Biomarkers of diverse pathophysiologic mechanisms may improve risk stratification for incident or progressive diabetic kidney disease (DKD) in persons with type 2 diabetes. To evaluate such ...biomarkers, we performed a nested case-control study (
=190 cases of incident DKD and 190 matched controls) and a prospective cohort study (
=1156) using banked baseline plasma samples from participants of randomized, controlled trials of early (ACCORD) and advanced (VA NEPHRON-D) DKD. We assessed the association and discrimination obtained with baseline levels of plasma TNF receptor-1 (TNFR-1), TNFR-2, and kidney injury molecule-1 (KIM-1) for the outcomes of incident DKD (ACCORD) and progressive DKD (VA-NEPHRON-D). At baseline, median concentrations of TNFR-1, TNFR-2, and KIM-1 were roughly two-fold higher in the advanced DKD population (NEPHRON-D) than in the early DKD population (ACCORD). In both cohorts, patients who reached the renal outcome had higher baseline levels than those who did not reach the outcome. Associations between doubling in TNFR-1, TNFR-2, and KIM-1 levels and risk of the renal outcomes were significant for both cohorts. Inclusion of these biomarkers in clinical models increased the area under the curve (SEM) for predicting the renal outcome from 0.68 (0.02) to 0.75 (0.02) in NEPHRON-D. Systematic review of the literature illustrated high consistency in the association between these biomarkers of inflammation and renal outcomes in DKD. In conclusion, TNFR-1, TNFR-2, and KIM-1 independently associated with higher risk of eGFR decline in persons with early or advanced DKD. Moreover, addition of these biomarkers to clinical prognostic models significantly improved discrimination for the renal outcome.
Background
Many people with mental, neurological and substance‐use disorders (MNS) do not receive health care. Non‐specialist health workers (NSHWs) and other professionals with health roles (OPHRs) ...are a key strategy for closing the treatment gap.
Objectives
To assess the effect of NSHWs and OPHRs delivering MNS interventions in primary and community health care in low‐ and middle‐income countries.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 21 June 2012); MEDLINE, OvidSP; MEDLINE In Process & Other Non‐Indexed Citations, OvidSP; EMBASE, OvidSP (searched 15 June 2012); CINAHL, EBSCOhost; PsycINFO, OvidSP (searched 18 and 19 June 2012); World Health Organization (WHO) Global Health Library (searched 29 June 2012); LILACS; the International Clinical Trials Registry Platform (WHO); OpenGrey; the metaRegister of Controlled Trials (searched 8 and 9 August 2012); Science Citation Index and Social Sciences Citation Index (ISI Web of Knowledge) (searched 2 October 2012) and reference lists, without language or date restrictions. We contacted authors for additional studies.
Selection criteria
Randomised and non‐randomised controlled trials, controlled before‐and‐after studies and interrupted‐time‐series studies of NSHWs/OPHR‐delivered interventions in primary/community health care in low‐ and middle‐income countries, and intended to improve outcomes in people with MNS disorders and in their carers. We defined an NSHW as any professional health worker (e.g. doctors, nurses and social workers) or lay health worker without specialised training in MNS disorders. OPHRs included people outside the health sector (only teachers in this review).
Data collection and analysis
Review authors double screened, double data‐extracted and assessed risk of bias using standard formats. We grouped studies with similar interventions together. Where feasible, we combined data to obtain an overall estimate of effect.
Main results
The 38 included studies were from seven low‐ and 15 middle‐income countries. Twenty‐two studies used lay health workers, and most addressed depression or post‐traumatic stress disorder (PTSD). The review shows that the use of NSHWs, compared with usual healthcare services: 1. may increase the number of adults who recover from depression or anxiety, or both, two to six months after treatment (prevalence of depression: risk ratio (RR) 0.30, 95% confidence interval (CI) 0.14 to 0.64; low‐quality evidence); 2. may slightly reduce symptoms for mothers with perinatal depression (severity of depressive symptoms: standardised mean difference (SMD) ‐0.42, 95% CI ‐0.58 to ‐0.26; low‐quality evidence); 3. may slightly reduce the symptoms of adults with PTSD (severity of PTSD symptoms: SMD ‐0.36, 95% CI ‐0.67 to ‐0.05; low‐quality evidence); 4. probably slightly improves the symptoms of people with dementia (severity of behavioural symptoms: SMD ‐0.26, 95% CI ‐0.60 to 0.08; moderate‐quality evidence); 5. probably improves/slightly improves the mental well‐being, burden and distress of carers of people with dementia (carer burden: SMD ‐0.50, 95% CI ‐0.84 to ‐0.15; moderate‐quality evidence); 6. may decrease the amount of alcohol consumed by people with alcohol‐use disorders (drinks/drinking day in last 7 to 30 days: mean difference ‐1.68, 95% CI ‐2.79 to ‐0.57); low‐quality evidence).
