA成为一种重要的成像方式。这些发现对KD患儿的治疗计划和随访策略具有重要意义。
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引用次数: 0
SARS-CoV-2 infections before, during, and after the Omicron wave: a 2-year Indian community cohort study 奥密克浪潮之前、期间和之后的 SARS-CoV-2 感染情况:一项为期两年的印度社区队列研究
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-21 DOI: 10.1016/j.lansea.2024.100470
Ramya Madhavan , Jackwin Sam Paul , Sudhir Babji , Isai Thamizh , Dilesh Kumar , Shainey Alokit Khakha , Aarene Rennie , Keerthana Kumar , Pavithra Dhanapal , Poornima Saravanan , Ajith Kumar , Sushil Immanuel , Vaishnavi Gandhi , Anand Kumar , Johnson John Babu , Nandu Thrithamarassery Gangadharan , Premkumar Jagadeesan , Elizabeth John , Colin Jamora , Dasaradhi Palakodeti , Jacob John

Background

We measured the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and re-infections in an adult community-based cohort in southern India.

Methods

We conducted a 2-year follow-up on 1229 participants enrolled between May and October 2021. Participants provided vaccination histories, weekly saliva samples, and blood samples at 0, 6, 12, and 24 months. Salivary reverse transcription polymerase chain reaction (RT-PCR) and Meso-Scale Discovery panels were used for SARS-CoV-2 detection and anti-spike, anti-nucleocapsid immunoglobulin G quantification. Whole genome sequencing was performed on a subset of positive samples. SARS-CoV-2 infection incidence was measured across Pre-Omicron (May–December 2021), Omicron-I (December 2021–June 2022), and Omicron-II (July 2022–October 2023) periods.

Findings

In total, 1166 (95%) participants with 83% seropositivity at baseline completed the follow-up, providing 2205 person-years of observation. Utilizing both RT-PCR and serology we identified 1306 infections and yielded an incidence rate of 591.3 per 1000 person-years (95% confidence interval, 559.6–624.3), which peaked during Omicron-I at 1418.1 per 1000 person-years (95% confidence interval, 1307.4–1535.6). During Omicron-I and II, neither prior infection nor vaccination conferred protection against infection. Overall, 74% of infections were asymptomatic.

Interpretation

Integrated RT-PCR and serology revealed significant SARS-CoV-2 infection frequency, highlighting the prevalence of asymptomatic cases among previously infected or vaccinated individuals. This underscores the effectiveness of combining surveillance strategies when monitoring pandemic trends and confirms the role of non-invasive sampling in ensuring participant compliance, reflecting national transmission patterns.

Funding

The study was funded by the Bill and Melinda Gates Foundation.

背景我们测量了印度南部成人社区队列中严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)感染和再感染的发病率。方法我们对 2021 年 5 月至 10 月间入组的 1229 名参与者进行了为期两年的随访。参与者提供了疫苗接种史、每周唾液样本以及 0、6、12 和 24 个月的血液样本。唾液反转录聚合酶链反应(RT-PCR)和中观尺度发现(Meso-Scale Discovery)面板用于检测 SARS-CoV-2 和抗尖峰、抗核头免疫球蛋白 G 定量。对部分阳性样本进行了全基因组测序。结果共有 1166 人(95%)完成了随访,基线血清阳性率为 83%,观察时间为 2205 人/年。通过 RT-PCR 和血清学检测,我们发现了 1306 例感染病例,发病率为每千人年 591.3 例(95% 置信区间:559.6-624.3),在 Omicron-I 期间达到峰值,为每千人年 1418.1 例(95% 置信区间:1307.4-1535.6)。在 Omicron-I 和 II 期间,既往感染和接种疫苗都不会对感染产生保护作用。综合 RT-PCR 和血清学检测显示,SARS-CoV-2 的感染频率很高,这突出说明了无症状病例在既往感染过或接种过疫苗的人群中很普遍。这强调了在监测大流行趋势时结合监测策略的有效性,并证实了非侵入性采样在确保参与者遵守规定方面的作用,反映了国家传播模式。
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引用次数: 0
Impact of health benefit package policy interventions on service utilisation under government-funded health insurance in Punjab, India: analysis of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) 印度旁遮普邦政府资助的医疗保险中,一揽子医疗福利政策干预措施对服务利用率的影响:对 Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) 的分析
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-19 DOI: 10.1016/j.lansea.2024.100462
Shankar Prinja , Jyoti Dixit , Ruby Nimesh , Basant Garg , Rupinder Khurana , Amit Paliwal , Arun Kumar Aggarwal

