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   Table of Contents - Current issue
Coverpage
April-June 2022
Volume 7 | Issue 2
Page Nos. 53-100

Online since Friday, July 22, 2022

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EDITORIAL  

The 2022 update of the Global Initiative for Chronic Obstructive Lung Disease guidelines for chronic obstructive pulmonary disease: Implications for primary health care p. 53
Ashutosh Nath Aggarwal
DOI:10.4103/jncd.jncd_39_22  
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REVIEW ARTICLE Top

Tobacco endgame in India p. 55
Sonu Goel, Jagdish Kaur, Monika Arora, Garima Bhatt, Rana J Singh, Anne Jones, Leimapokpam Swasticharan, Prakash Chandra Gupta
DOI:10.4103/jncd.jncd_25_22  
The epidemic of tobacco use persists as a leading risk factor for noncommunicable diseases and impoverishment worldwide. Globally, more nations are undertaking measures for moving beyond “tobacco control” to a “tobacco-free world” under the unified theme of “tobacco endgame.” This concept of endgame includes an array of measures addressing both demand side and supply-side strategies for phasing out all commercial tobacco products within a specified time period. Globally, there have been many successes from countries such as New Zealand, Australia, Scotland, Netherlands, Finland, Ireland, Canada, France, and California. The Indian subcontinent has also been stepping up to progress the endgame concept and has been displaying exemplary leadership in the tobacco control. It has several national and subnational achievements to its credit. However, the tobacco endgame requires collaboration and capacity building of several sectors and stakeholders to align their activities with the tobacco endgame goals and vision of the Government of India. Besides, acceptance of endgame as a political objective is perhaps the first requirement for tobacco endgame in addition to program and community-level strategies. The need of the hour calls for a robust unified approach that engages all the stakeholders and involves increased investment in tobacco control by the country's governments and region.
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ORIGINAL ARTICLES Top

Empowering Accredited Social Health Activist (ASHA) in a rural communities of Pune (Maharashtra): Process evaluation of a community-based intervention for diabetes care p. 63
Shalini Bassi, Tina Rawal, Gaurang Prafulla Nazar, Prasanna B Dhore, Anjali A Bhatt, Shailesh R Deshpande, Ambika Gopalakrishnan Unnikrishnan, Monika Arora
DOI:10.4103/jncd.jncd_15_22  
Background: Diabetes is quickly reaching the status of a potential epidemic, with more than 74.2 million Indians diagnosed with the disease. With the majority of India's population residing in rural areas, the potential burden of diabetes is compounded by rising healthcare expenses, lower literacy, lack of awareness, limited access, and availability of healthcare. Objective: The process evaluation of project diabetes with dignity (DWD) aimed to test the feasibility and effectiveness of a model of enhanced diabetes care for adults, empowering Accredited Social Health Activists (ASHAs) in rural communities of Pune, Maharashtra. Methods: A community-based, quasi-experimental study was conducted with high-risk identified adults with Type 2 diabetes (n = 431, 30–70 years), in two Primary Health Centers of Baramati block of Pune district. ASHAs implemented six months' DWD intervention, including screening of subjects at risk of Type 2 diabetes using Indian diabetes risk score questionnaire, random blood glucose testing using glucometer, counseling, monthly house-to-house visits, and community-based awareness-raising activities about diabetes care-related issues. Results: Results indicated that the delivery, and reach of DWD intervention were favorable. The intervention was delivered as intended with a high degree of fidelity with dosage delivery, high attendance, and good participation rates. The participants were satisfied with intervention strategies activities and recognized to scale it up further. The engagement of ASHAs as a protagonist in the successful project implementation was emphasized. Conclusions: The findings on DWD intervention satisfaction, reach, and participation favored the capacity-building of ASHAs for diabetes screening, prevention, management, and referrals in rural Indian settings.
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Prevalence and predictors of medication nonadherence among hypertensive patients p. 71
Deepak Sharma, Naveen Krishan Goel, Sarabmeet Singh Lehl, Dinesh Kumar Walia, Sonia Puri, Kritee Shukla, Shreyas Mishra
DOI:10.4103/jncd.jncd_11_22  
Introduction: Hypertension is a chronic disease that needs to be treated adequately. Nonadherence to antihypertensive medicines can lead to coronary heart disease and stroke complications. The present study assessed the prevalence and predictors of medication nonadherence among hypertensive patients. Methodology: A cross-sectional study was conducted among hypertensive patients visiting the outdoor patient department of a tertiary care hospital in North India. Trained investigators interviewed the study participants after obtaining their written informed consent. A validated tool, namely the Brief Medication Questionnaire, was used to assess the medication nonadherence. Statistical analyses were performed using the Epi Info version for Windows. Results: A total of 400 hypertensive patients participated in the study. The mean age of study participants was 62.8 years (standard deviation = 11.0). Around half (55.0%) of the hypertensive patients suffered from comorbid disease conditions. The prevalence of antihypertensive medication nonadherence was 23.8%. The logistic regression model revealed that patients having a shorter duration of hypertension (odds ratio = 2.2 [1.2–3.9]) and those living in a joint family (odds ratio = 1.7 [1.1–2.8]) had higher medication nonadherence, as compared to their counterparts. Conclusion: Nearly one-fifth of the study participants were nonadherent to their antihypertension medication. There is a need for designing and implementing effective strategies by health-care providers for increasing antihypertensive medication adherence.
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Environmental risk factors for cardiovascular diseases using geographic information systems in an urban slum, Bengaluru p. 76
Deepa Srinivasan, Avita Rose Johnson, Subin Jang, Savan Sara Mathew, Farah Naaz Fathima
DOI:10.4103/jncd.jncd_10_22  
Background: Cardiovascular disease (CVD), a growing epidemic, is influenced by various environmental factors, and the potential connection is not studied adequately. Objective: Hence, our study was aimed at assessing the environmental risk factors for CVD and assessing perceptions about the same among the adults residing in an urban slum, Bengaluru. Methods: A cross-sectional descriptive study was conducted using a validated environmental assessment tool – Environmental Profile of Community Health. It consists of two parts: (i) an assessment of the physical environment for CVD-risk behaviors and (ii) a questionnaire to collect residents' perceptions of their community's environmental risks for CVD. Results: The community had two environmental risk factors for CVD-tobacco stores and fast-food restaurants. The community had ten convenience stores, all of which sold tobacco products. Vegetables and fruits were available, and the community also had a park for recreation. We interviewed a total of four study participants with a mean age of 38.5 ± 5.4 years. All participants reported that they have seen people smoke outside public places and inside residences. They felt that society disapproved of women and children smoking while men were excluded. Study participants have reported seeing tobacco and junk food advertisements. Tobacco was easily accessible and available to all ages. Conclusions: The urban community was not CVD-friendly. Awareness regarding risk factors for CVD was good. Adequate urban planning, policy-level advocacy, and tailor-made lifestyle changes for patients are the key to preventing CVD.
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Psychocognitive functions among breast cancer survivors: A randomized controlled trial p. 83
Deeksha Sharma, Budhi Singh Yadav, Monika Dutta, Sukhpal Kaur, Krishan Kumar, Divya Dahiya
DOI:10.4103/jncd.jncd_6_22  
Purpose: Chemotherapy-related cognitive impairments (CRCIs) are one of the adverse effects of chemotherapy, so there is a need to explore alternative measures to maintain normal cognitive functions or to prevent decline in cognitive abilities. This study was conducted to assess the effectiveness of Cognitive Training Interventions Package on cognitive functions among breast cancer survivors (BCSs). Materials and Methods: A total of 59 BCSs were randomly assigned to control and intervention groups. Participants of the intervention group were provided with a Cognitive Training Interventions Package to be practiced from 1st cycle until the completion of 4th cycle of chemotherapy. Both the groups were reassessed on the 4th cycle of chemotherapy. FACT Cog Version-3, Post Graduate Institute Memory Scale (PGIMS), and trail making test were used to assess cognitive functions. Activities of daily livings (ADLs) and depression, stress, and anxiety were measured using Barthel Index Scale and Depression, Anxiety, and Stress Scale-21, respectively. Satisfaction level among participants was measured using a self-structured questionnaire. Results: The mean age was 50.82 ± 10.12 years in the control group and 50 ± 11.24 years in the intervention group. BCSs in the intervention group demonstrated a significant improvement in attention and concentration (P = 0.02); retention for similar pairs (P = 0.001); recognition (P = 0.01); and visual attention, processing speed, and executive functions (P = 0.01). Intervention group also showed a significant improvement in ADLs (P = 0.04). Overall, the participants in the experimental group were more satisfied (mean = 2.00) as compared to those in the control group (mean = 1.896), which is supported by the observed statistical significant difference in the satisfaction levels of the participants (P = 0.04). Reduction in the levels of anxiety and depression was also noticed in both the groups but it was not significant. Conclusion: Cognitive training interventions package was beneficial for BCSs with CRCI to overcome cognitive impairments.
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BRIEF REPORT Top

