Widowhood status, morbidity, and mortality in India: evidence from a follow-up survey.

A known health effect of widowhood is an increased mortality risk among surviving spouses, with gender- and age-specific observations. While morbidity conditions with socio-economic factors may exacerbate the effect of widowhood on mortality, no research has attempted to predict mortality among the widowed over the married population with the presence of morbidity in India. Thus, the present study concurrently examines marital status and health in the Indian setting, bringing substantial empirical evidence to explore the link between marital status, morbidity, and mortality. The study used prospective data from India Human Development Survey (IHDS) wave 1 (2004-2005) and wave 2 (2011-2012). In total, 82,607 individuals aged 25 years and above were considered for the analysis. To present the preliminary findings, descriptive statistics and bivariate analysis were used. Using multivariable logistic regression, the interaction effect of marital status and morbidity status was estimated to predict the likelihood of mortality. Across all socio-economic groups, widowed individuals reporting any morbidity had a higher mortality proportion than married people. Young widowers with any morbidity are more susceptible to increased mortality. Asthma among young widowers and cardiovascular diseases among elderly widowers significantly elevate the probability of mortality. However, older widowed women with diabetes had a lower probability of mortality than older married women with diabetes. The widowers' disadvantage in mortality and morbidity may be attributable to less care-receiving and the greater incidence of unhealthy lifestyle practices during the post-widowhood period, indicating the need for more research.

Neurocognitive evaluation using the International HIV Dementia Scale (IHDS) and Montreal Cognitive Assessment Test (MoCA) in an HIV-2 population.

OBJECTIVES: We aimed to characterize neurocognitive impairment (NI) in an HIV-2 population using an observational cross-sectional study in four Portuguese hospitals. METHODS: Adult HIV-2-infected patients were included. Montreal Cognitive Assessment Test (MoCA) and International HIV Dementia Scale (IHDS) scales were applied for screening of NI. Patient Health Questionnaire-9 (PHQ-9) and Instrumental Activities of Daily Living (IADL) scales were used for assessment of depression and functionality. A multivariate analysis was performed to assess for risk factors for NI. RESULTS: Eighty-one patients were included, 50.6% of African origin (n = 41) and 49.4% of Portuguese origin (n = 40). The MoCA scale showed alterations in 81.5% of patients (100% of migrants vs. 62.5% of non-migrants, P < 0.001) and the IHDS scale showed alterations in 42%. Both scales were altered simultaneously in 35.8%. Variables independently associated with NI were age [odds ratio (OR) = 0.885] and migrant status (OR = 9.150). CONCLUSIONS: Neurocognitive impairment (both scales altered) was present in 35.8%, which is comparable to what is described for HIV-1. The MoCA performed worse in the migrant population and might not be applicable in this setting.

Psychometric utility of the international HIV dementia scale and Montreal Cognitive Assessment in HIV-associated asymptomatic neurocognitive impairment.

There is a growing need for brief screening measures for HIV Associated Neurocognitive Disorders (HAND). We compared two commonly used measures (the Montreal Cognitive Assessment [MoCA] and the International HIV Dementia Scale [IHDS]) in their ability to identify asymptomatic HAND (i.e., asymptomatic neurocognitive impairment [ANI]). Participants included 74 Thai PLWH: 38 met Frascati criteria for ANI and 36 were cognitively normal (CN). Participants completed Thai language versions of the MoCA (MoCA-T) and IHDS, and a validated neurocognitive battery. We examined between-group differences for MoCA-T and IHDS total scores, and scale subcomponents. We also conducted receiver operating characteristic (ROC) analyses to determine the ability of the MoCA-T and IHDS to discriminate between CN and ANI groups, and compared their area under the curve (AUC) values. Results revealed lower MoCA-T total score, as well as the Visuospatial/Executive and Delayed Recall subtask scores, in the ANI relative to CN group. Groups did not differ on the IHDS. For ROC analyses, the MoCA-T, but not the IHDS, significantly differentiated the ANI from CN group, and there was a significant difference in AUC values between the MoCA-T (AUC = .71) and IHDS (AUC = .56). Sensitivity and specificity statistics were poor for both screening measures. These data indicate while the MoCA-T functions better than the IHDS in detecting Thai PLWH with ANI, the mildest form of HAND, neither cognitive screener, showed strong utility. Our findings reflect the limited efficacy of common screening measures in detecting subtler cognitive deficits among Thai PLWH, and highlight the need for better screening tools.

