Assessment of resources for physical activity and understanding people's perception and practices regarding physical activity in an Indian city.

BACKGROUND: Promoting physical activity in urban India is imperative considering the burden of non-communicable diseases in the country. Planning for improving population level physical activity needs sound understanding of availability and quality of resources/facilities for physical activity and knowing people's perception and practices regarding the physical activity. METHODS: A cross-sectional study was undertaken in Kolar city of Karnataka state in India. All the resources/facilities required for supporting physical activity were mapped and their quality was assessed utilizing adapted version of physical activity resource assessment questionnaire. The information regarding latitude, longitude and approximate size of the resource was obtained using a hand-held GPS tracker. 495 individuals aged ≥ 18 years, selected by two stage cluster random sampling with probability proportionate to population size technique, were interviewed to assess their perception and practices regarding physical activity using semi-structured questionnaire and global physical activity questionnaire. RESULTS: Kolar city has 36.3 physical activity resources per lakh population and per person availability of park and playground area was 0.4 Sq. meters. Available resources were concentrated in the center of the city. Half of the sports facilities and 14 of the 17 recreational facilities in the city were of poor to mediocre quality. 38.2% of adults in Kolar city were found to be physically active. Only 19.2% of the study participants had accessed sports/fitness facilities/playgrounds in past 3 months and only 18.8% of the study participants accessed parks in the previous 3 months. 28.6% to 59.1% of the participants preferred 'walking' for work, college and shopping. Less than 5% of the participants preferred and used cycle as a mode of transport. 1/3rd of the study participants felt that Kolar city is safe of walking and 44.6% felt that the city is safe for cycling. CONCLUSION: Creating enabling environment by increasing the number and quality of resources/facilities for physical activity along with their equitable distribution is required to promote and improve population level physical activity in Kolar city. Urban planning with a focus on non-motorized transport including walking would contribute to improved people's perception and practices regarding physical activity in the city.

Psychological Distress among Care Recipients Attending Youth Mental Health Promotion Centers across Karnataka, India.

BACKGROUND: Yuva Spandana (YS) is a unique community-based youth mental health promotion program implemented across Karnataka. OBJECTIVE: We assessed factors affecting PD among the population served by YS between January 1, 2017, and December 31, 2021. MATERIALS AND METHODS: A retrospective cross-sectional analysis was done utilizing the visit forms of 10,340 YS's care recipients. A conceptual framework was developed, and all hypothesized variables within this framework were considered exposures. All exposure variables significant at P < 0.10 in univariate analysis were included in multivariable analysis. Multivariable logistic regression analysis was performed by including each of the significant potential exposure variables from univariate analysis using a forward-stepping process. RESULTS: Care recipients with health and lifestyle issues were at almost two times increased risk for PD (adjusted odds ratio [AOR] =1.74 and 95% confidence interval [CI] - 1.52-2.00), and those with self-development issues were almost 2.5 times more likely to have PD (AOR = 2.44 and 95% CI - 2.12-2.79). Those who reported emotional statuses of feeling worried, lost, incapable, lonely, and distrusting were at 21.4, 3.5, 26.3, 37.9, and 4.7 times higher odds of having PD, respectively. CONCLUSIONS: Isolating the risk factors associated with PD will help tailor the mental health promotion provided by YS to at-risk groups.

Yuva spandana - A youth mental health promotion model in India - Design, methods and progress.

A unique youth mental health promotion program called Yuva Spandana is implemented and functional across all districts within Karnataka. Trained guidance providers named Yuva Parivarthakas (YPs) and Yuva Samalochakas (YS) provide support to youth having issues at Yuva Spandana Kendras (YSKs). We highlight the process of development of the program "Yuva Spandana" into a sustainable community-based youth mental health promotion model addressing youth issues across Karnataka and describe the profile of beneficiaries attending YSKs in Karnataka between 2017 and 2019. Yuva Spandana has evolved over time and got established in local-self-governments and communities.

Population-based cohort across stroke life course in India-The NIMHANS-NH-SKAN stroke project: A study protocol.

