Relationship between serum lipids and depression: A cross sectional survey among adults in Haryana, India.

Introduction: Dyslipidemia and mental illnesses are significant contributors to the global noncommunicable disease burden and studies suggest an association between them. Aim: Using data from a noncommunicable disease risk factor survey conducted in Haryana, India, we undertook a secondary data analysis to examine the association between lipids and depressive symptoms. Methods: The survey involved 5,078 participants and followed the World Health Organisation STEPwise approach to NCD risk factor surveillance approach. Biochemical assessments were undertaken in a subset of participants. Lipid markers were measured using wet chemistry methods. Depressive symptoms were assessed using the Patient Health Questionnaire-9. Descriptive statistics were presented for all variables; logistic regression was used for association analyses. Results: The mean age of the study population was 38 years and 55% of them were females. A majority of the participants belonged to a rural background. The mean total cholesterol was 176 mg/dL and approximately 5% of the participants were found to have moderate to severe depression. The association of total cholesterol (odds ratio [OR] 0.99, P = 0.84), LDL-cholesterol (OR = 1.00, P = 0.19), HDL-cholesterol (OR = 0.99, P = .76), and triglycerides (OR 1.00, P = .12) with depressive symptoms was not significant. Conclusion: This study did not find any association between lipids and depressive symptoms. However, further investigations using prospective designs are warranted to understand this relationship and complex interactions with other mediating factors better.

Prevalence, Awareness, Treatment, and Control of Hypertension and Diabetes: Results From Two State-Wide STEPS Survey in Punjab and Haryana, India.

Background: India which is home to more than one sixth of the world's population, accounts for more than two thirds of total deaths due to non-communicable diseases (NCD). Out of this, hypertension and diabetes are the most common NCDs. Awareness, treatment, and control of hypertension and diabetes remains a major challenge despite various national programs being run to curb the rising burden NCDs. In order to fill the knowledge gap, awareness, treatment, and control of diabetes and hypertension were studied by using data from the STEPS survey among the adult population in two major northern Indian states of Punjab and Haryana. Methods: Two state-wide NCD risk factors surveys were conducted using WHO STEPS methodology among 5,127 individuals in Punjab and 5,078 individuals in Haryana aged 18-69 years in the year 2014-15 and 2016-18. Standardized questionnaire was used to determine the behavioral risk factors in step one followed by anthropometric measurements for physical risk factors in step two and in the third step serum and urine samples were collected for biochemical risk factors. Results: The prevalence of hypertension in Punjab was 40.1% while that in Haryana was 26.2%. In Punjab, only 48.3% of the hypertensive were aware of their condition, 30.9% were on treatment while only 18.3% of the cases were controlled. While in Haryana 33.4% of the respondents were aware of their condition, 26.3% are on treatment while only 12% of the cases were controlled. Similarly, the prevalence of diabetes was 14.3 and 15.1% in Punjab and Haryana, respectively. In Punjab 34.2% of diabetics were aware of their condition, 28.2% were on treatment while only 14.2% of the cases were controlled. The awareness and control rates in Haryana were similar to that in Punjab. 29.5% of the respondents were aware of their condition, 22.4% were on treatment while only 13.8% of the cases of diabetes were controlled. Family history of diabetes and hypertension was found to be associated with higher odds of being aware, on treatment and controlled blood glucose and blood pressure levels in both Punjab and Haryana. Discussion: Hypertension and diabetes are a major public health problem in Punjab and Haryana and awareness, treatment and control rates are low which require specific interventions with a focus on access to treatment, regular follow up for better control. There is an urgent need to effectively implement the existing national NCD programmes in these states in India.

Progress and challenges in achieving noncommunicable diseases targets for the sustainable development goals.