Screening for HIV-Associated Neurocognitive Disorder (HAND) in Adults Aged 50 and Over Attending a Government HIV Clinic in Kilimanjaro, Tanzania. Comparison of the International HIV Dementia Scale (IHDS) and IDEA Six Item Dementia Screen.

Validated screening tools for HIV-associated neurocognitive disorders (HAND) are lacking for the newly emergent ageing population of people living with HIV (PLWH) in sub-Saharan Africa (SSA). We aimed to validate and compare diagnostic accuracy of two cognitive screening tools, the International HIV dementia scale (IHDS), and the Identification and Interventions for Dementia in Elderly Africans (IDEA) screen, for identification of HAND in older PLWH in Tanzania. A systematic sample of 253 PLWH aged ≥ 50 attending a Government clinic in Tanzania were screened with the IHDS and IDEA. HAND were diagnosed by consensus American Academy of Neurology (AAN) criteria based on detailed clinical neuropsychological assessment. Strict blinding was maintained between screening and clinical evaluation. Both tools had limited diagnostic accuracy for HAND (area under the receiver operating characteristic (AUROC) curve 0.639-0.667 IHDS, 0.647-0.713 IDEA), which was highly-prevalent (47.0%). Accurate HAND screening tools for older PLWH in SSA are needed.

RESUMEN: Faltan pruebas cognitivas válidas para los trastornos neurocognitivos asociados al VIH (según sus siglas en inglés, HIV-Associated Neurocognitive Disorder (HAND) en la población emergente de personas mayores que viven con el VIH en el África subsahariana. Nuestro objetivo era validar y comparar la precisión diagnóstica de dos pruebas cognitivas, la escala internacional de demencia por VIH (según sus siglas en ingles International HIV dementia scale (IHDS) y la prueba 'IDEA', para el cribado de trastornos neurocognitivos asociados al VIH (HAND) en personas mayores viviendo con VIH en Tanzania. Una muestra sistemática de 253 personas de ≥50 años que asistieron a una clínica gubernamental en Tanzania se examinó con el IHDS y la IDEA. HAND fueron diagnosticados por consenso según los criterios de la Academia Americana de Neurología (AAN) basados en una detallada evaluación neuropsicológica y clínica. Las fases de cribado y de evaluación clínica se realizaron de forma independiente y a ciegas. Ambas herramientas tenían una precisión de diagnóstico limitada para HAND (área bajo la característica de funcionamiento del receptor (AUROC) curva 0.639 ­ 0.667 IHDS, 0.647-0.713 IDEA). HAND era altamente frecuente (47%). Se necesitan pruebas cognitivas por cribado de deterioro cognitivo en personas mayores con VIH en el África subsahariana.

Impact of lifestyle diseases on income and household consumption: evidence from an emerging economy.

With increase in lifestyle diseases such as diabetes, hypertension and heart disease in emerging economies, it is important to understand the impact of acquiring these health issues on household income and consumption. Using a panel data of Indian households, we show that acquiring diabetes, hypertension or heart disease results in increased medical and non-medical expenses for high-income households. However, affected low-income households, to meet their increased medical expenses, had to divert resources from non-medical expenses. Our findings add to the extant marketing literature on impact of crises on consumption behaviour and the marketing implications of such changes in consumption behaviour.

Impact of education on health-beliefs in an emerging economy: Understanding urban vs. rural differences and the moderating effect of social capital.

In this paper, we assert the critical influence of education on health-beliefs among women from India, an emerging economy. We further examine the urban vs. rural differences and the role of social capital in shaping health-beliefs of women. Using nationally representative data of eligible women from India, we find education to have a positive influence on health-beliefs. We find this effect to be higher in rural regions. Further, we find social capital to negatively moderate the effect of education. Our findings stress the importance of education, especially in rural regions.

Cognitive screening in treatment-naïve HIV-infected individuals in Hong Kong - a single center study.

