Leisure as social engagement: does it moderate the association between subjective wellbeing and depression in later life?

ObjectivesTo investigate the role of leisure (as social engagement) in moderating the association between subjective wellbeing and depressive symptoms among older Indians.MethodsThe sample included data from 39,538 older adults (aged 55–80) from the Longitudinal Aging Study in India (LASI, Wave-1), 2017–2018. Individual level questionnaire was used to examine the relationship among social engagement, subjective wellbeing, and depressive symptoms. Moderating effects of leisure activities were estimated through interaction analysis and linear multivariable modeling.ResultsLow participation in social engagement activities (or leisure) was associated with greater likelihood of depressive symptoms. Leisure activities positively and significantly moderated the subjective wellbeing among older adults with depressive symptoms. Results suggest a significant wealth gradient where affluent older Indians having a clear advantage in heightened levels of social engagement and subsequently lower likelihood of depressive symptoms. Additionally, being in an urban area, co-residence in a “joint” household and belonging to the dominant social groups in terms of caste and religious categories are associated with gains in wellbeing.DiscussionThe direct and indirect effects of social engagement suggest that depressive symptoms can be mitigated while enhancing overall wellbeing of older adults. This holds promise for social policy in redirecting efforts to develop age-friendly initiatives and social infrastructure that enhance the link between engagement and wellbeing

Analysis of spontaneously reported adverse drug reactions to pharmacovigilance cell of a tertiary care hospital

Background: The objective of the study was to study the clinical patterns, causality and severity of adverse drug reactions in a tertiary care hospital.Methods: Total 131 ADR forms were collected from January 2012 to December 2012 and evaluated. Patient’s characteristics, ADR and drug characteristics, causality, severity and preventability of collected ADR were analyzed.Results: Total 131 ADR forms were evaluated. Male patient experiencing ADR were more (73, 55.7%) than female (58, 44.2%). Adult patients (12-60 years) experienced 110 (84%) ADR followed by pediatric patients (60 years) 10 (7.63%). Antimicrobial were the most common group of drugs responsible for ADR followed by NSAIDs and antipsychotic group.Conclusions: Present study shows lack of awareness among health care professionals for reporting of an ADR. Training and collaboration of health care professionals are needed for improvement in ADR reporting. Appropriate feedback from ADR reporting will help in selection of drug and promotes safer use of drugs

Drug utilization pattern of antimicrobial agents in an outpatient department of otorhinolaryngology in a tertiary care hospital: a prospective, cross-sectional study

Background: Study based on antimicrobial drug utilization pattern and focus on factors related to prescribing, administering and its associated events. The aim of this study is to assess the prescribing patterns of antimicrobials, to assess the appropriateness of prescribed antimicrobials in an ear, nose and throat (ENT) infections.Methods: A prospective observational drug utilization study was carried out in otorhinolaryngology department for a period of 4 months. Patients who attended the ENT outpatient department (OPD) with ENT infections were included in the study and patients who were not willing to participate in the study were excluded and the data were analyzed.Results: Out of 155 patients, the average number of drugs per patient was 1.2. The percentage of drugs prescribed with the generic name was 26.32%. During this study, it was found that the most commonly prescribed groups of antimicrobials were penicillins (34.87%) followed by fluroqinolones (26.32%) and nitroimidazole (25%). During the study, it was observed that 46.71% patients visited for treating ear infections, 12.5% for nasal infections and 40.79% for throat infections. The routes of administration were oral (74.23%) and topical (20.10%).Conclusions: Our study shows some rational prescription patterns like less utilization of antimicrobials in ENT infections and were according to standard treatment guideline. The results of this study will be useful in future for making standard treatment guidelines. It also promotes the rational prescription and rational use of drugs

Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.publishedVersio

Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12.2 million (95% UI 11.0-13.6) incident cases of stroke, 101 million (93.2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6.55 million (6.00-7.02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11.6% 10.8-12.2] of total deaths) and the third-leading cause of death and disability combined (5.7% 5.1-6.2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70.0% (67.0-73.0), prevalent strokes increased by 85.0% (83.0-88.0), deaths from stroke increased by 43.0% (31.0-55.0), and DALYs due to stroke increased by 32.0% (22.0-42.0). During the same period, age-standardised rates of stroke incidence decreased by 17.0% (15.0-18.0), mortality decreased by 36.0% (31.0-42.0), prevalence decreased by 6.0% (5.0-7.0), and DALYs decreased by 36.0% (31.0-42.0). However, among people younger than 70 years, prevalence rates increased by 22.0% (21.0-24.0) and incidence rates increased by 15.0% (12.0-18.0). In 2019, the age-standardised stroke-related mortality rate was 3.6 (3.5-3.8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3.7 (3.5-3.9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62.4% of all incident strokes in 2019 (7.63 million 6.57-8.96]), while intracerebral haemorrhage constituted 27.9% (3.41 million 2.97-3.91]) and subarachnoid haemorrhage constituted 9.7% (1.18 million 1.01-1.39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79.6 million 67.7-90.8] DALYs or 55.5% 48.2-62.0] of total stroke DALYs), high body-mass index (34.9 million 22.3-48.6] DALYs or 24.3% 15.7-33.2]), high fasting plasma glucose (28.9 million 19.8-41.5] DALYs or 20.2% 13.8-29.1]), ambient particulate matter pollution (28.7 million 23.4-33.4] DALYs or 20.1% 16.6-23.0]), and smoking (25.3 million 22.6-28.2] DALYs or 17.6% 16.4-19.0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Giving voice to the environment as the silent partner in aging: examining the moderating roles of gender and family structure in older adult wellbeing

Gerontological scholarship has long seen the environment to be a silent partner in aging. Environmental Gerontology, an established approach in Social Gerontology, has shown how the everyday lives of older adults are deeply entangled in socio-spatial environments. Adopting an Environmental Gerontology approach, we explore social and cultural dimensions of the association between out-of-home mobility and wellbeing among older adults in a north western city of India. This was established by combining high resolution time-space data collected using GPS receivers, questionnaire data and time diaries. Following a multi-staged analytical strategy, we first examine the correlation between out-of-home mobility and wellbeing using bivariate correlation. Second, we introduce gender and family structure into regression models as moderating variables to improve the models’ explanatory power. Finally, we use our results to reinterpret the Ecological Press Model of Aging to include familial structure as a factor that moderates environmental stress. Findings emphasize the central role that social constructs play in the long-established relationship between the environment and the wellbeing of older adults

Neurobehavioural, biochemical and immunological manifestations in workers exposed to organophosphate insecticides

305-310Organophosphate (OP) pesticides commonly used in agriculture in India are reported to cause poisoning. The effects of acute poisoning by pesticides are well-established; however, low and long-term exposure causing ill health is controversial. Further, the existing database regarding the toxicity effects of OP pesticides (triazophos and acephate) is much limited in India. In this study, we investigated the neurobehavioral, biochemical and immunological manifestation and their possible correlation with triazophos and acephate exposure in humans. A total number of 161 employees comprising control group (n=40), maintenance group (n=50) and exposed group (n=71) working in a unit manufacturing triazophos and acephate were enrolled in the study. Control group comprised of executives, clerks, security and peon, etc. Exposed and maintenance groups included workers engaged in production, formulation, transportation and maintenance of triazophos and acephate. Demographic profile and occupational history were recorded. A battery of neurobehavioral tests was employed as per ILO (1971) recommendations to evaluate neurobehavioral performance. In a sub-set study of population, serum samples were analyzed for immunological (IgG, IgM and IgA) and thyroid function tests (T3, T4 and TSH). Neurobehavioral findings indicated that exposed group of workers had performance deficiency in digit symbol test in percentage of accuracy, compared to the other groups. A significant (P <0.05) decrease in neurobehavioral performance like finger dexterity test (accuracy %), memory test (forward and backward) and digit symbol test (total) was observed in maintenance group, as compared to control and exposed groups. Workers of exposed group showed poor performance in only tweezer dexterity test (accuracy %). Serum IgM levels showed a significant increase in exposed subjects, indicating the impairment of immune system, while thyroid function was normal in study population. The study showed a possible correlation with exposure to OP pesticides in relation to impairment in some of the neurobehavioral and immunological parameters that might be useful in assessing OP poisoning

Non-Alcoholic fatty liver disease (NAFLD) and Cardiovascular Risk: Is Imaging helpful?

NAFLD is proving to be a globally prevalent condition and is on the rise. Moreover, NAFLD might be an independent risk factor associated with higher CVD morbidity and mortality. More studies need to assess whether NAFLD needs to be included in the atherosclerotic risk score algorithms or whether patients with NAFLD need to be screened early on to assess their CVD risk especially since imaging such as positron emission tomography can be used to assess both NAFLD and CV disease at the same time. Hence, employing cardiovascular imaging modalities to investigate the incidence, extent and nature of atherosclerotic lesions In NAFLD may be beneficial. Additionally, whether treating NAFLD halts the progression of CAD on imaging remains to be seen. Further research to delineate NAFLD and CVD associations, deciphering screening imaging modalities and investigating targeted interventions could improve CVD morbidity and mortality in NAFLD