Background

The design of health benefits package (HBP), and its associated payment and pricing system, is central to the performance of government-funded health insurance programmes. We evaluated the impact of revision in HBP within India’s Pradhan Mantri Jan Arogya Yojana (PM-JAY) on provider behaviour, manifesting in terms of utilisation of services.

Methods

We analysed the data on 1.35 million hospitalisation claims submitted by all the 886 (222 government and 664 private) empanelled hospitals in state of Punjab, from August 2019 to December 2022, to assess the change in utilisation from HBP 1.0 to HBP 2.0. The packages were stratified based on the nature of revision introduced in HBP 2.0, i.e., change in nomenclature, construct, price, or a combination of these. Data from National Health System Cost Database on cost of each of the packages was used to determine the cost-price differential for each package during HBP 1.0 and 2.0 respectively. A dose–response relationship was also evaluated, based on the multiplicity of revision type undertaken, or based on extent of price correction done. Change in the number of monthly claims, and the number of monthly claims per package was computed for each package category using an appropriate seasonal autoregressive integrated moving average (SARIMA) time series model.

Findings

Overall, we found that the HBP revision led to a positive impact on utilisation of services. While changes in HBP nomenclature and construct had a positive effect, incorporating price corrections further accentuated the impact. The pricing reforms highly impacted those packages which were originally significantly under-priced. However, we did not find statistically significant dose–response relationship based on extent of price correction. Thirdly, the overall impact of HBP revision was similar in public and private hospitals.

Interpretation

Our paper demonstrates the significant positive impact of PM-JAY HBP revisions on utilisation. HBP revisions need to be undertaken with the anticipation of its long-term intended effects.

Funding

Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ).

背景医疗福利包(HBP)及其相关支付和定价系统的设计对于政府资助的医疗保险项目的绩效至关重要。我们评估了印度 Pradhan Mantri Jan Arogya Yojana(PM-JAY)一揽子医疗福利计划的修订对医疗服务提供者行为的影响,具体表现在服务利用率方面。方法我们分析了旁遮普邦所有 886 家(222 家政府医院和 664 家私立医院)医院在 2019 年 8 月至 2022 年 12 月期间提交的 135 万份住院报销申请数据,以评估从一揽子医疗福利计划 1.0 到一揽子医疗福利计划 2.0 的利用率变化。根据 HBP 2.0 中引入的修订性质(即名称、结构、价格或这些因素的组合变化)对套餐进行了分层。利用国家卫生系统成本数据库中关于每种套餐成本的数据,分别确定了 HBP 1.0 和 2.0 期间每种套餐的成本-价格差异。此外,还根据修订类型的多样性或价格修正的程度评估了剂量-反应关系。使用适当的季节性自回归综合移动平均(SARIMA)时间序列模型,计算了每个套餐类别的月索赔数量变化和每个套餐的月索赔数量。虽然医保方案名称和结构的变化产生了积极影响,但价格调整进一步加剧了这种影响。定价改革对那些原本定价明显偏低的套餐产生了很大影响。然而,根据价格修正的程度,我们并没有发现统计学上显著的剂量-反应关系。第三,对公立医院和私立医院来说,修订住院费用方案的总体影响是相似的。在修订住院费用标准时,需要考虑到其长期预期效果。
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引用次数: 0
A service evaluation of weight management for glycaemic control and remission of type 2 diabetes using traditional food in Nepal (Ho-DIRECT NEPAL): a single-arm trial 尼泊尔利用传统食品控制血糖和缓解 2 型糖尿病的体重管理服务评估(Ho-DIRECT NEPAL):单臂试验
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-17 DOI: 10.1016/j.lansea.2024.100465
Biraj Karmacharya , Sujata Sapkota , Prasanna Rai , Charoula Nikolaou , Roshan Kasti , Jyoti Bhattarai , Rashmi Maharjan , Abha Shrestha , Archana Shrestha , Binaya Bhattarai , Anthony R. Leeds , Alasdair McIntosh , Michael E.J. Lean

Background

Remission of early type 2 diabetes (T2D) is possible; however, diet programmes proven effective are unaffordable in many southeast Asian populations where T2D is more frequent and more aggressive at lower body weight and younger age. We evaluate an entirely food-based service.