BACKGROUND: HIV-associated neurocognitive disorder (HAND) remains prevalent in the era of combination antiretroviral therapy (cART). The prevalence of HAND in Hong Kong is not known. METHODS: Between 2013 and 2015, 98 treatment-naïve HIV-1-infected individuals were referred to and screened by the AIDS Clinical Service, Queen Elizabeth Hospital with (1) the International HIV Dementia Scale (IHDS), a screening tool that targets moderate to severe HAND, (2) the Montreal Cognitive Assessment (MoCA), a frequently used cognitive screening test and (3) the Patient Health Questionnare-9 (PHQ-9), a 9-item questionnaire that evaluates depression symptoms. Within the study period, 57 of them completed the second set of IHDS and MoCA at 6 months after baseline assessment. RESULTS: Most participants were male (94%), with a median age of 31 years. At baseline, 38 (39%) and 25 (26%) of them scored below the IHDS (≤10) and MoCA (25/26) cut-offs respectively. Poor IHDS performers also scored lower on MoCA (p = 0.039) but the correlation between IHDS and MoCA performance was weak (r = 0.29, p = 0.004). Up to a third of poor IHDS performers (13/38) showed moderate depression (PHQ-9 > 9). In the multivariable analysis, a lower education level (p = 0.088), a history of prior psychiatric illness (p = 0.091) and the presence of moderate depression (p = 0.079) tended to be significantly associated with poor IHDS performance. At follow-up, 54 out of 57 were on cART, of which 46 (85%) had achieved viral suppression. Their blood CD4+ T-lymphocytes and IHDS scores were higher at follow-up compared to baseline values (both p < 0.001) but their MoCA performance was similar at both assessments. Of note, 17 participants in this subgroup scored below the IHDS cut-off at both assessments. CONCLUSIONS: Poor IHDS performance, and likely cognitive impairment, was frequently observed in treatment-naïve HIV-infected individuals in our locality. A considerable proportion continued to score below the IHDS cut-off at 6 months after cART. Depression was frequently observed in this vulnerable population and was associated with poor IHDS performance.

Chronic morbidity and reported disability among older persons from the India Human Development Survey.

BACKGROUND: The burden of disability and chronic morbidity among the elderly has been increasing substantially in India in recent years. Yet, the use of nationally representative data to investigate the relationship between chronic morbidity and reported disability in the country has been minimal. The objective of this study is twofold: i) to quantify the association between chronic morbidities and overall disabilities in the activities of daily living (ADLs) among elderly people in India, and ii) to understand how various chronic morbidities influence individual ADLs, specifically, walking, toileting and dressing. METHODS: We used data from the India Human Development Survey-II (IHDS-II) as a basis for this study. We computed the Katz Index of independence in ADL to examine the burden of disability among the elderly. Ordered logistic regression was carried out to examine the effect of chronic morbidities on: i) the disability index (where 0 = no disability; 1 = disability in 1 or 2 ADLs; and 2 = disability in 3 ADLs), and ii) disabilities in three ADLs in the population over-60 years of age in India. RESULTS: The percentage of people scoring lower Katz index (indicating severe and mild disability) in at least one of the three ADLs is very high in India (17.91% for males and 26.21% for females). Irrespective of the type of ADL, the Katz score is lower in elderly females than in elderly males. Elderly people who are illiterate and belong to the poorest wealth quintile report lower Katz scores in ADL. Both bivariate and multivariate analyses confirm that all three types of chronic morbidities are positively and significantly associated with a disability condition in the ADLs. Yet, the effects of morbidities vary greatly according to the type of disability. For instance, while diabetes affect walking (OR: 2.56; 95% CI: 2.29-2.86), and toileting (OR: 2.63; 95% CI: 2.26-3.07), high blood pressure mainly affects walking (OR: 2.29, 95% CI: 2.09-2.5) and dressing disabilities (OR: 2.13, 95% CI: 1.84-2.46). CONCLUSIONS: Chronic morbidity is a decisive factor in old age disability. It is crucial to reduce chronic morbidity in a timely way to minimise the enormous associated burden of disability.

Comparison of food consumption in Indian adults between national and sub-national dietary data sources.

