Anti-Obesity Vaccines Could Reverse the Epidemic

Obesity and excess weight are major risk factors for chronic diseases, including type II diabetes, cardiovascular diseases, gastrointestinal disorders and certain forms of cancer. Understanding the neuroendocrine mechanisms that govern body weight is an important research priority because such insight could guide the rational design of new agents to treat obesity. If this becomes a reality, it will be a dream come true for people who are suffering from obesity. In 2014, 39% of adults aged 18 years and older (38% of men and 40% of women) were overweight. In the modern world, we have a long list of measures that includes both medical and surgical, which can help us to reduce obesity out of which the therapeutic vaccines show promise. Recent studies have shown that therapeutic vaccines may be new targets for development of anti-obesity medications. These vaccines will aim at multiple targets, which include a spectrum of problems ranging from metabolic derangements to infectious agents including suppressing the appetite-stimulating hormone and blocking absorption of nutrients

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Elderly depression: A public health dilemma; challenges and opportunities

India is undergoing a demographic transition that has resulted in rapid growth of the elderly population. This enormous growth has mandated an urgent need for the development of mental health services. Elderly depression is a significant contributor to morbidity and mortality in this age group. The Global Burden of Disease report 2015 outlines depression as the third leading contributor to global disability measured as disability adjusted life years (DALYs). Early identification, diagnosis and initiation of treatment can provide the elderly an opportunity to improve their quality of life and a considerable reduction in the morbidity and mortality. This public health challenge can be addressed by social support and engaging primary health care providers in providing patient centred care. The philosophy of geriatric medicine is not only to add years to life but to help the elderly attain the desired life span with minimal distress and disability

Quality of life and its determinants among ambulatory diabetic patients attending NCD prevention clinic: A cross sectional study from Eastern India

Introduction: India is experiencing an upward spiral in diabetic population. With the impact of diabetes on physical, social, psychological components of individual's life, a holistic view in terms of Quality of Life (QoL) is being increasingly recognized as an essential component of diabetes care and management. The objective of this study was to evaluate the QoL in ambulatory diabetic patients and factors affecting it in a tertiary care medical institution in eastern India. Material and methods: In this cross-sectional study, 103 adult diabetic ambulatory patients were recruited by systematic random sampling from a Non-Communicable Disease (NCD) Clinic of a tertiary care hospital of Eastern India. The QoL of patients were accessed by the validated Odia version of WHO-QoL BREF questionnaire. Bivariate analysis was performed to compare the effect of sociodemographic and clinical parameters on QoL scores. Results: The maximum domain wise score was in social (65.98 ± 13.89) followed by environmental (61.73 ± 16.27) domain. Overall, 64% of the respondents perceived as their QoL as good. Males, urban residents, persons aged less than 60 years and overweight individuals reported a better QoL than their counterparts. Gender and residence were found to be significantly associated with QoL, across domains. Conclusions: QoL assessment is pivotal as an outcome measure in diabetes care and management. Policy makers ought to consider quality adjusted life years while evaluating health outcomes in patients of chronic diseases like diabetes

Clinical correlates and profile of patients on antiretroviral therapy: A hospital-based cross-sectional study from a tertiary care institution of North India

Introduction: HIV/AIDS as a global pandemic has affected each and every region of the world. The HIV epidemic is dynamic in nature with relation to temporal changes, geographic distribution, and modes of transmission. India, though in the declining phase, is still confronting with the varied nature of the spread of the disease. Materials and Methods: This hospital-based cross-sectional study was conducted among four hundred people living with HIV/AIDS (PLHIV) attending the antiretroviral therapy (ART) center of a tertiary care institute of North India. Data were collected from the patients using a predesigned pretested questionnaire maintaining confidentiality. The data were analyzed using simple proportion and percentages. Results: The mean age of the study participants was 32.8 ± 7.4 years. The mean duration of ART intake was 24.5 ± 14.4 months. There was a significant improvement in clinical staging and CD4 count with ART intake among PLHIV. The most prevalent possible route of transmission was found to be heterosexual (85.5%) route. Conclusion: The spread among the population, particularly in the younger age group, reinforces the fact that preventive strategies need to be initiated within the target population at an early stage. Health education and social campaigns are the mainstays for “getting to zero” target

