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   Table of Contents - Current issue
January-March 2019
Volume 4 | Issue 1
Page Nos. 1-33

Online since Monday, March 18, 2019

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Inhaled corticosteroids in chronic obstructive pulmonary disease: Moving toward precision medicine p. 1
Ashutosh Nath Aggarwal
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National accountability and response for noncommunicable diseases in the United Arab Emirates p. 4
Ibtihal Fadhil, Buthaina Bin Belaila, Hira Abdul Razzak
Noncommunicable diseases (NCDs) remain significant health and developmental challenge in the United Arab Emirates (UAE). The four main NCDs accounted for 77% of all deaths in UAE and 17% of premature deaths (30–70 years). The UAE National Agenda 2021 reflects high-level political commitment demonstrating strong leadership to address the national challenge and meet the global commitments providing a clear roadmap to guide planning, implementation, multisectoral response, and accountability for NCD Prevention and Control. This paper, therefore, aims to present the national response to NCD highlighting the strong leadership of the government at the highest level in the UAE, together with multisectoral engagements, thus establishing a national accountability framework.
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Innovative approaches to implement MPOWER policies in low-resource settings: A significant reduction in tobacco use (21.2%–16.1%) since Global Adult Tobacco Survey-1 in Himachal Pradesh, India p. 10
Gopal Chauhan, Jarnail Singh Thakur
MPOWER is the evidence-based toolkit for effective tobacco control under the WHO-framework convention on tobacco control (FCTC). Indian Tobacco Control Law (COTPA, 2003) and National Tobacco Control Program (NTCP, 2006) are not fully compliant to FCTC. Himachal Pradesh a northern hilly state in India with a population of about 7 million was not included under NTCP till 2014 whereas as per the Global Adult Tobacco Survey (GATS) 2009–2010 the prevalence of smoking among males (33.4%) was much higher than the national average (24.3%) with high exposure of passive smoking (82.5%) at homes. Implementing MPOWER without technical and financial support was a huge challenge. The multisectoral engagement especially the partnership between the local NGO (HPVHA) and the State Health Department under the guidance of the International Union against TB and Lung Diseases New Delhi helped in bridging the policy gaps through advocacy and capacity building. Building partnerships, sharing the responsibilities, and empowering the key stakeholders to utilize the funds collected as fine for tobacco control helped in policy implementation effectively. MPOWER implementation has achieved substantial progress in all six demand and supply reduction strategies of tobacco in the state of Himachal Pradesh. GATS, 2016–2017 shows a significant decline (21.2%–16.1%) in tobacco use and passive smoking at homes (82.5%–32.9%) in the state. Innovative approaches of implementing MPOWER policies are the way forward for effective tobacco control in low resource settings.
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Effect of nutritional counseling on body mass index of adult hypertensive attending general outpatient clinic, federal medical center, Ido-Ekiti South-Western Nigeria p. 15
Taiwo Adebayo Olukokun, Abayomi Olusola Ayodapo, Kehinde Fasasi Monsudi
Background: Achieving target blood pressure (BP) control has become an important management challenge, as the prevalence of hypertension increases in adult Nigerians. Overweight/obesity and lack of lifestyle behaviors are associated with difficulty in achieving target BP control. This study aim at determine the effect of nutritional counseling on body mass index (BMI) of adult hypertensive attending general outpatient clinic. Materials and Methods: An interventional study was performed on 322 adult patients (161 in the intervention group and 161 in the control group) with hypertension who had been on treatment for at least 3 months. Relevant data were collected using interviewer-administered the semi-structured questionnaire and clinical parameters were measured pre- and post-intervention. The intervention group was given nutritional counseling. Results: The mean BMI in the intervention group decreased to a statistically significant level (P < 0.001), from 25.42 ± 3.99 to 24.89 ± 3.64 compared to an increase in the control group from 25.36 ± 3.73 to 25.39 ± 3.74. The mean change in BMI of the intervention group (−0.53 ± 0.59) was higher than the mean change in BMI of the control group (0.03 ± 0.45), which was statistically significant (P < 0.001). More than two-third of the intervention group 135 (83.9%) had good BP control, compared to 68 (42.2%) of the control group. Conclusion: The nutritional status of the respondents in the intervention group is better than in the control group at the end of the study. Improved nutritional status led to better BMI. Family physicians will do well to counsel hypertensive patients on nutritional and lifestyle behavior with a view to improving BP control in them.