BACKGROUND: Stroke is a leading cause of death and disability worldwide. In India, it is the fourth leading cause of death and fifth leading cause of disability, posing a major public health concern. National surveys reveal an increasing trend in stroke risk factors such as tobacco use, physical activity, alcohol use, hypertension, and dyslipidemia. However, knowledge regarding the combined effect of these risk factors and their various combinations is limited. Understanding the individual, combined, and synergistic effects of known risk factors, along with new risk factors, is essential to address gaps in stroke epidemiology. This study aims to examine the effect of various risk factors of acute stroke and their association with stroke occurrence and its outcomes (survival, disability and quality of life). METHODS: This retrospective-prospective cohort will be conducted in one taluka of Kolara district and two urban wards of Bengaluru with a total population of ~400,000. All stroke-free individuals above 30 years of age ~200,000 individuals in the selected sites will be participants of stroke-free period and all first ever stroke patients in the community will be part of stroke and post-stroke period respectively. The study subjects will be recruited through a complete house-to-house survey at baseline and undergo annual follow-ups during the stroke-free period, with specific assessments at defined time points during the stroke and post-stroke period for a period of one year. Efforts are implemented to minimize loss to follow-up, including community engagement, a helpline number, and hospital-based surveillance. DISCUSSION: This large population-based cohort study addressing stroke epidemiology in the country, is one -of-its-kind, attempting to fill certain critical gaps in the natural history, management, and outcomes of stroke in India. This research has the potential to provide important insights into the effect of novel risk factors of stroke and various combinations of risk factors of stroke. Furthermore, the development of a stroke risk predictability calculator will add value to the existing Indian National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD) and offers a model for similar countries once developed.

Smoked tobacco dependence and its correlates among participants attending life skills training and counselling services programme across Karnataka (2017-2022).

Introduction: Indian National Mental Health Survey reports an alarming prevalence of 20.9% for tobacco dependence in India. Dependence on smoked tobacco can be prevented by thorough knowledge of the risk factors associated with it. Objectives: To estimate the prevalence and identify the factors associated with smoked tobacco dependence among participants attending the life skills training and counselling services programme (LSTCSP) across Karnataka from 2017 to 2022. Materials and Methods: Pretraining data of 3104 participants from training programmes between 2017 and 2022 were utilised. Univariate and multivariable logistic regression analysis was performed based on a conceptual framework with various hypothesised exposure variables and smoked tobacco dependence as outcome. Results: The overall prevalence of smoked tobacco dependence among LSTCSP participants who used smoked tobacco products was 59.4%. Ever use of smokeless tobacco products (Adjusted odds ratio (AOR) =2.05, 95% CI: 1.11-3.78) and screening positive for symptoms of generalised anxiety (AOR = 2.53, 95% CI: 1.32-4.84) significantly increased the odds of smoked tobacco dependence, whereas making decisions collectively in the family (AOR = 0.35, 95% CI: 0.18-0.66) and individuals with increased score for neurotic personality traits (AOR = 0.64, 95% CI: 0.44-0.93) were the factors associated with reduced odds of smoked tobacco dependence. Conclusion: The identified risk factors associated with smoked tobacco dependence are important to develop tobacco control programmes as well as in preventing its onset. With the risk factors for smoked tobacco dependence identified, the results of this study have implications for health promotion and prevention programmes as well as cessation programmes related to smoked tobacco dependence, within India and similar countries.

Profile of Acute Encephalitis Syndrome Patients from South India.

Introduction: Encephalitis is a major public health problem worldwide that causes huge emotional and economic loss to humanity. Encephalitis, being a serious illness, affects people of all ages. The aim is to describe the sociodemographic, clinical, etiological, and neuroimaging profile among 101 acute encephalitis syndrome (AES) patients visiting a tertiary neuro-specialty care hospital in India. Methods: Record review of medical records of all patients attending neurology emergency and outpatient services at NIMHANS Hospital, diagnosed with AES in 2019, was conducted. Data were collected using standardized data collection forms for all cases in the study. Descriptive analyses (mean and standard deviation for continuous variables and proportions for categorical variables) were conducted. The Chi-square test/Fisher's exact test was used for the comparison of independent groups for categorical variables, and t-test for comparing means for continuous variables. Results: About 42.6% of AES patients had viral etiology, while in 57.4%, etiology was not ascertained. Common presenting symptoms were fever (96%), altered sensorium (64.4%), seizures (70.3%), headache (42.6%), and vomiting (27.7%). Herpes simplex was the most common (21.8%) identified viral encephalitis, followed by chikungunya (5%), arboviruses (chikungunya and dengue) (4%), Japanese encephalitis (4%), rabies (3%), dengue (1%), and varicella virus (1%). About 40% of AES patients showed cerebrospinal fluid pleocytosis (44%), increased protein (39.6%), abnormal computed tomography brain (44.6%), and magnetic resonance imaging abnormalities (41.6%). Conclusion: The study highlights the need to ascertain etiology and importance of evidence-based management of AES patients. A better understanding of opportunities and limitations in the management and implementation of standard laboratory and diagnostic algorithms can favor better diagnosis and management of AES.

