Background: Low- and middle-income countries (LMICs) face numerous challenges in the implementation of noncommunicable diseases (NCDs) prevention programs due to a shortage of health workforce. Task shifting to nurses is a viable and effective solution to address the healthcare human resource crisis. We, therefore, intend to assess the existing evidence on the effectiveness of interventions by nurses for the management of chronic NCDs in LMICs. Methods: We did a systematic review and meta-analysis of the trials that utilized nurses for the management of NCDs in LMICs. We searched PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and clinical registries of different LMICs to search for relevant literature. Meta-analysis using an inverse-variance weighted random effect model was used to summarize the findings. The study protocol was registered in the PROSPERO database (CRD42019118430). Results: We found 2097 studies from the literature search, out of which 39 studies with 15,672 participants were eligible for narrative synthesis. Result of the meta-analysis showed that nurse-led interventions were effective in the reduction of systolic blood pressure (SBP) (average pooled mean difference was −4.32 [95% (confidence interval) CI − 7.07–−1.57]), diastolic blood pressure (DBP) (−3.11 mmHg; 95% CI −4.96–−1.26), glycated hemoglobin (HbA1c) (−0.73; 95% CI − 1.08–−0.38), fasting blood sugar (FBS) (−0.8; 95% CI −13.42–−2.58), total cholesterol (TC) (−1.18; 95% CI −20.06–−3.57), and triglycerides (TG) (−12.20; 95% CI − 23.52–−0.87). However, there was no major significant difference in low-density lipoprotein (LDL) and high-density lipoprotein (HDL). The overall quality of evidence based on the Grading of Recommendations Assessment, Development, and Evaluations was moderate for FBS, low for SBP, DBP, HbA1c, HDL, TC, and TG, and very low for LDL. Interpretation: Nurse-led interventions as compared to usual care are effective for the management of diabetes and hypertension and can be effectively used for national NCD programs in LMICs.

Background: Studies indicate that chronic obstructive pulmonary disease (COPD) patients may have increased risk of developing cognitive dysfunction. The role of 25-hydroxyvitamin D [25(OH)D] and Vitamin D binding protein (VDBP) have been implicated in cognitive dysfunction in several diseases. However, their role in COPD patients in this domain has not been explored. This study was undertaken to evaluate correlation between serum 25(OH) D and VDBP levels with cognitive function in COPD patients. Materials and Methods: Forty-seven stable COPD patient and 33 healthy controls were recruited. Cognitive function was assessed for both the groups using the Hindi Mental State Examination (HMSE) cognitive test. Serum 25(OH) D and VDBP levels were estimated using commercially available ELISA kits. Results: COPD patients had significantly lower HMSE scores (25 vs. 29, P < 0.0001) as compared to the controls. Cognitive impairment was present in 25.53% (n = 12) of the COPD patients in comparison to none of the controls (P = 0.001). Serum 25(OH)D and VDBP levels did not differ significantly between the two groups. 65.96% of the COPD cases and 72.73% of the controls had Vitamin D deficiency. Serum biomarkers did not correlate with the HMSE scores. In multilinear regression model presence of COPD, lower education status and higher smoking index were found to be predictors of lower HMSE scores in the study participants. Conclusion: COPD patients were found to have lower HMSE scores than the controls. However, serum 25(OH) D or VDBP levels were not correlated with cognitive function in COPD patients. Further, cumulative exposure to tobacco smoke could be an independent risk factor for cognitive decline.

Background: Road traffic injuries (RTIs) are the major causes of mortality, morbidity, and disability among young adults and pose a significant economic burden to individuals, families, and communities. Objective: To estimate the cost of care at discharge, 3 months and 6 months among patients with RTIs admitted to a private tertiary hospital in Bengaluru, India. Methods: A cost-of-illness study from patient's perspective was done among 150 hospitalized injured subjects with RTIs admitted to a tertiary care hospital in Bengaluru city. A face validated, structured interview schedule was administered in local language at baseline (hospital discharge time), 1 month and at 6 months to capture data on direct medical costs, direct nonmedical costs, and indirect costs incurred by the RTI victims and their family members. Hospital bills were reviewed for all the patients included in the study. Results: Among the 150 study participants, majority were men (94.67%), with a mean age of 35.36 years ± 14.62 years and majority were two-wheeler riders/pillions and pedestrians. Our results show the median cost incurred for care of RTI to be INR 106,374 (inter quartile range [IQR] 57,402–163,250) (USD 1418 [IQR 765–2176]). Direct medical costs contributed to 66% of the costs, whereas direct nonmedical and indirect costs contributed to 21% and 13% of the total costs, respectively. Conclusion: RTIs contribute to significant economic burden to patients. While prevention should be our primary goal, health financing and risk protection mechanisms should be strengthened by streamlining insurance coverage mechanisms to reduce out-of-pocket expenditure.