Accurate data on dietary intake are important for public health, nutrition and agricultural policy. The National Sample Survey is widely used by policymakers in India to estimate nutritional outcomes in the country, but has not been compared with other dietary data sources. To assess relative differences across available Indian dietary data sources, we compare intake of food groups across six national and sub-national surveys between 2004 and 2012, representing various dietary intake estimation methodologies, including Household Consumption Expenditure Surveys (HCES), FFQ, food balance sheets (FBS), and 24-h recall (24HR) surveys. We matched data for relevant years, regions and economic groups, for ages 16-59. One set of national HCES and the 24HR showed a decline in food intake in India between 2004-2005 and 2011-2012, whereas another HCES and FBS showed an increase. Differences in intake were smallest between the two HCES (1 % relative difference). Relative to these, FFQ and FBS had higher intake (13 and 35 %), and the 24HR lower intake (-9 %). Cereal consumption had high agreement across comparisons (average 5 % difference), whereas fruit and nuts, eggs, meat and fish and sugar had the least (120, 119, 56 and 50 % average differences, respectively). Spearman's coefficients showed high correlation of ranked food group intake across surveys. The underlying methods of the compared data highlight possible sources of under- or over-estimation, and influence their relevance for addressing various research questions and programmatic needs.

Burden of ischemic heart diseases in Iran, 1990-2010: Findings from the Global Burden of Disease study 2010.

BACKGROUND: Cardiovascular diseases are viewed worldwide as one of the main causes of death. This study aims to report the burden of ischemic heart diseases (IHDs) in Iran by using data of the global burden of disease (GBD) study, 1990-2010. MATERIALS AND METHODS: The GBD study 2010 was a systematic effort to provide comprehensive data to calculate disability-adjusted life years (DALYs) for diseases and injuries in the world. Years of life lost (YLLs) due to premature mortality were computed on the basis of cause-of-death estimates, using Cause of Death Ensemble model (CODEm). Years lived with disability (YLDs) were assessed by the multiplication of prevalence, the disability weight for a sequel, and the duration of symptoms. A systematic review of published and unpublished data was performed to evaluate the distribution of diseases, and consequently prevalence estimates were calculated with a Bayesian meta-regression method (DisMod-MR). Data from population-based surveys were used for producing disability weights. Uncertainty from all inputs into the calculations of DALYs was disseminated by Monte Carlo simulation techniques. RESULTS: The age-standardized IHDs DALY specified rate decreased 31.25% over 20 years from 1990 to 2010 [from 4720 (95% uncertainty interval (UI): 4,341-5,099) to 3,245 (95% UI: 2,810-3,529) person-years per 100,000]. The decrease were 38.14% among women and 26.87% among men. The age-standardized IHDs death specefied rate decreased by 21.17% [from 222) 95% UI: 207-243 (to 175 (95% UI:152-190) person-years per 100,000] in both the sexes. The age-standardized YLL and YLD rates decreased 32.05% and 4.28%, respectively, in the above period. CONCLUSION: Despite decreasing age-standardized IHD of mortality, YLL, YLD, and DALY rates from 1990 to 2010, population growth and aging increased the global burden of IHD. YLL has decreased more than IHD deaths and YLD since 1990 but IHD mortality remains the greatest contributor to disease burden.

Association of Viral and Host Genetic Architecture with the Status of Neurocognitive Disorder in HIV-Infected Individuals.

The polymorphisms in host genes such as CCR5, CCR2, stromal derived factor (SDF), and MBL (mannose-binding lectin) as well as the viral nef gene have been shown to influence human immunodeficiency virus (HIV) infection, followed by the development of HIV-associated neurocognitive disorder (HAND). In this preliminary study with a limited number of samples, we have tried to associate the genetic polymorphism from the host and viral genetic factors with the neurocognitive status along with immuno-virological parameters. The total RNA was isolated from 10 unlinked plasma samples containing 5 samples from each group with and without HAND based on the International HIV Dementia Scale (IHDS) score <9.5 and >9.5, respectively. The CCR5, CCR2, SDF, MBL, and HIV nef genes were amplified and digested with restriction enzymes, except for the nef gene amplicon. Restrictions fragment length polymorphism (RFLP) was used to determine whether allelic variations were present in the digested host gene products, while sequencing was done for HIV nef amplicons without digestion. CCR5 delta 32 heterozygous variants were present in two samples from the HAND group. Three samples with HAND showed SDF-1 3' heterozygous allelic variant, while the MBL-2 gene presented with a homozygous mutant allele (D/D) in codon 52, heterozygous mutant allele (A/B) in codon 54, and codon 57 (A/C) for all samples except IHDS-2 irrespective of dementia status. Furthermore, amino acid alignment of Nef sequences confirmed the heterogeneity, while prediction of the human leukocyte antigen binding epitopes further explored its effect on functional motifs with variable binding efficiency such as epitopes GAFDLSFFL (aa 83) and LTFGWCFKL (aa 138) binding with HLA molecules at 60% and 80%, respectively. Thus, host genetics evidently influence predisposition to HIV infection and HAND. The genetic variability in the nef gene from both groups resulted in altering the functionality of specific domains and showing its impact on the progression of the disease, which needs to be explored.