Methods

This study employed a single-arm intervention and follow-up design for intervention evaluation in existing hospital people with T2D of under 5 years known duration. Individuals attending a diabetes clinic in Kathmandu with early T2D (<5 years) aged 30–70 years, BMI ≥23 kg/m2, were offered a low-cost nutritionally complete diet-programme, using traditional Nepali foods to provide 8-weeks ∼850 kcal/day weight loss induction, and then weight maintenance. The participants received 4-weekly dietetic appointments (30–45 min) and verbo-pictorial leaflets using household measures. Glucose-lowering medications (49/70 at baseline) were stopped at baseline or soon after. The study was registered as ISRCTN10671396, testing a traditional food-based intervention for weight loss and T2D remission.

Findings

For 70 individuals (45 female) invited between March 19, 2022 and September 19, 2023, baseline mean (SD) age was 48.6 (9.9) years, bodyweight 74.6 (9.5) kg, BMI 29.7 (3.6) kg/m2, known diabetes duration 2.5 (1.9) years, HbA1c on treatment 8.1 (1.6) %. At 12, 24 and 52 weeks respectively, evaluating n = 44, 46, 45, bodyweight was 70.1 (8.5), 69.8 (8.9), 70.0 (8.8) kg, HbA1c 6.8 (0.9), 6.9 (1.5), 7.1 (1.3) %; HbA1c <6.5% was recorded for 46%, 48% and 36% and remission of T2D (HbA1c <6.5% off medication >3 months) in 43%, 39% and 29%. The main reported adherence barriers were fears of weakness, hunger, and inconvenience during travel. Incentives were ease of the diet, reduced doses and costs of medications, and improved appearance.

Interpretation

Traditional food-based weight management can valuably improve control, reduce medication needs, and generate remissions of established T2D, but adherence barriers must be overcome to optimise outcomes.

Funding

All Saints Educational Trust, England.

背景早期 2 型糖尿病(T2D)的缓解是可能的;然而,在东南亚的许多人群中,T2D 的发病率更高,且在体重较轻和年龄较小的人群中更具侵袭性。我们对一项完全以食物为基础的服务进行了评估。方法这项研究采用单臂干预和随访设计,对已知病程不足 5 年的现有医院 T2D 患者进行干预评估。在加德满都一家糖尿病诊所就诊的早期 T2D(5 年)患者年龄在 30-70 岁之间,体重指数≥23 kg/m2,他们接受了一项低成本、营养全面的饮食计划,该计划使用传统的尼泊尔食品,提供为期 8 周、每天 850 千卡热量的减肥诱导,然后维持体重。参与者每 4 周接受一次营养师预约(30-45 分钟),并利用家庭措施获得文字图片传单。降糖药物(基线时为 49/70)在基线时或不久后停止使用。研究结果在2022年3月19日至2023年9月19日期间受邀的70人(45名女性)中,基线平均(标清)年龄为48.6(9.9)岁,体重为74.6(9.5)公斤,体重指数为29.7(3.6)公斤/平方米,已知糖尿病病程为2.5(1.9)年,治疗期间的HbA1c为8.1(1.6)%。12 周、24 周和 52 周时,评估 n = 44、46、45,体重分别为 70.1 (8.5)、69.8 (8.9)、70.0 (8.8) kg,HbA1c 分别为 6.8 (0.9)、6.9 (1.5)、7.46%、48% 和 36% 的患者 HbA1c 为 6.5%,43%、39% 和 29% 的患者 T2D 缓解(停药 3 个月后 HbA1c 为 6.5%)。据报告,坚持治疗的主要障碍是担心身体虚弱、饥饿和旅行不便。解释传统的以食物为基础的体重管理可有效改善控制、减少药物需求并使已确诊的 T2D 患者病情缓解,但必须克服坚持治疗的障碍,才能取得最佳效果。
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引用次数: 0
Drug development in LMICs: could the emerging Indian model usher the southeast Asian region? 低收入和中等收入国家的药物开发:新兴的印度模式能否带动东南亚地区?
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-16 DOI: 10.1016/j.lansea.2024.100464
Bharat Pant , Jayant Goda , Vikram Gota