Youth focused life skills training and counselling services program-An inter-sectoral initiative in India: Program development and preliminary analysis of factors affecting life skills.

OBJECTIVES: This paper describes the methodology of developing and implementation of a youth focused life skills training and counselling services programme (LSTCP) and assessment of factors associated with life skills of participants pre-training. DESIGN: Development of all aspects of LSTCP (modules, methods and evaluation) was through a consultative process. Experiential learning based facilitation was decided as the approach for training participants. A quasi-experimental design with pre, post and follow-up assessment post-training was finalised. Data collection was done using specifically developed semi-structured self-administered questionnaire. RESULTS: Multivariable logistic regression with life skills as outcome and various exposure variables was performed. About 2/3rd of participants had high level of life skills (68%). Increased score of extraversion (AOR = 1.57,95% CI = 1.32-1.85), agreeableness (AOR = 1.42,95% CI = 1.16-1.73), conscientiousness (AOR = 1.9,95% CI = 1.55-2.33), physical (AOR = 1.03,95% CI = 1.01-1.04), environmental (AOR = 1.02,95% CI = 1.004-1.03) and social quality of life (AOR = 1.01,95% CI = 1.006-1.02) were associated with high life skills score. Higher score of neuroticism (AOR = 0.66,95% CI = 0.53-0.79) was associated with low life skills score. CONCLUSION: The results presented provide an opportunity to understand the evolution of factors affecting life skills during the follow-up of this study. This study throws light on development of LSTCP for apparently healthy population in a setting like India and its states.

Mental health morbidities in Kerala, India: Insights from National Mental Health Survey, 2015-2016.

Background: The National Mental Health Survey was borne out of the felt need for a comprehensive epidemiological survey on mental health to understand the magnitude of psychiatric morbidities in India to aid in mental health policymaking, service planning, and delivery. Kerala was one of the 12 surveyed states, representing southern India. Aims: To estimate the prevalence and pattern of various mental illnesses and substance use disorders in a representative sample from Kerala state. Settings and Design: A household survey using a multi-stage, stratified, random cluster sampling technique, with selection based on probability proportionate to size at each stage. Materials and Methods: The community-based survey was carried out by trained field staff on individuals from systematically selected households from three randomly selected districts of Kerala. The instruments used in the survey included M.I.N.I adult version 6.0, a modified version of the Fagerström Nicotine Dependence Scale and questionnaires to screen for epilepsy, intellectual disability, and autism spectrum disorders. Results: A total of 2479 respondents aged >18 years were interviewed. The lifetime and current prevalence of mental morbidity (excluding tobacco use disorders) was 14.14% and 11.36%, respectively. Neurotic/stress-related disorders and depressive disorders were 5.43% and 2.49%, respectively, while severe mental disorders were prevalent in 0.44% of the sample. The prevalence of high risk for suicide was 2.23%. Conclusions: The survey revealed high rates of common mental illnesses and suicide risk in the state when compared to national estimates.

A bird's eye view of the mental health systems in India.

Background: A staggering 85% of the global population resides in low- and middle-income countries (LAMICs). India stands as an exemplary pioneer in the realm of mental health initiatives among LAMICs, having launched its National Mental Health Program in 1982. It is imperative to effectively evaluate mental health systems periodically to cultivate a dynamic learning model sustained through continuous feedback from mental healthcare structures and processes. Materials and Methods: The National Mental Health Survey (NMHS) embarked on the Mental Health Systems Assessment (MHSA) in 12 representative Indian states, following a pilot program that contextually adapted the World Health Organization's Assessment Instrument for Mental Health Systems. The methodology involved data collection from various sources and interviews with key stakeholders, yielding a set of 15 quantitative, 5 morbidity, and 10 qualitative indicators, which were employed to encapsulate the functional status of mental health systems within the surveyed states by using a scorecard framework. Results: The NMHS MHSA for the year 2015-16 unveiled an array of indices, and the resultant scorecard succinctly encapsulated the outcomes of the systems' evaluation across the 12 surveyed states in India. Significantly, the findings revealed considerable interstate disparities, with some states such as Gujarat and Kerala emerging as frontrunners in the evaluation among the surveyed states. Nevertheless, notable gaps were identified in several domains within the assessed mental health systems. Conclusion: MHSA, as conducted within the framework of NMHS, emerges as a dependable, valid, and holistic mechanism for documenting mental health systems in India. However, this process necessitates periodic iterations to serve as critical indicators guiding the national mental health agenda, including policies, programs, and their impact evaluation.

