Association between poor oral health and diabetes among Indian adult population: potential for integration with NCDs.

BACKGROUND: Studies in high-income countries have reported associations between oral health and diabetes. There is however a lack of evidence on this association from low and middle-income countries, especially India. The current study aimed to assess the prevalence of common oral diseases and their association with diabetes. METHODS: This cross-sectional study was nested within the second Cardiometabolic Risk Reduction in South Asia Surveillance Study. A subset of study participants residing in Delhi were administered the World Health Organization's Oral Health Assessment Questionnaire and underwent oral examination for caries experience and periodontal health assessment using standard indices. Diabetes status was ascertained by fasting blood glucose, glycosylated hemoglobin values or self-reported medication use. Information was captured on co-variates of interest. The association between oral health and diabetes was investigated using Multivariable Zero-Inflated Poisson (ZIP) regression analysis. RESULTS: Out of 2045 participants, 47% were women and the mean age of study participants was 42.17 (12.8) years. The age-standardised prevalence (95% confidence interval) estimates were 78.9% (75.6-81.7) for dental caries, 35.9% (32.3-39.6) for periodontitis. Nearly 85% participants suffered from at least one oral disease. Compared to diabetes-free counterparts, participants with diabetes had more severe caries experience [Mean Count Ratio (MCR) = 1.07 (1.03-1.12)] and attachment loss [MCR = 1.10 (1.04-1.17)]. Also, the adjusted prevalence of periodontitis was significantly higher among participants with diabetes [42.3%(40.0-45.0)] compared to those without diabetes [31.3%(30.3-32.2)]. CONCLUSION: We found that eight out of ten participants in urban Delhi suffered from some form of oral disease and participants with diabetes had worse oral health. This highlights the need for public health strategies to integrate oral health within the existing Non-Communicable Disease control programs.

Association between antibody responses post-vaccination and severe COVID-19 outcomes in Scotland.

Several population-level studies have described individual clinical risk factors associated with suboptimal antibody responses following COVID-19 vaccination, but none have examined multimorbidity. Others have shown that suboptimal post-vaccination responses offer reduced protection to subsequent SARS-CoV-2 infection; however, the level of protection from COVID-19 hospitalisation/death remains unconfirmed. We use national Scottish datasets to investigate the association between multimorbidity and testing antibody-negative, examining the correlation between antibody levels and subsequent COVID-19 hospitalisation/death among double-vaccinated individuals. We found that individuals with multimorbidity ( ≥ five conditions) were more likely to test antibody-negative post-vaccination and 13.37 [6.05-29.53] times more likely to be hospitalised/die from COVID-19 than individuals without conditions. We also show a dose-dependent association between post-vaccination antibody levels and COVID-19 hospitalisation or death, with those with undetectable antibody levels at a significantly higher risk (HR 9.21 [95% CI 4.63-18.29]) of these serious outcomes compared to those with high antibody levels.

Association of Long-Term Exposure to Fine Particulate Matter and Cardio-Metabolic Diseases in Low- and Middle-Income Countries: A Systematic Review.

: Background: Numerous epidemiological studies indicated high levels of particulate matter less than2.5 µm diameter (PM2.5) as a major cardiovascular risk factor. Most of the studies have been conducted in high-income countries (HICs), where average levels of PM2.5 are far less compared to low- and middle- income countries (LMICs), and their socio-economic profile, disease burden, and PM speciation/composition are very different. We systematically reviewed the association of long-term exposure to PM2.5 and cardio-metabolic diseases (CMDs) in LMICs. METHODS: Multiple databases were searched for English articles with date limits until March 2018. We included studies investigating the association of long-term exposure to PM2.5 (defined as an annual average/average measure for 3 more days of PM2.5 exposure) and CMDs, such as hospital admissions, prevalence, and deaths due to CMDs, conducted in LMICs as defined by World Bank. We excluded studies which employed exposure proxy measures, studies among specific occupational groups, and specific episodes of air pollution. RESULTS: A total of 5567 unique articles were identified, of which only 17 articles were included for final review, and these studies were from Brazil, Bulgaria, China, India, and Mexico. Outcome assessed were hypertension, type 2 diabetes mellitus and insulin resistance, and cardiovascular disease (CVD)-related emergency room visits/admissions, death, and mortality. Largely a positive association between exposure to PM2.5 and CMDs was found, and CVD mortality with effect estimates ranging from 0.24% to 6.11% increased per 10 µg/m3 in PM2.5. CVD-related hospitalizations and emergency room visits increased by 0.3% to 19.6%. Risk factors like hypertension had an odds ratio of 1.14, and type 2 diabetes mellitus had an odds ratio ranging from 1.14-1.32. Diversity of exposure assessment and health outcomes limited the ability to perform a meta-analysis. CONCLUSION: Limited evidence on the association of long-term exposure to PM2.5 and CMDs in the LMICs context warrants cohort studies to establish the association.

