Advancing our Understanding of Heat Wave Criteria and Associated Health Impacts to Improve Heat Wave Alerts in Developing Country Settings.

Health effects of heat waves with high baseline temperatures in areas such as India remain a critical research gap. In these regions, extreme temperatures may affect the underlying population's adaptive capacity; heat wave alerts should be optimized to avoid continuous high alert status and enhance constrained resources, especially under a changing climate. Data from registrars and meteorological departments were collected for four communities in Northwestern India. Propensity Score Matching (PSM) was used to obtain the relative risk of mortality and number of attributable deaths (i.e., absolute risk which incorporates the number of heat wave days) under a variety of heat wave definitions (n = 13) incorporating duration and intensity. Heat waves' timing in season was also assessed for potential effect modification. Relative risk of heat waves (risk of mortality comparing heat wave days to matched non-heat wave days) varied by heat wave definition and ranged from 1.28 [95% Confidence Interval: 1.11-1.46] in Churu (utilizing the 95th percentile of temperature for at least two consecutive days) to 1.03 [95% CI: 0.87-1.23] in Idar and Himmatnagar (utilizing the 95th percentile of temperature for at least four consecutive days). The data trended towards a higher risk for heat waves later in the season. Some heat wave definitions displayed similar attributable mortalities despite differences in the number of identified heat wave days. These findings provide opportunities to assess the "efficiency" (or number of days versus potential attributable health impacts) associated with alternative heat wave definitions. Findings on both effect modification and trade-offs between number of days identified as "heat wave" versus health effects provide tools for policy makers to determine the most important criteria for defining thresholds to trigger heat wave alerts

Gastroretentive drug delivery system of captopril and hydrochlorothiazide bilayer tablet: formulation, optimization and in vivo evaluation

The purpose of the present study was to develop and optimize floating-bioadhesive bilayer gastroretentive drug delivery system (GRDDS) exhibiting a unique combination of floatation and bioadhesion to prolong residence in the stomach using captopril (CP) and hydrochlorothiazide (HCTZ) as a model drug. Captopril being unstable in intestinal pH and HCTZ has specific absorption from duodenum and the first part of the jejunum and to a small extent in the stomach are suitable candidate for GRDDS. 32 factorial design was employed in formulating and optimizing the GRDDS for bilayer tablet of CP and HCTZ matrix tablet. The main effect and interaction terms were quantitatively evaluated using a mathematical model. The gastroretentive ability of the tablets was evaluated by X-radiographic studies in healthy human volunteer. The tablet releases CP and HCTZ for extended period up to 24 h in controlled manner. The predicted values agreed well with the experimental values and the results demonstrate the feasibility of the optimization methodology in the development of GRDDS. The tablet was buoyant for up to 16 h in human stomach. Development of once a day gastroretentive formulation of CP and HCTZ improves the patience compliance and bioavailability of drugs.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Gastroretentive drug delivery system of captopril and hydrochlorothiazide bilayer tablet: formulation, optimization and in vivo evaluation

The purpose of the present study was to develop and optimize floating-bioadhesive bilayer gastroretentive drug delivery system (GRDDS) exhibiting a unique combination of floatation and bioadhesion to prolong residence in the stomach using captopril (CP) and hydrochlorothiazide (HCTZ) as a model drug. Captopril being unstable in intestinal pH and HCTZ has specific absorption from duodenum and the first part of the jejunum and to a small extent in the stomach are suitable candidate for GRDDS. 32 factorial design was employed in formulating and optimizing the GRDDS for bilayer tablet of CP and HCTZ matrix tablet. The main effect and interaction terms were quantitatively evaluated using a mathematical model. The gastroretentive ability of the tablets was evaluated by X-radiographic studies in healthy human volunteer. The tablet releases CP and HCTZ for extended period up to 24 h in controlled manner. The predicted values agreed well with the experimental values and the results demonstrate the feasibility of the optimization methodology in the development of GRDDS. The tablet was buoyant for up to 16 h in human stomach. Development of once a day gastroretentive formulation of CP and HCTZ improves the patience compliance and bioavailability of drugs.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Ileo-cecal targeting mucoadhesive budesonide tablet