Neck circumference: Independent predictor for overweight and obesity in adult population

Background: Neck circumference (NC) measurement, an index of upper body fat (BF) distribution, seems promising as a community-based screening measure for overweight and obesity in want of evidence on its validity as a screener. Objective: The objective of this study was to determine the validity of NC as a screener for overweight and obesity in adults in community settings against BF percentage (BF%). Materials and Methods: This cross-sectional community-based study involved data collection on a predesigned, pretested, and semi-structured schedule that included the sociodemographic characteristics and anthropometric measurements of respondents. Results: NC correlated positively with body weight, waist circumference, and hip circumference. NC was found to have good discriminatory power with cutoff values of 36.55 cm for males and 34.05 cm for females, with maximum sensitivity and specificity to predict overweight and obesity in comparison to direct BF% estimation on receiver operating characteristic analysis. Conclusion: NC has a fair validity as a community-based screener for overweight and obese individuals in the study context. Further studies may be carried out to explore the generalizability of this observation

Public awareness lectures at hospital complex of AIIMS Bhubaneswar: Bridging the gap between people and healthcare professionals

Health communication forms an important link in a doctor patient relationship. Public health awareness lectures are organised across the world to disseminate key messages related to health and to improve the doctor patient interaction. With a plethora of information in this age of social media, which are many a time incomplete and erroneous, it is all the more important that people get the right information based on scientific evidence. In this article we intend to describe our experience of public awareness lectures held at AIIMS Bhubaneswar over the last one year

Prevalence and Correlates of Substance Use in rural Bhubaneswar – A Community based Cross sectional Study

Background: Substance use is an ever-increasing public health problem in the Indian society. Besides being a personal health risk, it is also a social and economic issue. The present study was undertaken to find out the prevalence and pattern of substance use in rural Bhubaneswar, Odisha. Material & Methods: A cross sectional community-based study was undertaken in rural Bhubaneswar in two phases, a pre survey qualitative assessment followed by the quantitative assessment. The prevalence, pattern and habit of use of different psychoactive substances were accessed using a predesigned pretested questionnaire among 574 study participants of greater than ten years of age. Results: The prevalence of use of at least one substance was 44.1%. Tobacco (smokeless) was the most commonly used substance followed by alcohol and smoked tobacco. Male gender, age greater than 40 years, joint family and being illiterate were the important predictors of substance use. Conclusions: A predominance of smokeless tobacco consumption was found in our study. Family members’ being the source of introduction in majority of users is a matter of serious concern. Community based intervention strategies can be helpful in targeting the rural population for deaddiction and delivering a social message for curbing the use of harmful substances

Correlation between the percentage of body fat and surrogate indices of obesity among adult population in rural block of Haryana

Introduction: The increasing prevalence of overweight and obesity has raised concerns regarding the importance of different techniques, which are used to assess body growth composition that can be used at the level of primary health care settings with minimal knowledge. The purpose of this study was to evaluate the relationship between different surrogate indices of fatness (body mass index [BMI], waist circumference [WC], waist-to-hip ratio [WHR], waist-to-height ratio [WHtR], and body fat percentage [BF%]) with the percentage of body fat and their usefulness as a predictor of obesity among adult population. Materials and Methods: The community-based cross-sectional study done over a period of 1-year involved 1080 adult participants from a rural area in Haryana. Anthropometry, along with BF% (using hand held analyzer) were recorded using standard procedures. Results: The prevalence of overweight and obesity as per the modified criteria of BMI for the Asian Indians was found to be 15.0% and 34.6%, respectively. Positive correlation was seen among all the indices except between the WHR and body adiposity index (BAI) using Pearson′s correlation analysis. Maximum correlation was seen between WHtR and WC (r = 0.923), whereas WHtR depicted maximum correlation (r = 0.810) with BF%. Receiver operating characteristic curve analysis revealed that the WHtR was the most sensitive and specific indicator for the study population to predict overweight and obesity comparable to that calculated by body fat analyser followed by BAI, BMI, and WHR. Conclusion: A single value of WHtR irrespective of gender and the area of residence can be used as a universal screening tool for the identification of individuals at high risk of development of metabolic complications