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   2018| January-March  | Volume 3 | Issue 1  
    Online since April 18, 2018

 
 
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REVIEW ARTICLE
Sustainable development goals and noncommunicable diseases: Roadmap till 2030 – A plenary session of world noncommunicable diseases congress 2017
Soundappan Kathirvel, Jarnail Singh Thakur Rapporteurs
January-March 2018, 3(1):3-8
DOI:10.4103/jncd.jncd_1_18  
The global epidemic of noncommunicable diseases (NCDs) was recognized by the United Nations and is addressed by the Sustainable Development Goals (SDGs) to be achieved by 2030. This review article describes the proceedings of the plenary session “SDGs and NCDs: Roadmap till 2030” of the first “World NCD Congress 2017” held at Chandigarh, India. The plenary session emphasized the need for political commitment to take up NCD agenda at the national level to prevent and reduce the premature NCD deaths. Establishing the national action plan and monitoring framework for prevention and control of NCDs are the major initial initiatives to implement the best buy NCD interventions. Primary prevention of four common and shared risk factors and health system strengthening are the important interventions to achieve the SDG goal 3.4. The implementation strategies at subnational level and engagement of sectors other than health on prevention and control of NCDs can be reviewed and further researched for effective implementation of the identified interventions.
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EDITORIAL
Two years on, and what an amazing journey
Ashutosh Nath Aggarwal
January-March 2018, 3(1):1-2
DOI:10.4103/jncd.jncd_17_18  
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ORIGINAL ARTICLES
Cardiovascular disease risk assessment in Nigerian adults with type 2 diabetes and metabolic syndrome using the Framingham's risk score
Ifeoma Christiana Udenze, Casmir Ezenwa Amadi
January-March 2018, 3(1):15-20
DOI:10.4103/jncd.jncd_33_17  
Background: Cardiovascular morbidity is a major burden in Nigerian patients with type 2 diabetes mellitus (DM). Aims and Objectives: The aim of the present study was to compare the cardiovascular risk scores of type 2 diabetics with those of individuals with metabolic syndrome and in healthy controls and examine the impact of glycemic control and lifestyle on cardiovascular risk. Subjects and Methods: This was a cross-sectional study of adult Nigerians with type 2 diabetes, metabolic syndrome, and age- and sex-matched controls. Written informed consent was obtained from all the participants. The Ethics Committee of the Lagos University Teaching Hospital, Lagos, Nigeria, approved the study protocol. Statistical Analysis: The data were analyzed using the IBM SPSS software version 20.0 package. Statistical significance was set at P < 0.05. Results: There was a statistically significant difference in cardiovascular disease (CVD) risk scores between the group with diabetes (20.41 ± 12.98), metabolic syndrome (10.00 ± 6.35) and the control group (6.79 ± 7.81) (P < 0.001), and also in glycated hemoglobin (HbA1c),high-density lipoproteins (HDL)-cholesterol, total cholesterol , and triglyceride concentrations between the groups (P < 0.05). CVD risk correlated positively and significantly with HbA1c, body mass index and waist circumference and negatively with the level of education (P < 0.05). Only 52.2% of the people with diabetes on treatment achieved HbA1ctarget of <7%. Conclusion: People with Type 2 diabetes had high CVD risk scores, control of CVD risk factors is not optimum in adult Nigerians. Strategies to achieve better glycemic control, weight reduction, and increase literacy levels will help achieve CVD risk reduction in adult Nigerians.
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Community environment and its relationship with tobacco use in selected North Indian communities
Ramashankar Rath, Anand Krishnan, Baridalyne Nongkynrih, Puneet Misra
January-March 2018, 3(1):21-27
DOI:10.4103/jncd.jncd_34_17  
Background: Community environmental factors can influence tobacco use and their modification could be one of the ways for reduction of tobacco use. This study measured community environmental determinants of tobacco use in urban and rural Haryana and relates them to tobacco use. Materials and Methods: Community audit was done in ten rural and urban communities of Ballabgarh, Haryana, to characterize the community, map establishments selling tobacco, and tobacco advertisements. Individual establishments were assessed for their compliance to national law. Fifteen men and 15 women were sampled from each community and interviewed for tobacco use, exposure to tobacco promotion, knowledge of tobacco laws, and attitude toward tobacco. Multilevel mixed-effects logistic regression was conducted to measure community-level determinants' contribution to tobacco use. Results: Overall, 218 establishments and 552 participants were assessed in these 20 communities. The median density of tobacco-selling stores expressed in terms of per square kilometer area of the community was 82.9 (75.5- 110.8) for rural area and lower in urban area 34.6 (9.0- 91.0). Nearly 18.5% of participants were currently using tobacco. Multilevel modeling shows that 35% of the differences in the tobacco use in the community were explained by community-level differences. Conclusion: The higher dependency of tobacco consumption on the community environment needs to be further explored.