Technology for Diagnosis, Treatment, and Prevention of Cardiometabolic Disease in India.

Cardiometabolic diseases (CMD) are a major cause of mortality, morbidity and disability worldwide. Among Indians, CMD onset is at a much younger age and is prevalent in all sections of the society. Prevention, control and management of CMD and its risk factors is a major public health challenge, and alternative approaches need to be explored and integrated into public health programs. Advancements in the fields of computers, electronics, telecommunication and medicine have resulted in the rapid development of health-related technology. In this paper we provide an overview of the major technological advances in diagnosis, treatment and prevention within the field of CMD in the last few decades. This non-exhaustive review focuses on the most promising technologies that the authors feel might be of relevance in the Indian context. Some of the techniques detailed include advances in imaging and mobile phone technology, surgical techniques, electronic health records, Nano medicine, telemedicine and decision support systems.

Early detection of chronic diseases and their risk factors: a women empowerment model from Kerala, India.

Identification of risk factors through screening is an important tool in the fight against chronic diseases. We have used a unique model, named Saantwanam (to console) in Malayalam language, for health screening in Kerala, India. Under the Saantwanam programme, government selects suitable women care-givers who are trained and equipped by a nongovernmental organization through loans from a public sector bank. After training, care-givers deliver screening services by measuring the weight and height, and blood pressure, glucose and cholesterol levels of people concerned in their local communities at a reasonable fee-for-service that provides a source of income to them. All care-givers are trained to counsel on healthy living, i.e. appropriate diet, exercise and unhealthy habits such as tobacco consumption. When cases are detected they are referred to local physicians and later on followed up by care-givers at their residence. In the last five years, the Saantwanam programme has screened more than 300 000 people for various diseases and risk factors. They have been counselled to avail of health-care services. The Saantwanam model does not cause additional expenditure to the government for early detection of chronic diseases and their risk factors. Moreover, it ensures that the care-givers are rewarded for their effort. However, before large-scale implementation of this model, measurement of baseline risk factors in a sample population should be done so that their impact can be measured at a later date. The cost-effectiveness of the model also needs to be determined.

Early detection of chronic diseases and their risk factors: A women empowerment model from Kerala, India

Identification of risk factors through screening is an important tool in the fight against chronic diseases. We have used a unique model, named Saantwanam (to console) in Malayalam language, for health screening in Kerala, India. Under the Saantwanam programme, government selects suitable women care-givers who are trained and equipped by a nongovernmental organization through loans from a public sector bank. After training, care-givers deliver screening services by measuring the weight and height, and blood pressure, glucose and cholesterol levels of people concerned in their local communities at a reasonable fee-for-service that provides a source of income to them. All care-givers are trained to counsel on healthy living, i.e. appropriate diet, exercise and unhealthy habits such as tobacco consumption. When cases are detected they are referred to local physicians and later on followed up by care-givers at their residence. In the last five years, the Saantwanam programme has screened more than 300 000 people for various diseases and risk factors. They have been counselled to avail of health-care services. The Saantwanam model does not cause additional expenditure to the government for early detection of chronic diseases and their risk factors. Moreover, it ensures that the care-givers are rewarded for their effort. However, before large-scale implementation of this model, measurement of baseline risk factors in a sample population should be done so that their impact can be measured at a later date. The cost-effectiveness of the model also needs to be determined.