Collaboration with medical colleges and public health institutions for implementation of national health programs: The way forward.

Health system strengthening is a much-needed priority to achieve the major public health goals of control, elimination, and eradication of various diseases. It depends on improving the country's ability to successfully perform essential functions while focusing on sustainability, equity, effectiveness, and efficiency. Medical colleges and public health institutions play an integral role in health system strengthening by educating and training the current and the future generations of health-care workforce with a vision to achieve the global standards in public health. This discussion focuses on the role of medical colleges and public health institutions in the success of various national health programs with a focus on challenges and improvement areas for the same.

Finding the most cost-effective option from commonly used Dipeptidyl peptidase-4 inhibitors in India: a systematic study.

OBJECTIVE: To identify a preferred and cost-effective drug among Dipeptidyl peptidase-4 inhibitors (DPP4Is) for Indian patients with T2DM. METHODS: We performed a systematic literature search using standard databases for relevant literature. Original studies comparing the efficacy and/or safety of different DPP4Is were included. Two authors independently performed the literature search, screening, and collected relevant data from the selected studies. The costs of all brands of individual DPP4Is were noted and compared for lowest, highest, and average cost. Finally, we summarized the information with respect to Efficacy, safety, suitability, and cost to find the most cost-effective DPP4I. RESULTS: We found 13 eligible studies containing data on 15,720 subjects. These studies showed similar efficacy (or better) and safety with teneligliptin as compared to other DPP4Is. Teneligliptin also showed additional benefits other than the glycemic control. The average cost per tablet of teneligliptin 20 mg was markedly lower as compared to sitagliptin, vildagliptin, and other commonly used DPP4Is. Teneligliptin also outscored other commonly used DPP4Is in India in suitability and seems to have better patient compliance. CONCLUSIONS: Teneligliptin 20 mg could be considered as the preferred and most cost-effective agent among commonly used DPP4Is for the effective management of patients with T2DM in India.

The Hindi Version of the Breastfeeding Self-Efficacy Scale-Short Form: Reliability and Validity Assessment.

BACKGROUND: Despite the cultural sanctity and elevation of breastfeeding practices, nearly one in two Indian women nationwide are unable to practice exclusive breastfeeding (EBF). Early identification of mothers at risk of reduced breastfeeding through a suitable instrument can enable targeted interventions for breastfeeding support. OBJECTIVES: We conducted this study with the objectives of translation into Hindi and to psychometrically test the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) and to ascertain the sociodemographic and other correlates of breastfeeding self-efficacy. METHODS: The BSES-SF was translated into Hindi using a back and forth translation process to ensure linguistic validity. We enrolled a total of 210 married women who were mothers of infants at an urban primary health center in Delhi, India. RESULTS: The Cronbach's alpha for the Hindi translation of the BSES-SF was 0.87 with all except one correlation coefficient <0.3. We conducted an exploratory factor analysis using principal component analysis that revealed a two-component solution, which explained 47.9% and 16.7% of the total variance, respectively. Mothers perceiving higher social support registered significantly higher mean BSES-SF scores, indicating a greater confidence in their breastfeeding abilities (P = 0.01). However, breastfeeding self-efficacy was unrelated to the mother's age, parity, and education. The women planning to breastfeed partially had lower BSES-SF scores compared to the woman adhering to EBF norms (P < 0.001). CONCLUSION: The Hindi version of the BSES-SF demonstrates good reliability and validity and can also explain previous and planned breastfeeding behavior in mothers of infants.

A pharmacoeconomic analysis to compare cost-effectiveness of metformin plus teneligliptin with metformin plus glimepiride in patients of type-2 diabetes mellitus.

BACKGROUND: With the available evidence of early combined oral drug therapies being more effective in lowering blood glucose levels than maximal doses of a single drug, many clinicians are taking the aggressive approach of adding a sulfonylurea or a dipeptidyl peptidase-4 (DPP-4) inhibitor to metformin as the initial therapy in type 2 diabetes mellitus (T2DM). Pharmacotherapy for a chronic disease like diabetes has substantial economic implications for patients especially in a developing country like India. So it is important to scientifically evaluate the cost-effectiveness of these commonly practiced combination therapies in the management of T2DM. MATERIALS AND METHODS: This was a prospective observational randomized comparative study conducted over 8 weeks on patients of T2DM who were prescribed either of the two therapies of metformin (500 mg) plus glimepiride (1 mg) or metformin (500 mg) plus teneligliptin (20 mg). Cost-effectiveness analysis was done by calculating the expense incurred on 0.1% reduction in HbA1 c and 1 mg/dl reduction in fasting plasma glucose (FPG)/post-prandial plasma glucose (PPG) levels after 8 weeks and compared for both the groups. The same was also evaluated for differences in BMI levels. RESULTS: The cost-effectiveness for per unit reduction in HbA1c and FPG was significant in metformin plus glimepiride group as compared to the metformin plus teneligliptin group though it was comparable for both the groups for per unit PPG reduction. There was no significant change in BMI levels between the groups. CONCLUSION: Compared to metformin plus teneligliptin, metformin plus glimepiride is a significantly cost-effective therapy when used as an initial combination therapy in patients of T2DM in lowering HbA1c and FPG.

Impact of antiepileptic drugs on bone health: Need for monitoring, treatment, and prevention strategies.

Epilepsy is the most common neurological disorder affecting approximately 50 million people worldwide. In India, overall prevalence of epilepsy is reported to be 5.59/1000 population. Antiepileptic drugs (AEDs) constitute the main-stay of treatment with a large number of AEDs available in the market. High incidence of adverse effects is a major limitation with AEDs. One of the major concerns is significant metabolic effects on the bone. However, little attention has been paid to this issue because most of the bone effects remain subclinical for a long time and may take years to manifest clinically. The main effects include hypocalcemia, hypophosphatemia, reduced serum levels of Vitamin D, increase in parathormone (PTH) levels, and alterations in bone turnover markers. The CYP450 enzyme-inducing AEDs such as phenytoin, phenobarbital, carbamazepine, and primidone are the most common AEDs associated with bone disorders while the data regarding the effect of valproate and newer AEDs such as lamotrigine, gabapentin, vigabatrin, levetiracetam, and topiramate on bone metabolism and bone density are scanty and controversial. Deficiency of Vitamin D is commonly described as a cause for the bone loss in epileptic patients while others being decreased absorption of calcium, increased PTH levels, and inhibition of calcitonin secretion, etc. However, there are no formal practical guidelines for the management of bone disease among those taking AEDs. Evidence-based strategies regarding monitoring, prevention, and treatment of bone diseases in patients on AED therapy are needed.