Elevated homocysteine and depression outcomes in patients with comorbid medical conditions in rural primary care p. 95
Krishnamachari Srinivasan, Luke Joshua Salazar, Elsa Heylen, Maria L Ekstrand
DOI:10.4103/jncd.jncd_18_22  
We examined the association of elevated concentration of total homocysteine (tHcy) with the severity of depression in patients diagnosed with depression and comorbid chronic medical conditions in rural primary care settings in Karnataka. Participants were included from the control arm of a cluster-randomized controlled trial designed to evaluate the effects of using a collaborative care model to integrate screening and treatment of primary health center patients. tHcy was assayed at baseline, and depression severity scores were assessed using the Patient Health Questionnaire (PHQ-9) 6 months later. There was no difference in the mean PHQ-9 score between those with (mean PHQ = 7.4) and without (mean PHQ = 7.6) elevated tHcy levels (P = 0.67).
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CASE REPORT Top

Primary epithelial–myoepithelial carcinoma of the lung: Reporting a rare entity at a rare location p. 98
Deepak Uppal, Divya Khosla, Debajyoti Chatterjee, Vrinda Singla, Divyesh Kumar, Renu Madan, Rakesh Kapoor
DOI:10.4103/jncd.jncd_78_20  
Epithelial–myoepithelial carcinoma (EMC) of the lung is a rare neoplasm, constituting about 0.1%–1% of all primary lung cancers. EMC usually has an indolent course with occasional distant metastasis. A 52-year-old male presented with an unresectable lesion in the upper lobe of the right lung with mediastinal lymph nodes. Bronchoscopic biopsy and detailed histopathological examination revealed an EMC of the lung. Due to advanced disease and poor performance status of the patient, he was treated with palliative radiation followed by palliative chemotherapy. However, the patient succumbed to the disease after two cycles of palliative chemotherapy. Experience with EMC of the lung is limited and optimal treatment protocols have not been defined, with current treatment mainly extrapolated from EMC of the salivary glands from the head and neck. We add another case to the limited literature of EMC of the lung.
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