Introduction: The aim of the World Health Organization (WHO) is to reduce global obesity to 2010 levels by 2025 is threatened by the increasing number of overweight and obese Indians and country's population size. Objectives: This study was planned with the objectives to determine the trends of prevalence and predictors of overweight and obesity in India over one and a half decade (2005–2021) using the National Family Health Survey (NFHS) (3, 4, and 5) and probably first analysis to describe waist-to-hip ratio (WHR) as an indicator of obesity in large population. Methods: The outcome measures, for assessing overweight and obesity were the body mass index (BMI) by using WHO classifications (overweight/obese defined by BMI ≥25 kg/m² and waist-to-hip ratio (WHR). Results: Our analysis showed that in the 15-year period, the repeated Indian NFHS recorded the combined prevalence of overweight or obese (BMI ≥25 kg/m²) among women (15 and 49 years) and men (15 and 49 years) increased from 12.6% to 24% and 9.3% to 22.9% respectively. All the northern, western, southern, eastern, and north-eastern states have shown a rise in the prevalence of overweight and obesity in males and females in NFHS-5 since NFHS-3. The rise in rural areas is appreciable much, in women from 8.6% (NFHS-3) to 19.7% (NFHS-5) and in men from 7.3% (NFHS-3) to 19.3% (NFHS-5). The highest WHR was observed among the women (both urban and rural) of Jammu and Kashmir followed by Ladakh. Conclusion: The results underline the increasing prevalence of overweight/obesity and central obesity in both men and women across both urban and rural regions of India. Policymakers should timely have solutions for this growing problem to reduce burden on health-care system.

Background: A major modifiable risk factor for cardiovascular disease is hypertension. Resistant hypertension is observed to be associated with an increased likelihood of deleterious effects such as cardiovascular events, cerebrovascular accident, and renal dysfunction. The raised levels of inflammatory cytokines in the plasma like the C-reactive protein (CRP) have previously been observed to be significantly raised in hypertensive patients, but the overlying mechanisms corresponding to these processes remain unknown. Materials and Methods: In essence, this was an observational study with data collected from a population at a specific moment in the time to assess the relationships between the variables analyzed. A total of 200 individuals with arterial hypertension took part in the study. Fasting venous blood was obtained to evaluate plasma lipoprotein-related phospholipase A2 (Lp-PLA2) activity, and baseline data were collected. To diagnose RH, a 24-h ambulatory blood pressure management was done. Results: RH was observed among 100 patients and found to be predominant among males and older individuals, who were smokers and having hypertension for a longer period of time with higher Lp-PLA2 activity. More RH patients used calcium channel blockers and diuretics, while a fewer used angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and statins (P 0.05 for all comparisons). Conclusion: The plasma Lp-PLA2 activity beyond a certain threshold suggests a raised risk of RH, and the statins can help in reducing the RH incidence among persons with high Lp-PLA2 levels.

Introduction: Cervical cancer (CC) is the fourth main cause of death among women. Poor uptake of CC screening has indirect effects on increased mortality among women. Therefore, we employed the care cascade to understand the CC outcomes in sub-Saharan Africa (SSA) using the PEPFAR Panorama CC data collected between 2019 and 2021. Methods: A retrospective study using the PEPFAR Panorama CC data, from 13 countries from SSA, was performed. We calculated the proportions of women who were screened, those who were found to have positive results after screening for CC, and those who were linked to CC treatment. Results: A total of 2,312,541 were eligible for screening and of these, 1,429,925 (62%) were screened for CC. Of these, 162,758 (11%) were diagnosed with CC. Of these, 115,890 (71%) were provided with treatment. CC screening increased from 41% in 2019 to 90% in 2021. The CC diagnosis ranged from 8% in 2019 to 13% in 2021. CC treatment coverage increased from 64% in 2019 to 75% in 2021. Screening uptake, CC diagnosis, and CC treatment coverage varied by country and age of the women. Conclusion: There were variations in CC screening and treatment uptake for CC by country and age. With these inequalities in screening and coverage of treatment for CC, eliminating CC as stipulated in the sustainable development goals will remain a farfetched dream.

A prospective study was conducted to assess the effectiveness of learning from an online public health course (6th International Course on Public Health Approaches to Noncommunicable Diseases) among participants from India. The knowledge significantly improved after attending the online public health practice course (P < 0.05) and remained without any significant change over the period of time till 6 months after the online course (P = 0.988). Majority of the respondents were applying the learnings from the course in their program management (64.7%–89.3%). Online delivery of public health courses in India has shown to improve knowledge and maintain the acquired knowledge.