It is uncertain whether lay health workers or teachers reduce PTSD symptoms among children. There were insufficient data to draw conclusions about the cost‐effectiveness of using NSHWs or teachers, or about their impact on people with other MNS conditions. In addition, very few studies measured adverse effects of NSHW‐led care ‐ such effects could impact on the appropriateness and quality of care.
Authors' conclusions
Overall, NSHWs and teachers have some promising benefits in improving people's outcomes for general and perinatal depression, PTSD and alcohol‐use disorders, and patient‐ and carer‐outcomes for dementia. However, this evidence is mostly low or very low quality, and for some issues no evidence is available. Therefore, we cannot make conclusions about which specific NSHW‐led interventions are more effective.
Random assignment to intensive blood pressure (BP) lowering (systolic BP<120mmHg) compared to a less intensive BP target (systolic BP<140mmHg) in the Action to Control Cardiovascular Risk in Diabetes ...BP (ACCORD-BP) trial resulted in a more rapid decline in estimated glomerular filtration rate (eGFR). Whether this reflects hemodynamic effects or intrinsic kidney damage is unknown.
Longitudinal analysis of a subgroup of clinical trial participants.
A subgroup of 529 participants in ACCORD-BP.
Urine biomarkers of tubular injury (kidney injury molecule 1, interleukin 18 IL-18), repair (human cartilage glycoprotein 39 YKL-40), and inflammation (monocyte chemoattractant protein 1) at baseline and year 2.
Changes in eGFR from baseline to 2 years.
We compared changes in biomarker levels and eGFRs across participants treated to an intensive versus less intensive BP goal using analysis of covariance.
Of 529 participants, 260 had been randomly assigned to the intensive and 269 to the standard BP arm. Mean age was 62±6.5 years and eGFR was 90mL/min/1.73m2. Baseline clinical characteristics, eGFRs, urinary albumin-creatinine ratios (ACRs), and urinary biomarker levels were similar across BP treatment groups. Compared to less intensive BP treatment, eGFR was 9.2mL/min/1.73m2 lower in the intensive BP treatment group at year 2. Despite the eGFR reduction, within this treatment group, ACR was 30% lower and 4 urinary biomarker levels were unchanged or lower at year 2. Also within this group, participants with the largest declines in eGFRs had greater reductions in urinary IL-18 and YKL-40 levels. In a subgroup analysis of participants developing incident chronic kidney disease (sustained 30% decline and eGFR<60mL/min/1.73m2; n=77), neither ACR nor 4 biomarker levels increased in the intensive treatment group, whereas the level of 1 biomarker, IL-18, increased in the less intensive treatment group.
Few participants with advanced baseline chronic kidney disease. Comparisons across treatment groups do not represent comparisons of treatment arms created solely through randomization.
Among a subset of ACCORD-BP trial participants, intensive BP control was associated with reductions in eGFRs, but not with an increase in injury marker levels. These findings support that eGFR decline observed with intensive BP goals in ACCORD participants may predominantly reflect hemodynamic alterations.
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The National Mental Health Survey of India (NMHS) was a ground-breaking nationwide study that harnessed a uniform, standardized methodology blending quantitative and qualitative approaches. Covering ...data from 12 states across diverse regions, its mission was to gauge the prevalence of psychiatric disorders, bridge treatment gaps, explore service utilization, and gauge the socioeconomic repercussions of these conditions. This initiative provided pivotal insights into the intricate landscape of mental health in India. One of the analyses planned for NMHS data was to undertake a logistic regression analysis with an aim to unravel how various sociodemographic factors influence the presence or absence of specific psychiatric disorders. Within this pursuit, two substantial challenges loomed. The first pertained to data separation, a complication that could perturb parameter estimation. The second challenge stemmed from the existence of disorders with lower prevalence rates, which resulted in datasets of limited density, potentially undermining the statistical reliability of our analysis. In response to these data-driven hurdles, NMHS recognized the critical necessity for an alternative to conventional logistic regression, one that could adeptly navigate these complexities, ensuring robust and dependable insights from the collected data. Traditional logistic regression, a widely prevalent method for modeling binary outcomes, has its limitations, especially when faced with limited datasets and rare outcomes. Here, the problem of "complete separation" can lead to convergence failure in traditional logistic regression estimations, a conundrum frequently encountered when handling binary variables. Firth's penalized logistic regression emerges as a potent solution to these challenges, effectively mitigating analytical biases rooted in small sample sizes, rare events, and complete separation. This article endeavors to illuminate the superior efficacy of Firth's method in managing small datasets within scientific research and advocates for its more widespread application. We provide a succinct introduction to Firth's method, emphasizing its distinct advantages over alternative analytical approaches and underscoring its application to data from the NMHS 2015-2016, particularly for disorders with lower prevalence.