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Insulin resistance and cardiovascular risk in older adult Nigerians with type 2 diabetes p. 21
Ifeoma Christiana Udenze, Idowu A Taiwo, Joseph B Minari, Wasiu Lanre Adeyemo
Background: Insulin resistance (IR), which refers to decreased metabolic response to normal concentrations of insulin, has been associated with increasing age and is a trigger to the cascade of cardiometabolic abnormalities hence increasing cardiovascular disease (CVD) risk in elderly populations with type 2 diabetes (T2D). Strategies targeting IR may be key to mitigating excess CVD morbidities in elderly patients with T2D. Aim: The aim of this study is to evaluate the relationship between IR and CVD and also to identify cardiometabolic risk (CMR) factors as primary targets of CVD reduction in the older populations of Nigerians with T2D. Settings and Design: Lagos, Nigeria. Cross-sectional, analytical. Subjects and Methods: A total of 363 adult Nigerians with T2D aged between 40 and 100 years old were consecutively recruited for this study. T2D was defined according to the WHO criteria. Data were collected using a questionnaire and fasting blood samples were collected for analysis. Statistical Analysis Used: The data were analyzed using the IBM SPSS statistical package. Statistical significance was set at value of P < 0.05. Results: T2D patients in the age group of 60–80 years had significantly higher blood pressure than those in the younger age group, (P = 0.009). Fasting plasma glucose (FPG) and glycated hemoglobin were the highest in the age group of 40–60 years, (P = 0.016). IR was associated with older age in the T2D (P = 0.026). IR showed a significant correlation with CMR factors. Multivariate regression showed FPG to be independently associated with IR (P = 0.003). Conclusion: IR correlated with CMR factors and was independently associated with FPG, re-emphasizing focus on short-term blood glucose control in elderly diabetic populations.
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Examining depression and quality of life in patients with thalassemia in Sri Lanka p. 27
Priya Patel, Paul Beamish, Tricia L da Silva, Dewmi Kaushalya, Anuja Premawardhena, Shehan Williams, Arun V Ravindran
Background: With more effective treatments and improved outcomes in thalassemia, there is increasing focus on its psychological sequelae. Most published data on this topic are from high-income countries and much less so from low- and middle-income countries, where thalassemia is more prevalent. Aim: The aim of this study was to systematically evaluate the psychiatric morbidity and quality of life in relation to demographic- and illness-related variables among Sri Lankan patients with thalassemia. Methods: This cross-sectional investigation was conducted at the University of Kelaniya Teaching Hospital in Sri Lanka. Patients with all forms of thalassemia, over 12 years of age, and in stable medical condition (n = 120) were recruited. Assessment tools included a general demographic questionnaire, the Beck Depression Inventory-II, and the World Health Organization Quality of Life Measure–Brief. Statistical analysis was conducted using linear regressions, Chi-squares, and analyses of variance. Results: Lack of family support, longer duration of inpatient admission, and female gender were associated with higher depression scores and reduced quality of life. Environmental and social quality of life were positively correlated with levels of peer support in males, while increased support from religion correlated with lower depression scores and higher satisfaction with environmental and psychological quality of life in women. There was no association between the type of thalassemia and either depression or quality of life measures. Conclusion: Several factors may influence the psychological state and well-being of patients with thalassemia in Sri Lanka. Specific service innovations (some gender-specific) may help to address these factors to improve treatment outcome and well-being.
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