Migration and health: Exploring the effect of destinations on the health outcomes among rural-urban migrants in India.

Conservative estimates of the census of India pegged the number of rural-urban migrants at 78 million, out of the total internal migrant population of 456 million, in 2011. Despite their sizable number, larger than several European nations, very little is known about whether the type of urban destination matters for the physical health of these largely poor populations. Using data from two waves of the India Human Development Survey (2004-05 and 2011-12), we conduct multi-level analyses to explore the impact of metropolitan versus non-metropolitan destinations on the odds of short-term and long-term illnesses among rural-urban migrants across residential durations. Findings show that rural-urban migrants to metropolitan cities experience higher likelihood of suffering from overall and pollution-related major illnesses relative to their counterparts in non-metropolitan urban areas. On the other hand, migrants to metropolitan cities experience lower odds of suffering from minor illnesses than non-metropolitan rural-urban migrants. However, these significant effects of urban destination disappear when we compare health outcomes between shorter versus longer-duration migrants. We subject these multi-level analytic findings to robustness checks that corroborate our foregoing mixed results. Our findings generate initial evidence on health disparities among rural-urban migrants by destination and duration. These findings underscore the importance of health needs among migrant populations, that require attention particularly in the short-term of their relocation to cities.

Is International HIV Dementia Scale good enough to diagnose HIV-associated neurocognitive disorders?

Introduction: Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) comprise impairment of multiple cognitive domains and cause significant morbidity. International HIV Dementia Scale (IHDS) is a quite sensitive and specific method for screening for HAND, and Modified Mini-Mental State Examination (3MS), though nonspecific, contains more parameters for screening for neurocognition. Hence, we compared 3MS and IHDS as screening tools for HAND with an aim to find out which was a better screening tool for HAND. Methods: Using 3MS and IHDS, we assessed the cognitive status of 200 HIV-positive patients (65% males) and 84 controls, presenting to the Department of Medicine, King George's Medical University, Lucknow, India from September 2015 to September 2019. Results: According to 3MS, 42 (21%) HIV-positive patients were neurocognitively impaired (mean 76.24 ± 1.51), and 158 (79%) patients were not (mean 87.02 ± 4.16). As per IHDS, 185 (92.5%) HIV patients were neurocognitively impaired (mean 8.45 ± 0.88), and 15 (7.5%) patients were not (mean 11.13 ± 0.35). The mean 3MS score of controls was 87.56 ± 4.26, and the IHDS score was 9.73 ± 1.00. According to Patient Health Questionnaire-9 (PHQ-9), moderate depression occurred in only 3.5% of the patients, and the rest had only minimal or mild depression. In IHDS, psychomotor speed was the most affected parameter, whereas in 3MS, similarities were the most affected. Conclusion: IHDS may be over diagnosing neurocognitive impairment in HIV patients due to difficulty in understanding the test, especially psychomotor speed testing. 3MS may be more accurate for detecting neurocognitive impairment in HIV patients, and scale combining both these methods may be a still better choice.

The NeuroinflammatoryPotential of HIV-1 NefVariants in Modulating the Gene Expression Profile of Astrocytes.

HIV-1 mediated neurotoxicity is thought to be associated with HIV-1 viral proteins activating astrocytes and microglia by inducing inflammatory cytokines leading to the development of HIV-associated neurocognitive disorder (HAND). In the current study, we observe how HIV-1 Nef upregulates the levels of IL-6, IP-10, and TNF-α around 6.0fold in normal human astrocytes (NHAs) compared to cell and empty vector controls. Moderate downregulation in the expression profile of inflammatory cytokines was observed due to RNA interference. Furthermore, we determine the impact of inflammatory cytokines in the upregulation of kynurenine pathway metabolites, such as indoleamine 2,3-dioxygenase (IDO), and 3-hydroxyanthranilic acid oxygenase (HAAO) in NHA, and found the same to be 3.0- and 3.2-fold, respectively. Additionally, the variation in the level of nitric oxide before and after RNA interference was significant. The upregulated cytokines and pathway-specific metabolites could be linked with the neurotoxic potential of HIV-1 Nef. Thus, the downregulation in cytokines and kynurenine metabolites observed after siRNA-Nef interference indicates the possibility of combining the RNA interference approach with current antiretroviral therapy to prevent neurotoxicity development.

