A lay epidemiological study on coexistent stress in hypertension: Its prevalence, risk factors, and implications in patients' lives.

INTRODUCTION: Hypertension poses a global challenge in terms of morbidity and mortality. Worldwide prevalence of hypertension is over 40%. Management of hypertension targets blood pressure control to prevent disease complications. Though stress and hypertension are closely related, stress management is often overlooked in the treatment of hypertension. AIMS: (1) To estimate the prevalence of stress in hypertensive patients and (2) to study the associated risk factors of stress and its implications in disease management. MATERIALS AND METHODS: It was a hospital-based, cross-sectional study done in Western India for 1 year. Data were collected from 400 hypertensive patients attending the selected health institutions using a pretested questionnaire. Chi-square tests were done using Medcalc 10.4.8.0. RESULTS: The prevalence of stress in hypertensive patients was found to be 84.3%. Only 2.4% of these patients sought help from any health professional for stress. The most common stressors found in the patients were financial dependence on others, living in rented house, having a daughter of marriageable age because of associated dowry, death of a loved one, sleep-related problem, and owing a debt among others. Significant statistical association (P < 0.05) of stress was observed with the type of family and socioeconomic status. A highly significant association (P < 0.001) of stress with religion and residential area (whether urban non-slum, slum, or rural) was observed. Stress in individuals leads to poorer compliance with treatment and blood pressure control. CONCLUSION: Coexistent stress should be diagnosed and managed in patients of hypertension for proper disease management and control.

Agricultural susceptibility to monsoon variability: A district level analysis of Maharashtra, India.

Indian Summer Monsoon (ISM) variability has always been a feature affecting Indian agriculture. However, nature of this variability is varying in the backdrop of climate change, and as a consequence, agriculture is getting significantly affected and subsequently threatening food security. To address the climate variability, most of the studies conducted so far have focused on a coarse scale such as Central India or Western Ghats. However, finer scale analysis for identification and quantification of the link between agriculture vulnerability and climate variables has not yet been attempted in a comprehensive manner. The latter is essential, as considering state and national domain as a single entity for regional level policy formulations have led to under-representation of grievances and issue related to agriculture and farmers in the past. In order to address these issues, focus of the current study is on finer scale analysis of districts of Maharashtra state in Western India. Inter and intra-regional spatio-temporal heterogeneity in monsoon variability parameters was found across districts of Maharashtra. Here, we ranked the districts of Maharashtra using monsoon variability index which includes six different monsoon variability parameters (Wet/Dry Spells, frequency/intensity of extreme rainfall events, deviation from the long-period average and daily-scale variability) by using factor analysis. Monsoon variability index indicated that districts under Vidarbha and Marathwada regions are at highest risk and need immediate attention from decision-makers and scientists. This index was further linked to average yield and cropped area using Structural equation modeling that will help to determine the ideal cropping pattern for the most vulnerable districts. An empirical model of monsoon variability is also proposed at district level for the state of Maharashtra that can contribute to the currently operating 'State Action Plan on Climate Change (SAPCC)' or can be used to formulate a new action plan at district level i.e. 'District Action Plan on Climate Change (DAPCC)'. The current study differs from other studies in terms of its application, levels of spatial aggregation and areas of coverage. The findings can be utilized by farmers and policy makers while formulating agricultural policies, risk reduction measures, and adaptation mechanisms to address the adverse impacts of climate change.

Contrasting influences of aerosols on cloud properties during deficient and abundant monsoon years.

Direct aerosol radiative forcing facilitates the onset of Indian monsoon rainfall, based on synoptic scale fast responses acting over timescales of days to a month. Here, we examine relationships between aerosols and coincident clouds over the Indian subcontinent, using observational data from 2000 to 2009, from the core monsoon region. Season mean and daily timescales were considered. The correlation analyses of cloud properties with aerosol optical depth revealed that deficient monsoon years were characterized by more frequent and larger decreases in cloud drop size and ice water path, but increases in cloud top pressure, with increases in aerosol abundance. The opposite was observed during abundant monsoon years. The correlations of greater aerosol abundance, with smaller cloud drop size, lower evidence of ice processes and shallower cloud height, during deficient rainfall years, imply cloud inhibition; while those with larger cloud drop size, greater ice processes and a greater cloud vertical extent, during abundant rainfall years, suggest cloud invigoration. The study establishes that continental aerosols over India alter cloud properties in diametrically opposite ways during contrasting monsoon years. The mechanisms underlying these effects need further analysis.

Aerosols cause intraseasonal short-term suppression of Indian monsoon rainfall.

Aerosol abundance over South Asia during the summer monsoon season, includes dust and sea-salt, as well as, anthropogenic pollution particles. Using observations during 2000-2009, here we uncover repeated short-term rainfall suppression caused by coincident aerosols, acting through atmospheric stabilization, reduction in convection and increased moisture divergence, leading to the aggravation of monsoon break conditions. In high aerosol-low rainfall regions extending across India, both in deficient and normal monsoon years, enhancements in aerosols levels, estimated as aerosol optical depth and absorbing aerosol index, acted to suppress daily rainfall anomaly, several times in a season, with lags of a few days. A higher frequency of prolonged rainfall breaks, longer than seven days, occurred in these regions. Previous studies point to monsoon rainfall weakening linked to an asymmetric inter-hemispheric energy balance change attributed to aerosols, and short-term rainfall enhancement from radiative effects of aerosols. In contrast, this study uncovers intraseasonal short-term rainfall suppression, from coincident aerosol forcing over the monsoon region, leading to aggravation of monsoon break spells. Prolonged and intense breaks in the monsoon in India are associated with rainfall deficits, which have been linked to reduced food grain production in the latter half of the twentieth century.