Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS).

BACKGROUND: The monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18). METHODS: NNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) - Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises. RESULTS: Total of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3-3.3) in rural public to 9.0% (95% CI; 6.2-13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities. CONCLUSION: Both private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.

Baseline risk factor prevalence among adolescents aged 15-17 years old: findings from National Non-communicable Disease Monitoring Survey (NNMS) of India.

OBJECTIVE: To generate national estimates of key non-communicable disease (NCD) risk factors for adolescents (15-17 years) identified in the National NCD Monitoring Framework and, study the knowledge, attitudes and practices towards NCD risk behaviours among school-going adolescents. DESIGN AND SETTING: A community-based, national, cross-sectional survey conducted during 2017-2018. The survey was coordinated by the Indian Council of Medical Research-National Centre for Disease Informatics and Research with 10 reputed implementing research institutes/organisations across India in urban and rural areas. PARTICIPANTS: A multistage sampling design was adopted covering ages between 15 and 69 years-adolescents (15-17 years) and adults (18-69 years). The sample included 12 000 households drawn from 600 primary sampling units. All available adolescents (15-17 years) from the selected households were included in the survey. MAIN OUTCOME MEASURES: Key NCD risk factors for adolescents (15-17 years)-current tobacco and alcohol use, dietary behaviours, insufficient physical activity, overweight and obesity. RESULTS: Overall, 1402 households and 1531 adolescents completed the survey. Prevalence of current daily use of tobacco was 3.1% (95% CI: 2.0% to 4.7%), 25.2% (95% CI: 22.2% to 28.5%) adolescents showed insufficient levels of physical activity, 6.2% (95% CI: 4.9% to 7.9%) were overweight and 1.8% (95% CI: 1.0% to 2.9%) were obese. Two-thirds reported being imparted health education on NCD risk factors in their schools/colleges. CONCLUSION: The survey provides baseline data on NCD-related key risk factors among 15-17 years in India. These national-level data fill information gaps for this age group and help assess India's progress towards NCD targets set for 2025 comprehensively. Though the prevalence of select risk factors is much lower than in many developed countries, this study offers national evidence for revisiting and framing appropriate policies, strategies for prevention and control of NCDs in younger age groups.

National noncommunicable disease monitoring survey (NNMS) in India: Estimating risk factor prevalence in adult population.

BACKGROUND: The primary objective of National NCD monitoring survey (NNMS) was to generate national-level estimates of key NCD indicators identified in the national NCD monitoring framework. This paper describes survey study protocol and prevalence of risk factors among adults (18-69 years). MATERIALS AND METHODS: NNMS was a national level cross-sectional survey conducted during 2017-18. The estimated sample size was 12,000 households from 600 primary sampling units. One adult (18-69 years) per household was selected using the World Health Organization-KISH grid. The study tools were adapted from WHO-STEPwise approach to NCD risk factor surveillance, IDSP-NCD risk factor survey and WHO-Global adult tobacco survey. Total of 8/10 indicators of adult NCD risk factors according to national NCD disease monitoring framework was studied. This survey for the first time estimated dietary intake of salt intake of population at a national level from spot urine samples. RESULTS: Total of 11139 households and 10659 adults completed the survey. Prevalence of tobacco and alcohol use was 32.8% (95% CI: 30.8-35.0) and 15.9% (95% CI: 14.2-17.7) respectively. More than one-third adults were physically inactive [41.3% (95% CI: 39.4-43.3)], majority [98.4% (95% CI: 97.8-98.8)] consumed less than 5 servings of fruits and / or vegetables per day and mean salt intake was 8 g/day (95% CI: 7.8-8.2). Proportion with raised blood pressure and raised blood glucose were 28.5% (95% CI: 27.0-30.1) and 9.3% (95% CI: 8.3-10.5) respectively. 12.8% (95% CI: 11.2-14.5) of adults (40-69 years) had ten-year CVD risk of ≥30% or with existing CVD. CONCLUSION: NNMS was the first comprehensive national survey providing relevant data to assess India's progress towards targets in National NCD monitoring framework and NCD Action Plan. Established methodology and findings from survey would contribute to plan future state-based surveys and also frame policies for prevention and control of NCDs.