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Do smoke-free laws or policies impact smoking at home? A comparison between smoke-free and nonsmoke-free jurisdiction in India
Neelam Bhatt, Mira B Aghi, Hemant Deepak Shewade, Pranay Lal, Vivek Gupta, Ajay MV Kumar, Govind Kumar Tripathi, Rana J Singh
January-March 2018, 3(1):28-35
DOI:10.4103/jncd.jncd_38_17  
Background: Globally, various studies have looked at the effect of smoke-free declaration in public spaces on secondhand smoke (SHS) exposure at home. However, a formal evaluation has not been reported from India. We assessed and compared smoking at home in two jurisdictions in India – a compliance-validated smoke-free jurisdiction (Shimla in 2010) versus a nonsmoke-free jurisdiction (Haridwar) between 2009 and 2015. Methods: We randomly sampled 247 households (with one smoker at least as on October 2009) each in Shimla (n = 123) and Haridwar (n = 124) during July–August 2015. Through an interviewer-administered questionnaire, information on number of bidi/cigarette smoked per day in the household (at home and at work) was collected from the smoking member across five time points: 2009, 2010, 2011, 2012, and 2015. From the nonsmoking member, we collected information regarding change in number of smokes per day and change in place of smoking in the household before and after 2010. We fitted a mixed effects maximum likelihood regression using random intercepts model for the effect of smoke-free declaration on number of smokes per day by the household adjusted for baseline differences, secular trends, clustering of data, and other potential confounders (time/year, number of children, number of adults, annual household income, and type of tobacco). Results: Introduction of smoke-free declaration in Shimla resulted in a decrease (over 1 year) of 1.24 (0.95 confidence interval [CI]: 0.8, 1.7), 0.55 (0.95 CI: 0.14, 0.96), and 0.98 (0.95 CI: 0.3, 1.6) bidi/cigarette smoked per day per household at home, at work, and at “work and home combined,” respectively. Within homes, when compared to Haridwar, there was an improved desirable behavior such as reduction in smoking within home and increase in smoking outside home in Shimla (reported by nonsmoking member). Conclusion: Smoke-free laws in public spaces in Shimla, India, were associated with the reduction in SHS exposure at home.
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Primary caregiver involvement in management of type 2 diabetes mellitus: A community-based observational study from urban Puducherry
Bijaya Nanda Naik, Yuvaraj Krishnamoorthy, Srikanta Kanungo, Mahalakshmy T, Sitanshu Sekhar Kar
January-March 2018, 3(1):36-41
DOI:10.4103/jncd.jncd_11_18  
Background: Adherence to medication and lifestyle modification is an important predictor of positive outcome of diabetes management among adults in which primary caregiver (PCG) plays an important role. Objectives: The objectives of this study were to describe the involvement of PCG in adherence to the drugs, diets, and lifestyle changes among patients with type 2 diabetes mellitus in an urban area of Puducherry. Methodology: A total of 311 type 2 diabetes patients irrespective of their source of diabetes care were included from the service area of an urban health and training center in an urban area of Puducherry. The PCG for each patient was identified, and the PCG and the patient were interviewed separately to obtain the information on adherence and involvement in various aspects of diabetes management, respectively, using an interview schedule. The information on diabetes control status of the patient was obtained from the records available. Results: About 10% of the patients did not have caregiver. Nearly 90% of the PCGs were involved in either of the lifestyle modification, drug adherence, checking type and frequency of medication, accompanying for consultation, or all. About 80% of the PCGs remind the patient to take medicines when out of station mainly by phone call/short message service. Encouragement toward physical activity was proportionately less compared to diet and drugs, and that was reflected in the patient's level of adherence in those domains. Overall involvement of spouse was more than the nonspouse. PCG involvement was found to be significantly associated with adherence to diet (P = 0.027) but not with drug and physical activity (P > 0.05). Conclusion: The PCG should also be considered while designing health education intervention on various aspects of diabetes management, focusing and highlighting the areas of poor involvement and their importance in disease management. The health system should place special focus on patients without PCG.
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Association between medication adherence and blood pressure control in urban hypertensive patients in central India
Ratinder Jhaj, Pushp Raj Gour, Sweta Kumari, Shweta Sharma
January-March 2018, 3(1):9-14
DOI:10.4103/jncd.jncd_29_16  
Introduction: Cardiovascular and renal complications associated with hypertension (HTN) can be reduced if blood pressure (BP) is well controlled. However, a large percentage of patients fail to achieve target BPs, largely due to poor medication adherence. We conducted a cross-sectional study of patients of HTN to assess patient adherence to treatment and the association between medication adherence and BP control. Methodology: The study was a cross-sectional survey of adult hypertensive patients of either sex who had been on antihypertensive therapy for the past 3 months. Medication adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). Level of control of BP was evaluated using the BP goals recommended by the Eighth Joint National Committee (JNC-8). Results: Out of a total of 200 patients, only 29.5% of patients had achieved their target BP as per JNC-8 recommendations after a minimum of 3 months of antihypertensive therapy. The average adherence score on the MMAS-8 was 6.47 (±1.8). A high adherence was found in 39% of patients, while 32.5% of HTN patients had a medium score and 28.5% had low adherence scores. There was a significant correlation between medication adherence and BP control. Only 1.5% of patients with low adherence score and 11.5% with medium score had achieved their target BP while 16.5% with high had done so. Conclusion: Higher medication adherence scores were associated with better BP control. However, the percentage of patients with controlled HTN on treatment was low as was the proportion of patients with a high medication adherence score.
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