Background
Primary headache disorders are among the commonest disorders, affecting people in all countries. India appears to be no exception, although reliable epidemiological data on headache in ...this highly populous country are not available. Such information is needed for health-policy purposes. Our aim was to estimate the prevalence of each of the headache disorders of public-health importance, and examine their sociodemographic associations, in urban and rural populations of Karnataka, south India.
Methods
In a door-to-door survey, 2,329 biologically unrelated adults (aged 18–65 years) were randomly sampled from urban (n = 1,226) and rural (n = 1,103) areas in and around Bangalore and interviewed by trained researchers using a pilot-tested, validated, structured questionnaire. ICHD-II diagnostic criteria were applied.
Results
The observed 1-year prevalence of any headache was 63.9 %, with a female preponderance of 4:3. The age-standardised 1 year prevalence of migraine was 25.2 %; prevalence was higher among females than males (OR: 2.1 1.7-2.6) and among those from rural areas than urban (OR = 1.5 1.3-1.8). The age-standardized 1 year prevalence of TTH was 35.1 %, higher among younger people. The estimated prevalence of all headache on ≥15 days/month was 3.0 %; that of pMOH was 1.2 %, five-times greater among females than males and with a rural preponderance.
Conclusions
There is a very high 1 year prevalence of migraine in south India (the mean global prevalence is estimated at 14.7 %). Explanations probably lie in cultural, lifestyle and/or environmental factors, although the observed associations with female gender and rural dwelling are usual. Levels of TTH, pMOH and other headache on ≥15 days/month are similar to global averages, while the very strong association of pMOH with female gender requires explanation. Until another study is conducted in the north of the country, these are the best data available for health policy in a population of over 1.2 billion people.
Background: Despite their higher prevalence, the Common Mental Disorders (CMDs) are under-recognized and under-treated resulting in huge disability. India, home to one-fifth of the global population, ...could offer insights for organizing better services for CMDs. However, the prevalence and resultant disability in the general population is unknown, and consequently, gaps in management or plan for services are enormous, by default overlooked.
Aim: Estimating the current prevalence, disability, socioeconomic impact, and treatment gap of CMDs in a nationally representative sample from India. We attempt to identify the missed opportunities and list priorities for planning.
Methodology: The National Mental Health Survey of India (2016) is a multisite nationwide household survey conducted across India using a uniform methodology. Overall, 39,532 adults were surveyed with a response rate of 88%. Diagnoses are based on the Mini International Neuropsychiatric Interview 6.0.0. CMDs for this analysis include depressive and anxiety disorders (generalized anxiety disorder, social phobia, agoraphobia, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder).
Results: The weighted prevalence of current CMDs was 5·1% (95% CI: 5.06-5.13). Prevalence was highest in females, among the 40-59 years of age group, and in metros. Nearly 60% of them reported disabilities of varying severity. The treatment gap was 80·4%. On average, patients and their families spent ₹1500/month towards the treatment of CMDs.
Conclusions: This survey gives valuable insights regarding the disability and treatment gap due to CMDs and is imperative for reframing mental health policies and planning interventions. This study also suggests an international investigation to understand the difference in the prevalence of CMDs in developing versus developed countries.
Abstract
Background
There is limited evidence on technology addiction among adolescents in low- and middle-income countries where 90% of global adolescents live. We aimed to investigate the ...prevalence and correlates of technology addiction (Internet, gaming, smartphone, television) among school-going adolescents in India.
Methods
A cross-sectional survey covering the entire district (administrative unit for health) of India was conducted among representative sample of school-going adolescents using stratified cluster sampling. A total of 1729 adolescents completed the survey (age M = 12.58; SD = 0.97) by responding to Internet Addiction Test-Adolescents, Game Addiction Scale, Smartphone Addiction Scale and Television Addiction Scale. Associated factors were analyzed using binomial logistic regression analysis.