Extreme active matter at high densities.

We study the remarkable behaviour of dense active matter comprising self-propelled particles at large Péclet numbers, over a range of persistence times, from τp â†’ 0, when the active fluid undergoes a slowing down of density relaxations leading to a glass transition as the active propulsion force f reduces, to τp â†’ ∞, when as f reduces, the fluid jams at a critical point, with stresses along force-chains. For intermediate τp, a decrease in f drives the fluid through an intermittent phase before dynamical arrest at low f. This intermittency is a consequence of periods of jamming followed by bursts of plastic yielding associated with Eshelby deformations. On the other hand, an increase in f leads to an increase in the burst frequency; the correlated plastic events result in large scale vorticity and turbulence. Dense extreme active matter brings together the physics of glass, jamming, plasticity and turbulence, in a new state of driven classical matter.

Aging effects on thermal conductivity of glass-forming liquids.

Thermal conductivity of a model glass-forming system in the liquid and glass states is studied using extensive numerical simulations. We show that near the glass transition temperature, where the structural relaxation time becomes very long, the measured thermal conductivity decreases with increasing age. Second, the thermal conductivity of the disordered solid obtained at low temperatures is found to depend on the cooling rate with which it was prepared. For the cooling rates accessible in simulations, lower cooling rates lead to lower thermal conductivity. Our analysis links this decrease of the thermal conductivity with increased exploration of lower-energy inherent structures of the underlying potential energy landscape. Further, we show that the lowering of conductivity for lower-energy inherent structures is related to the high-frequency harmonic modes associated with the inherent structure being less extended. Possible effects of considering relatively small systems and fast cooling rates in the simulations are discussed.

A random first-order transition theory for an active glass.

How does nonequilibrium activity modify the approach to a glass? This is an important question, since many experiments reveal the near-glassy nature of the cell interior, remodeled by activity. However, different simulations of dense assemblies of active particles, parametrized by a self-propulsion force, [Formula: see text], and persistence time, [Formula: see text], appear to make contradictory predictions about the influence of activity on characteristic features of glass, such as fragility. This calls for a broad conceptual framework to understand active glasses; here, we extend the random first-order transition (RFOT) theory to a dense assembly of self-propelled particles. We compute the active contribution to the configurational entropy through an effective model of a single particle in a caging potential. This simple active extension of RFOT provides excellent quantitative fits to existing simulation results. We find that whereas [Formula: see text] always inhibits glassiness, the effect of [Formula: see text] is more subtle and depends on the microscopic details of activity. In doing so, the theory automatically resolves the apparent contradiction between the simulation models. The theory also makes several testable predictions, which we verify by both existing and new simulation data, and should be viewed as a step toward a more rigorous analytical treatment of active glass.

Glassy swirls of active dumbbells.

Is an active glass different from a conventional passive glass? To address this, we study the dynamics of a dense binary mixture of soft dumbbells, each subject to an active propulsion force and thermal fluctuations. This dense assembly shows dynamical arrest, first to a translational and then to a rotational glass, as one reduces temperature T or the self-propulsion force f. We monitor the dynamics along an iso-relaxation-time contour in the (T-f) plane. We find dramatic differences both in the fragility and in the nature of dynamical heterogeneity, which characterize the onset of glass formation-the activity-induced glass exhibits large swirls or vortices, whose scale is set by activity, and it appears to diverge as one approaches the glass transition. This large collective swirling movement should have implications for collective cell migration in epithelial layers. We construct continuum hydrodynamic equations for the simulated system, and we show that the observed behavior of this growing dynamic length scale can be understood from these equations.

Active fluidization in dense glassy systems.