Incidence and Risk for Hypertension among Regular Medical Examination Attendee Cohort in an Automobile Industry. A Cox- Regression Analysis Model.

Introduction: With nearly 1,612,505 industrial workers in Karnataka, controlling hypertension among them is necessary to reduce subsequent non-communicable diseases (NCDs). However, information on prevalence, incidence, and risk for hypertension among industrial workers is limited. Objectives: To estimate the prevalence, incidence proportion, incidence rate, and risk for hypertension among annual medical examination [AME] attendee cohort between 2010 and 2014 in an automobile industry in India. Materials and Methods: Longitudinal record analysis (cohort approach) of 640 regular AME attendees between 2010 and 2014 was performed to estimate incidence and incidence rates. Cox regression was conducted to estimate the risk for hypertension in the study period. Necessary permission and ethics clearance was obtained. Results and Conclusion: The prevalence of hypertension significantly increased from 8.8% in 2010 to 26.6% in 2014. The small increase in mean blood pressure (BP) resulted in large increases in the prevalence of hypertension. The incidence rate increased from 6.5 per 1000 person-months of observation in 2012 to 14.5 in 2014. No significant risk for hypertension was observed for the work department and type of plant. Results indicate a rising burden of hypertension with no specific risks associated with different work departments or types of plants. AME data is a utility value to monitor hypertension trends among employees and evaluate the effectiveness of worksite health programs to reduce hypertension.

Effectiveness and Factors Associated with Improved Life Skill Levels of Participants of a Large-Scale Youth-Focused Life Skills Training and Counselling Services Program (LSTCP): Evidence from India.

(1) Background: To empower and facilitate mental health promotion for nearly 18 million youth, a pioneering state-wide Life Skills Training and Counselling Services Program (LSTCP) was implemented in Karnataka, India. This study assesses the changes in life skills scores, level of life skills and factors associated with increased life skills among participants of the LSTCP. (2) Method: This pre-post study design was conducted on 2669 participants who underwent a six-day structured LSTCP. Changes in mean life skills scores and level of life skill categories pre- and post-LSTCP were assessed. Multivariate logistic regression was performed to assess the factors associated with increases in life skills. (3) Results: The LSTCP resulted in significant changes in life skill scores and level of life skills, indicating the effectiveness of the training. All life skill domains, except empathy and self-awareness, increased post-training. There was a positive shift in the level of life skills. Age (AOR = 1.34, CI = 1.11-1.62), gender (AOR = 1.39, CI = 1.15-1.68), education (AOR = 1.44, CI = 1.05-1.97) and physical (AOR = 1.02, CI = 1.01-1.03) and psychological (AOR = 1.02, CI = 1.01-1.03) quality of life was associated with an increase in life skills among participants. (4) Conclusions: The LSTCP is effective in improving the life skills of participants. The LSTCP modules and processes can be used to further train youth and contribute to mental health promotion in the state.

Awareness and compliance to anti-smoking law in South Bengaluru, India.

INTRODUCTION: Tobacco smoke affects the health of non-smokers by exposure to second-hand smoke (SHS). The Indian Cigarettes and Other Tobacco Products (COTPA) Act 2003 Section 4 aims to reduce exposure to SHS. Awareness and compliance to COTPA are key to achieving its intended outcome. We assessed: a) awareness among persons responsible for compliance (PRC) and authorized officers (AO), and b) compliance of public places to COTPA in South Bengaluru, India. METHODS: A cross-sectional assessment of public places in South Bengaluru was conducted using time-location sampling. The Johns Hopkins Bloomberg School of Public Health's observational and interview checklist was used to assess compliance of public places to COTPA and awareness of COTPA among PRC/AO, respectively. RESULTS: Among 359 public places, one-third of the public places showed complete (1.9%) or partial compliance (28.1%). The majority (93%) of the PRCs and all AOs were aware of COTPA. However, they lacked information on the different provisions of the Act. Violations like persons smoking (3.9%), visible ashtrays (6%) and cigarette butts (13%) were noted more among eateries compared to other public places. Among those public places supposed to have designated smoking-areas, only 19% complied. CONCLUSIONS: This is the first representative survey of awareness and compliance of COTPA in Bengaluru City. Low compliance, coupled with the lack of appropriate awareness among PRCs and AOs about COTPA, demands a comprehensive strategy to enhance awareness. Comprehensive efforts towards making all stakeholders understand the health impacts of smoking, and strict enforcement, might facilitate effective implementation of COTPA.