Climate Change and Household Debt in Rural India.

Climate change and indebtedness have been repeatedly highlighted as major causes of distress for rural households in India. However, despite the close connection between climate conditions and rural livelihoods, there has been little attempt to systematically examine the association between the two. To address this gap, we combine national-level longitudinal data from IHDS, MERRA-2, and the Indian Ministry of Agriculture to study the impact of climate anomalies on household indebtedness across rural India. Using a longitudinal approach that accounts for potential confounders at household, village, and district levels, we find pervasive effects of season-specific, five-year climate anomalies on multiple dimensions of household debt, particularly in arid and semi-arid areas. Most notably, temperature anomalies in the winter cropping season in arid and semi-arid areas are associated with increasing household indebtedness. We further find that climate change interacts with existing socioeconomic differences-caste and landholding in particular-to deepen both the size and the depth of indebtedness for rural households.

Pulp Stones: Diagnostic Significance in Early Diagnosis and Radiographic Correlation with Ischemic Heart Diseases.

Context and Aim Sufficient evidence exists in the literature which indicates that patients with ischemic heart diseases (IHDs) show higher degree of pulp calcifications. The present study was, therefore, planned to estimate the prevalence of pulp stones in patients diagnosed with/or undergoing treatment for IHDs. Materials and Methods The present study, which consisted of 300 subjects within the age range of 25 to 65 years, was divided into two groups: study group comprising 150 patients (113 males and 37 females) and 150 age- and sex-matched healthy controls. Pulp stones were imaged using bitewing radiographs and paralleling technique under standard conditions. Statistical Analysis Used Statistical analysis was done using IBM SPSS Statistics for Windows version 21 (IBM Corp, Armonk, USA), while independent t -test and Chi-square test were done to check the prevalence of pulp stones in the study and control groups, based on gender-, arch-, region- and side-wise distribution. p < 0.05 was considered statistically significant. Results The patients with IHDs exhibited 100% prevalence of pulp stones and the difference was found to be statistically significant, although there was a significant difference in the mean number of pulp stones observed in the study and control groups, with the study group revealing 2217 pulp stones as against 639 pulp stones observed in the control group ( p < 0.001). Furthermore, maxillary arch and posterior teeth were predominantly affected in both the groups, although the difference was not found to be statistically significant. Conclusions The findings of the present study suggested a positive correlation between pulp stones and IHDs, highlighting the significance of dental radiographic examination, which may have a possibility for an early detection of IHDs.

Prevalence and Predictors of Neurocognitive Impairment in Ethiopian Population Living with HIV.

BACKGROUND: Modern antiretroviral therapy has extended the life expectancies of people living with HIV; however, the prevention and treatment of their associated neurocognitive decline have remained a challenge. Consequently, it is desirable to investigate the prevalence and predictors of neurocognitive impairment to help in targeted screening and disease prevention. MATERIALS AND METHODS: Two hundred and forty-four people living with HIV were interviewed in a study using a cross-sectional design and the International HIV Dementia Scale (IHDS). Additionally, the sociodemographic, clinical, and psychosocial characteristics of the patients were recorded. Chi-square and binary logistic regression analysis were used to determine the level of significance among the independent risk factors and probable neurocognitive impairment. RESULTS: The point prevalence of neurocognitive impairment was found to be 39.3%. Participants' characteristics of being older than 40 years (AOR= 2.81 (95% CI; 1.11-7.15)), having a history of recreational drug use (AOR= 13.67 (95% CI; 6.42-29.13)), and being non-compliant with prescribed medications (AOR= 2.99 (95% CI; 1.01-8.87)) were independent risk factors for neurocognitive impairment. CONCLUSION: The identification of predictors, in the Ethiopian people living with HIV, may help in the targeted screening of vulnerable groups during cART follow-up visits. This may greatly help in strategizing and implementation of the prevention program, more so, because (i) HIV-associated neurocognitive impairment is an asymptomatic condition for considerable durations, and (ii) clinical trials on neurocognitive impairment therapies have been unsuccessful.