Dense soft glasses show strong collective caging behavior at sufficiently low temperatures. Using molecular dynamics simulations of a model glass former, we show that the incorporation of activity or self-propulsion, f0, can induce cage breaking and fluidization, resulting in the disappearance of the glassy phase beyond a critical f0. The diffusion coefficient crosses over from being strongly to weakly temperature dependent as f0 is increased. In addition, we demonstrate that activity induces a crossover from a fragile to a strong glass and a tendency of active particles to cluster. Our results are of direct relevance to the collective dynamics of dense active colloidal glasses and to recent experiments on tagged particle diffusion in living cells.

Record of Tropical Rat Mite, Ornithonyssus bacoti (Acari: Mesostigmata: Macronyssidae) from Domestic and Peridomestic Rodents (Rattus rattus) in Nilgiris, Tamil Nadu, India.

BACKGROUND: Tropical rat mite (Ornithonyssus bacoti) is reported from many parts of the world and is considered important in transmitting rickettsial pathogens. There have been scanty reports on prevalence of this parasite from India. Following a recent report of O. bacoti infestation in a laboratory mice colony from Nilgiris, Tamil Nadu, India, attempts were made to detect the parasite in its natural reservoir, ie the domestic and peridomestic rats (Rattus rattus). METHODS: The National Centre for Disease Control, Coonoor is involved in screening plague in domestic and peridomestic rats in Nilgiris and erstwhile plague endemic areas of Southern India. The parasite samples were identified based on the morphological characteristics attributable to O. bacoti and as per description of published literature. RESULTS: Seven mite samples identified as O. bacoti based on morphological characteristics were isolated incidentally from domestic and peridomestic rodents in and around the hilly districts of Nilgiris, Southern India, during the routine plague surveillance programme. The identification was based on the morphological characteristics attributable to O. bacoti observed under a low power microscope. CONCLUSION: In India, this is probably the first record of isolation of O. bacoti from domestic and peridomestic rodents. Prevalence of such parasite in domestic and peridomestic rats necessitates further investigation on monitoring and surveillance of rickettsial diseases in the locality, as these parasites are considered to be potential vector of transmitting rickettsial pathogens.

Isolation of fourth-instars larva of Aedes (Finlaya) harveyi (Diptera: Culicidae) from the Nilgiri hills, Southern India.

During the post monsoon season of 2012, the ovitraps were employed for dengue vector surveillance nearer to human habitations in the Nilgiri hills of Southern India. All the eggs obtained were brought to laboratory, and reared individually to adult stage for identification. A total of 30 exuviae of fourth-instars larva specimen were identified as Aedes (Finlaya) harveyi which were compared to other closely related species. Though the adult male and female of Aedes (Finlaya) harveyi were recorded from some parts of India but so far the larval stage has not been recorded.

Road traffic accident: an emerging public health problem in assam.

BACKGROUND: In the northern states, there is hardly any scientific study except road traffic accidents (RTAs) statistics obtained by the Ministry of Home whereas the main way of transportation is by road. There is the increasing load of motor vehicles on the already dilapidated roadways which has resulted in the increasing trend of RTAs in Assam. OBJECTIVES: To find out the prevalence, probable epidemiological factors and morbidity and mortality pattern due to RTAs in Dibrugarh district. MATERIALS AND METHODS: Descriptive study was carried out in Dibrugarh district from September 1998 to August 1999 under the department of Community Medicine. The information was collected from Assam Medical College and Hospital and cross checked with the police report. A medical investigation including interview, clinical and radiological investigation was carried out; in case of fatality, post-mortem examination was examined in details. An on the spot investigation was carried out in accessible RTAs to collect the probable epidemiological factors. RESULTS: RTAs affected mainly the people of productive age group which were predominantly male. Majority of the RTAs were single vehicle accidents and half of the victims were passengers. Accident rate was maximum in twilight and winter season demanding high morbidity and mortality. Head and neck, U.limb and L.limb were commonly involved. CONCLUSION: RTAs is a major public health problem in Assam which needs more scientific study.