Crohn's disease occurs at any part of gastro-intestinal tract (GIT) but the most susceptible is the ileo-cecal region. For an effective treatment of this disease is essential the drug to be released at ileo-cecal region for an extended period of time. The present study is an attempt to design and develop an ileo-cecal targeting mucoadhesive drug delivery system that may be released specifically and slowly in ileo-cecal region without being released in the upper GIT for an extended period of time (12 h). Budesonide mucoadhesive tablets are coated with Eudragit S100, which is a polymer that specifically dissolves at and above pH 6.8. The in vitro drug release by changing pH method was done and in vivo study using X-ray radiography was carried out to ascertain the position of tablets in GIT after specific time intervals. The in vitro performance of the tablet with 10 % w/w coating level showed that the tablet did not disintegrate till 16 h with constant drug release. An in vivo study also reveals that the tablet lasted till 16 h in the ileo-cecal region.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Dissolution Improvement of Poorly Water Soluble Drug Valsartan and Improving Flow Properties of Solid Dispersion

The aim of the present investigation is to improve the dissolution of poorly water soluble drug valsartan by preparing solid dispersions and also to evaluate the effect of different inert carriers on flow properties of solid dispersion. Valsartan is a poorly soluble drug useful in the treatment of hypertension. Absorption window of valsartan is stomach and upper part of small intestine. One possible way to improve dissolution rate is solid dispersions of the drug. The solid dispersions were prepared by solvent evaporation method using HPMC E5 LV as water soluble carrier, as use of HPMC low viscosity polymers for solid dispersion preparations were reported in literature. But film formation took place during solid dispersion formulation and was creating difficulty in releasing the drug from formulation; and those solid dispersions, were not free flowing. Thus such preparations are not useful from the formulation development point of view. So to improve the flow properties some inert material were tried like microcrystalline cellulose (MCC) and lactose. The solid dispersions were evaluated for drug content, solubility and dissolution studies. In vitro drug release of solid dispersions was studied by USP type II paddle dissolution apparatus. For the solid dispersion the solubility and dissolution of the drug increased with the increase in the carrier concentration. Probable mechanisms of improved solubility and dissolution were characterized by Differential Scanning Calorimetry (DSC), Powder X-ray Diffractometry (Powder XRD) and Scanning Electron Microscopy (SEM) of drug, physical mixture and solid dispersions. This study revealed that solid dispersions technique is promising and useful for valsartan to improve its solubility and dissolution and incorporation of inert carriers improved the flow property of solid dispersion.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Lost in translation: The challenge of adapting integrated approaches for worker health and safety for low- and middle-income countries

Objectives: To describe the process of adapting an intervention integrating occupational safety and health (OSH) and health promotion for manufacturing worksites in India and the challenges faced in implementing it; and explore how globalization trends may influence the implementation of these integrated approaches in India and other low- and middle-income countries (LMICs). Methods: This study—conducted in 22 manufacturing worksites in Mumbai, India—adapted and implemented an evidence-based intervention tested in the U.S. that integrated OSH and tobacco control. The systematic adaptation process included formative research and pilot testing, to ensure that the tested intervention was tailored to the local setting. We used qualitative methods and process evaluation to assess the extent to which this intervention was implemented, and to explore barriers to implementation. Results: While participating worksites agreed to implement this intervention, not all components of the adapted intervention were implemented fully in the 10 worksites assigned to the intervention condition. We found that the OSH infrastructure in India focused predominantly on regulatory compliance, medical screening (secondary prevention) and the treatment of injuries. We observed generally low levels of leadership support and commitment to OSH, evidenced by minimal management participation in the intervention, reluctance to discuss OSH issues with the study team or workers, and little receptivity to recommendations resulting from the industrial hygienist’s reports. Conclusion: India presents one example of a LMIC with a rising burden of non-communicable diseases and intensified exposures to both physical and organizational hazards on the job. Our experiences highlight the importance of national and global trends that shape workers’ experiences on the job and their related health outcomes. Beyond a singular focus on prevention of non-communicable diseases, coordinated national and international efforts are needed to address worker health outcomes in the context of the conditions of work that clearly shape them

Gastroretentive drug delivery system of captopril and hydrochlorothiazide bilayer tablet: formulation, optimization and in vivo evaluation

The purpose of the present study was to develop and optimize floating-bioadhesive bilayer gastroretentive drug delivery system (GRDDS) exhibiting a unique combination of floatation and bioadhesion to prolong residence in the stomach using captopril (CP) and hydrochlorothiazide (HCTZ) as a model drug. Captopril being unstable in intestinal pH and HCTZ has specific absorption from duodenum and the first part of the jejunum and to a small extent in the stomach are suitable candidate for GRDDS. 32 factorial design was employed in formulating and optimizing the GRDDS for bilayer tablet of CP and HCTZ matrix tablet. The main effect and interaction terms were quantitatively evaluated using a mathematical model. The gastroretentive ability of the tablets was evaluated by X-radiographic studies in healthy human volunteer. The tablet releases CP and HCTZ for extended period up to 24 h in controlled manner. The predicted values agreed well with the experimental values and the results demonstrate the feasibility of the optimization methodology in the development of GRDDS. The tablet was buoyant for up to 16 h in human stomach. Development of once a day gastroretentive formulation of CP and HCTZ improves the patience compliance and bioavailability of drugs.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Illiteracy, low educational status, and cardiovascular mortality in India