Low-income and middle-income countries (LMICs) of southeast Asia are passing through a similar phase as India in their tryst with the development of novel drugs. They are beginning to break away from their dependency on the institutions of our developed world. Over the past few years, Tata Memorial Centre—India's premier cancer centre—has shown the tenacity to develop drugs within the national frontiers. By collaborating with the domestic pharmaceutical industries, it has been able to have a steady pipeline of drugs under development, with two of them receiving marketing authorization recently. Lately, Indonesia and Vietnam have also shown an inclination towards public-private partnerships for similar motives. However, due to prolonged innovative stagnation, the entire drug development machinery faces challenges stretching all the way from arranging funds to persuading regulatory bodies. In this Viewpoint, we have tried to address a few of those issues and their potential solutions, with the intention to share our own experience which might be useful to other LMICs in connecting some adamant dots.

东南亚的低收入和中等收入国家(LMICs)在尝试开发新型药物方面正经历着与印度相似的阶段。它们开始摆脱对发达国家机构的依赖。在过去的几年里,塔塔纪念中心--印度首屈一指的癌症中心--表现出了在本国范围内开发药物的韧劲。通过与国内制药业合作,该中心拥有了稳定的药物研发渠道,其中两种药物最近获得了上市许可。最近,印度尼西亚和越南也出于类似的动机倾向于公私合作。然而,由于创新长期停滞不前,整个药物开发机制面临着从安排资金到说服监管机构的重重挑战。在本 "观点 "中,我们试图探讨其中的几个问题及其潜在的解决方案,目的是分享我们自己的经验,这些经验可能对其他低成本、低收入和中等收入国家很有帮助,因为它们可以将一些棘手的问题联系起来。
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引用次数: 0
Empowering communities: implementing a COPD self-management program in Nepal 增强社区能力:在尼泊尔实施慢性阻塞性肺病自我管理计划
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-16 DOI: 10.1016/j.lansea.2024.100469
Saroj Adhikari , Bhuvan Saud , Pravin Kumar Yadav
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引用次数: 0
Impact of a community health worker led intervention for improved blood pressure control in urban Nepal: an open-label cluster randomised controlled trial 由社区卫生工作人员主导的干预措施对改善尼泊尔城市血压控制的影响:开放标签分组随机对照试验
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-08 DOI: 10.1016/j.lansea.2024.100461
Sanju Bhattarai , Eva Skovlund , Archana Shrestha , Bente Prytz Mjølstad , Bjørn Olav Åsvold , Abhijit Sen

Background

Effective control of hypertension remains challenging in low and middle-income countries. We tested the effectiveness of comprehensive approaches to hypertension management including six home visits by community health workers with regular follow up by a trained healthcare provider on blood pressure levels in Nepal.

Methods

We implemented a non-blinded, open-label, parallel-group, two-arm cluster randomised controlled trial, with 1:1 allocation ratio in Budhanilakantha municipality, Kathmandu, Nepal. Ten public health facilities and their catchment area were randomly allocated to receive comprehensive intervention or only usual hypertension care. We recruited 1252 individuals aged 18 years and older with hypertension. The primary outcome was systolic blood pressure. Secondary outcomes were diastolic blood pressure, proportion with controlled blood pressure, waist to hip ratio, body mass index, physical activity, diet quality score, daily salt intake, adherence to antihypertensives, hypertension knowledge and perceived social support. Primary analysis was by intention-to-treat using a linear mixed model.