An appraisal of allergic disorders in India and an urgent call for action.

India is the second most populous country in the world with a population of nearly 1.3 billion, comprising 20% of the global population. There are an estimated 37.5 million cases of asthma in India, and recent studies have reported a rise in prevalence of allergic rhinitis and asthma. Overall, 40-50% of paediatric asthma cases in India are uncontrolled or severe. Treatment of allergic rhinitis and asthma is sub-optimal in a significant proportion of cases due to multiple factors relating to unaffordability to buy medications, low national gross domestic product, religious beliefs, myths and stigma regarding chronic ailment, illiteracy, lack of allergy specialists, and lack of access to allergen-specific immunotherapy for allergic rhinitis and biologics for severe asthma. High quality allergen extracts for skin tests and adrenaline auto-injectors are currently not available in India. Higher postgraduate specialist training programmes in Allergy and Immunology are also not available. Another major challenge for the vast majority of the Indian population is an unacceptably high level of exposure to particulate matter (PM)2.5 generated from traffic pollution and use of fossil fuel and biomass fuel and burning of incense sticks and mosquito coils. This review provides an overview of the burden of allergic disorders in India. It appraises current evidence and justifies an urgent need for a strategic multipronged approach to enhance quality of care for allergic disorders. This may include creating an infrastructure for education and training of healthcare professionals and patients and involving regulatory authorities for making essential treatments accessible at subsidised prices. It calls for research into better phenotypic characterisation of allergic disorders, as evidence generated from high income western countries are not directly applicable to India, due to important confounders such as ethnicity, air pollution, high rates of parasitic infestation, and other infections.

The double burden of malnutrition: an assessment of 'stunted child and overweight/obese mother (SCOWT) pairs' in Kerala households.

A double burden of malnutrition (DBM) is the coexistence of under-nutrition and over-nutrition in a single household that has been reported from many developing countries. We performed a secondary analysis on India Human Development Survey (IHDS-II) data assessing 'stunted child and overweight/obese mother (SCOWT) pairs' in Kerala households. We included 344 pairs of children below 5 years of age and their mothers, with anthropometric measurements. We also performed the Pearson's Chi-square test to study the association of SCOWT pairs with socio-economic variables. The prevalence of SCOWT pairs was 10.7% for Kerala. The bivariate analysis showed no significant association for SCOWT pairs, irrespective of their socio-economic status. It is clear that the DBM is prevalent in Kerala and cannot be addressed exclusively by policies focusing on over-nutrition.

Breastfeeding Duration and Adolescent Educational Outcomes: Longitudinal Evidence From India.

OBJECTIVE: There is a significant evidence gap on the long-term educational benefits of longer breastfeeding in low- and middle-income countries. We estimated the association between duration of (any) breastfeeding and educational outcomes of Indian children. METHODS: We used regression analysis to examine the association between the length of breastfeeding (in months) and future education outcomes on the basis of 2 data sets: (1) data from a follow-up survey known as the Andhra Pradesh Children and Parents Study (APCAPS, 2003-2005) of 1165 children aged 13 to 18 years from a controlled nutrition trial originally conducted in South India during the period of 1987 to 1990; and (2) nationally representative data from the India Human Development Survey (IHDS-2, 2011-2012) of 6121 children aged 6 to 12 years. RESULTS: In APCAPS, children with >36 months of breastfeeding scored 0.28 (95% confidence interval [95% CI]: 0.00-0.56; P < .05) higher on tests than those with up to 12 months of breastfeeding. In the nationally representative IHDS-2 data, above-median breastfeeding duration was associated with 0.1 year (95% CI: 0.04-0.16; P < .01) higher educational attainment. In IHDS-2, >12 to 24 months and >24 months of breastfeeding were associated with 0.12 (95% CI: 0.01-0.23; P < .05) and 0.19 years of (95% CI: 0.05-0.34; P < .05) higher educational attainment, respectively, than for those with up to 6 months of breastfeeding. In additional analyses by sex, we found that the benefits of breastfeeding accrued primarily to boys. CONCLUSION: Breastfeeding duration was associated with small gains in educational outcomes for boys but not for girls in India.