Results
Almost all the participants (99.59%; 95% confidence interval (CI): 99.28–99.91%) were using technology in one or other form. Prevalence of technology addiction among the users was 10.69% (95% CI: 5.26–16.11%). Phone addiction (8.91%; 95% CI: 3.31–14.52%) was the most common type followed by gaming addiction (2.55%; 95% CI: 1.16–3.95%). Technology addiction among adolescents was significantly associated with several risk factors at individual, family and school levels.
Conclusion
Technology addiction emerges as an important public health problem among adolescents in India. An integrated socio-ecological framework with multi-level approach that targets risk factors at various levels is required to promote healthy behaviors towards technology.
Background:
Psychiatric disorders are among the leading contributors to disability in India and worldwide. The pattern, prevalence, and distribution of psychiatric disorders in the country and its ...regions need to be assessed to facilitate early diagnosis and treatment. No study on the epidemiology of psychiatric disorders has been conducted in the Chhattisgarh state. This paper, as part of the National Mental Health Survey (NMHS), discusses the prevalence and pattern of psychiatric disorders in Chhattisgarh state.
Methods:
A stratified random cluster sampling technique and random selection based on probability proportional to size (PPS) at each stage were adopted. Participants were from three selected districts of Chhattisgarh, such as Janjgir-Champa, Kabirdham, and Raipur. Adults (aged ≥18 years) residing in selected households were interviewed using Mini International Neuropsychiatric Interview (version 6.0), the Fagerstrom test for nicotine dependence, the WHO-SEARO screening questionnaire for generalized tonic-clonic seizures, and screening tools for intellectual disability and autism spectrum disorders.
Results:
A total of 2841 individuals were interviewed. The state’s lifetime and current prevalence of psychiatric disorders for adults were 14.06% 95% confidence interval (CI) = 13.83–14.29 and 11.66% (95% CI = 11.45–11.87), respectively. Prevalence of substance use disorders, tobacco use disorders, schizophrenia and related disorders, and mood disorders was 32.4% (95% CI = 32.09–32.71), 29.86% (95% CI = 29.56–30.16), 0.8% (95% CI = 0.75–0.86), and 4.44% (95% CI = 4.31–4.58), respectively. High risk for suicide was detected in 0.28% (95% CI = 0.25–0.31). Psychiatric disorders were twice more common in males than in females.
Conclusions:
The study gives authentic data on the prevalence of psychiatric disorders in Chhattisgarh. This shall pave the way for policymakers and planners to design state-specific plans for dealing with mental disorders and related issues.
Anxiety disorders (ADs) impact the quality of life and productivity at an individual level and result in substantial loss of national income. Representative epidemiological studies estimating the ...burden of ADs are limited in India. National Mental Health Survey (NMHS) 2016 of India aimed to strengthen mental health services across India assessed the prevalence and pattern of public health priority mental disorders for mental health-care policy and implementation. This article focuses on the current prevalence, sociodemographic correlates, disability, and treatment gap in ADs in the adult population of NMHS 2016.
NMHS 2016 was a nationally representative, multicentered study across 12 Indian states during 2014-2016. Diagnosis of ADs (generalized AD, panic disorder, agoraphobia, and social AD) was based on Mini-International Neuropsychiatric Interview 6.0.0. Disability was by Sheehan's Disability Scale.
The current weighted prevalence of ADs was 2.57% (95% confidence interval: 2.54-2.60). Risk factors identified were female gender, 40-59 age group, and urban metro dwellers. Around 60% suffered from the disability of varying severity. The overall treatment gap for ADs was 82.9%.
The burden of AD is similar to Depressive disorders, and this article calls for the immediate attention of policymakers to institute effective management plans in existing public health programs.
Introduction
Prospective, population‐based, aging, and cognition studies are an important approach to understand normal and pathological aging processes.
Methods
This is a longitudinal, ...community‐based cohort study (n = 10,000) in rural India, with long‐term follow‐up for comprehensive evaluation of risk and protective factors associated with cognitive changes during aging. All participants will undergo comprehensive clinical, neurocognitive, and biochemical assessments. Genotyping using genome‐wide association studies will be done for all participants. Whole genome sequencing and brain imaging (magnetic resonance imaging) will be done in a subset.
Results
This study will generate a rich database of clinical, neurocognitive, biochemical, neuroimaging, and genetic data that can help identify risk and protective factors for dementia and other related disorders.
Discussion
This longitudinal study is first of its kind, involving comprehensive evaluations, spanning phenotype to genotype, in a rural Indian cohort, and has major public health implications.
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