Findings

Participants were, on average 57 years old, 60% females, 84% married, 54% Brahmin/Chettri ethnicity and 33% were illiterate. The decrease in mean systolic blood pressure (1.7 mm Hg, 95% CI −0.1, 3.4) and diastolic blood pressure (1.6 mm Hg, 95% CI 0.5, 2.6) was more in the intervention arm compared to the control. The proportion with blood pressure control (OR 1.5 95% CI 1.0, 2.1) and engaging in adequate physical activity (≥600 Metabolic equivalents of task per week) (OR 2.2, 95% CI 1.6, 3.1) were higher in the intervention arm compared to control. The change in hypertension knowledge score was higher and daily salt intake was lower in the intervention arm compared to control. Waist to hip ratio increased more and global dietary requirement scores decreased more in the intervention group and there was no effect on the body mass index and adherence to antihypertensives.

Interpretation

Community health workers facilitated home support and routine follow-up care by healthcare providers was effective in controlling blood pressure in urban Nepal. These findings suggest comprehensive interventions targeting individual, community and health system barriers are feasible in low resource settings, but larger implementation trials are needed to inform future scale-up.

Funding

This work was supported by Norwegian University of Science and Technology, Trondheim, Norway (Project number 981023100).

背景在中低收入国家,有效控制高血压仍然是一项挑战。我们在尼泊尔测试了高血压综合管理方法的有效性,其中包括由社区卫生工作者进行六次家访,并由经过培训的医疗服务提供者对血压水平进行定期随访。方法我们在尼泊尔加德满都布达尼拉坎塔市实施了一项非盲、开放标签、平行组、双臂群组随机对照试验,分配比例为 1:1。十家公共医疗机构及其覆盖区域被随机分配到接受综合干预或仅接受常规高血压护理。我们招募了 1252 名 18 岁及以上的高血压患者。主要结果是收缩压。次要结果包括舒张压、血压得到控制的比例、腰臀比、体重指数、体力活动、饮食质量评分、每日食盐摄入量、服用降压药的依从性、高血压知识和感知的社会支持。研究结果参与者平均 57 岁,60% 为女性,84% 已婚,54% 为婆罗门/切特里族,33% 为文盲。与对照组相比,干预组的平均收缩压(1.7 毫米汞柱,95% CI -0.1,3.4)和舒张压(1.6 毫米汞柱,95% CI 0.5,2.6)降幅更大。与对照组相比,干预组的血压控制比例(OR 1.5 95% CI 1.0, 2.1)和参加适当体育活动的比例(每周≥600 代谢当量)(OR 2.2, 95% CI 1.6, 3.1)更高。与对照组相比,干预组的高血压知识评分变化更大,每日食盐摄入量更低。干预组的腰臀比增加较多,总体饮食要求评分减少较多,但对体重指数和服用降压药的依从性没有影响。这些研究结果表明,针对个人、社区和医疗系统障碍的综合干预措施在资源匮乏的环境中是可行的,但需要进行更大规模的实施试验,以便为今后的推广工作提供参考。
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引用次数: 0
Metabolic syndrome among marginalised school-going adolescents: a call for clarity 边缘化在校青少年的代谢综合征:呼吁澄清问题
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-03 DOI: 10.1016/j.lansea.2024.100458
Ajeet Singh Bhadoria , Archisman Mohapatra , Vineet Kumar Pathak , Mohan Kumar
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引用次数: 0
Addressing health inequities in Southeast Asia: challenges and opportunities 解决东南亚卫生不平等问题:挑战与机遇
IF 5 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-03 DOI: 10.1016/j.lansea.2024.100455
Natarajan Sisubalan , Bhagavathi Sundaram Sivamaruthi , Periyanaina Kesika , Chaiyavat Chaiyasut
{"title":"Addressing health inequities in Southeast Asia: challenges and opportunities","authors":"Natarajan Sisubalan ,&nbsp;Bhagavathi Sundaram Sivamaruthi ,&nbsp;Periyanaina Kesika ,&nbsp;Chaiyavat Chaiyasut","doi":"10.1016/j.lansea.2024.100455","DOIUrl":"10.1016/j.lansea.2024.100455","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"28 ","pages":"Article 100455"},"PeriodicalIF":5.0,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772368224001057/pdfft?md5=999fb776431bd3ca750832461079fb70&pid=1-s2.0-S2772368224001057-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
The Lancet regional health. Southeast Asia
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