The 2030 Agenda for Sustainable Development adopted by the United Nations in 2015 recognizes noncommunicable diseases (NCDs) as a major public health challenge. Sustainable Development Goal (SDG) 3 includes target 3.4 to reduce premature NCD mortality by one-third by 2030. This review article analyzes the progress towards the attainment of targets within 3.4, the gaps in meeting the targets, and implementation challenges correlated with those gaps. A literature review was performed in September 2020 to identify the published literature and data discussing the SDGs and NCDs, its progress since 2015, and the associated challenges. The analysis reveals SDG target 3.4 is interrelated to at least nine SDGs. There have been many positive SDG initiatives, but the progress has been slow. Data from various countries show that only two out of the ten NCD progress indicators are being met by at least half of the 176 countries who signed the SDGs. The ongoing COVID-19 pandemic is expected to further aggravate the prevalence and hinder the progress towards the achievement of goals and the targets of the SDGs. The next decade is critical to advance progress on reducing NCDs across countries. The article concludes with a commentary and recommended actions. A combination of prevention, early detection, and treatment are the key to achieve the SDG 3.4 targets. Increased funding and commitments at international and national levels are required to bring about the transformative changes.

Protocol for a systematic review of reviews evaluating effectiveness of mass media interventions for prevention and control of non-communicable diseases.

INTRODUCTION: Timely interventions are required in order to change unhealthy lifestyles because if continued for a prolonged period of time, these become risk factors for non-communicable diseases (NCDs). Education through mass media is an important factor in bringing out the behavioural change which may get missed in community-based interventions due to their limited reach. Many countries engage in mass media interventions, however, the nature of interventions and their effectiveness differs. We, therefore, describe the protocol of a systematic review to evaluate the effectiveness of the mass media interventions to reduce the risk of NCDs in the general population and compare the differences in effectiveness estimates across low/middle-income countries and developed countries. METHODS AND ANALYSIS: We will search The Cochrane Library, Database of Abstracts of Reviews of Effectiveness, PubMed, Excerpta Medica Database limited to publications since 2000 to October 2019. Specific terms for the search strategy will be piloted as database-controlled vocabulary in the databases searched. The searches will include variations of the following terms: mass media, mass communication, campaign, publicity and terms for types of media, that is, print media, mobile, digital media, social media and broadcast. Study designs to be included will be systematic reviews followed by grey literature and other good quality reviews identified. The primary outcome of effectiveness will be the percentage change in population having different behavioural risk factors. In addition, mean overall change in levels of several physical or biochemical parameters will be studied as secondary outcomes. ETHICS AND DISSEMINATION: The review is being done under the doctoral research which has been approved by the Institute Ethics Committee of the Post Graduate Institute of Medical Education and Research Dissemination will be done by submitting scientific articles to academic peer-reviewed journals. We will present the results at relevant conferences and meetings. PROSPERO REGISTRATION NUMBER: CRD42016048013.

Non-communicable diseases risk factors and their determinants: A cross-sectional state-wide STEPS survey, Haryana, North India.

BACKGROUND: Recent studies have documented high variation in epidemiologic transition levels among Indian states with noncommunicable disease epidemic rising swiftly. However, the estimates suffer from non-availability of reliable data for NCDs from sub populations. In order to fill the knowledge gap, the distribution and determinants of NCD risk factors were studied along with awareness, treatment and control of NCDs among the adult population in Haryana, India. METHODS: NCD risk factors survey was conducted among 5078 residents, aged 18-69 years during 2016-17. Behavioural risk factors were assessed using STEPS instrument, administered through an android software (mSTEPS). This was followed by physical measurements using standard protocols. Finally, biological risk factors were determined through the analysis of serum and urine samples. RESULTS: Males were found to be consuming tobacco and alcohol at higher rates of 38.9% (95% CI: 35.3-42.4) and 18.8% (95% CI: 15.8-21.8). One- tenth (11%) (95% CI: 8.6-13.4) of the respondents did not meet the specified WHO recommendations for physical activity for health. Around 35.2% (95%CI: 32.6-37.7) were overweight or obese. Hypertension and diabetes were prevalent at 26.2% (95% CI: 24.6-27.8) and 15.5% (95% CI: 11.0-20.0). 91.3% (95% CI: 89.3-93.3) of the population had higher salt intake than recommended 5gms per day. CONCLUSION: The documentation of strikingly high and uniform distribution of different NCDs and their risk factors in state warrants urgent need for evidence based interventions and advocacy of policy measures.