Background: Influence of education, a marker of SES, on cardiovascular disease (CVD) mortality has not been evaluated in low-income countries. To determine influence of education on CVD mortality a cohort study was performed in India. Methods: 148,173 individuals aged ≥ 35 years were recruited in Mumbai during 1991-1997 and followed to ascertain vital status during 1997-2003. Subjects were divided according to educational status into one of the five groups: illiterate, primary school ( ≦ 5 years of formal education), middle school (6-8 years), secondary school (9-10 years) and college (> 10 years). Multivariate analyses using Cox proportional hazard model was performed an

Antenatal tobacco use and iron deficiency anemia: integrating tobacco control into antenatal care in urban India

Abstract Background In India, tobacco use during pregnancy is not routinely addressed during antenatal care. We measured the association between tobacco use and anemia in low-income pregnant women, and identified ways to integrate tobacco cessation into existing antenatal care at primary health centers. Methods We conducted an observational study using structured interviews with antenatal care clinic patients (n = 100) about tobacco use, anemia, and risk factors such as consumption of iron rich foods and food insecurity. We performed blood tests for serum cotinine, hemoglobin and ferritin. We conducted in-depth interviews with physicians (n = 5) and auxiliary nurse midwives (n = 5), and focus groups with community health workers (n = 65) to better understand tobacco and anemia control services offered during antenatal care. Results We found that 16% of patients used tobacco, 72% were anemic, 41% had iron deficiency anemia (IDA) and 29% were food insecure. Regression analysis showed that tobacco use (OR = 14.3; 95%CI = 2.6, 77.9) and consumption of green leafy vegetables (OR = 0.6; 95%CI = 0.4, 0.9) were independently associated with IDA, and tobacco use was not associated with consumption of iron-rich foods or household food insecurity. Clinics had a system for screening, treatment and follow-up care for anemic and iron-deficient antenatal patients, but not for tobacco use. Clinicians and community health workers were interested in integrating tobacco screening and cessation services with current maternal care services such as anemia control. Tobacco users wanted help to quit. Conclusion It would be worthwhile to assess the feasibility of integrating antenatal tobacco screening and cessation services with antenatal care services for anemia control, such as screening and guidance during clinic visits and cessation support during home visits.https://deepblue.lib.umich.edu/bitstream/2027.42/143514/1/12978_2018_Article_516.pd

Association between tobacco use and body mass index in urban Indian population: implications for public health in India

BACKGROUND: Body mass index [BMI, weight (kg)/height (m(2))], a measure of relative weight, is a good overall indicator of nutritional status and predictor of overall health. As in many developing countries, the high prevalence of very low BMIs in India represents an important public health risk. Tobacco, smoked in the form of cigarettes or bidis (handmade by rolling a dried rectangular piece of temburni leaf with 0.15–0.25 g of tobacco) or chewed, is another important determinant of health. Tobacco use also may exert a strong influence on BMI. METHODS: The relationship between very low BMI (< 18.5 kg/m(2)) and tobacco use was examined using data from a representative cross-sectional survey of 99,598 adults (40,071 men and 59,527 women) carried out in the city of Mumbai (formerly known as Bombay) in western India. Participants were men and women aged ≥ 35 years who were residents of the main city of Mumbai. RESULTS: All forms of tobacco use were associated with low BMI. The prevalence of low BMI was highest in bidi-smokers (32% compared to 13% in non-users). For smokers, the adjusted odds ratio (OR) and 95% confidence interval (CI) were OR = 1.80(1.65 to 1.96) for men and OR = 1.59(1.09 to 2.32) for women, respectively, relative to non-users. For smokeless tobacco and mixed habits (smoking and smokeless tobacco), OR = 1.28(1.19 to 1.38) and OR = 1.83(1.67 to 2.00) for men and OR = 1.50(1.43 to 1.59) and OR = 2.19(1.90 to 3.41) for women, respectively. CONCLUSION: Tobacco use appears to be an independent risk factor for low BMI in this population. We conclude that in such populations tobacco control research and interventions will need to be conducted in concert with nutrition research and interventions in order to improve the overall health status of the population