The first WHO Global Report on Diabetes was launched on World Health Day 7 ^th April 2016 which was dedicated to Diabetes (1). Diabetes has been described in ancient scripts and recognized as a serious illness, but it does not appear to have been frequently encountered by physicians or healers. It is in the past few decades that human health and development is increasingly affected by the rising numbers of people with this condition. Diabetes, together with cardiovascular disease, cancer and chronic respiratory disease has been targeted in the Political Declaration on the Prevention and Control of Noncommunicable Diseases (NCDs) at the Un High-level Political Meeting in 2011. In 2013 WHO member states endorsed a global monitoring framework for noncommunicable diseases, with 9 targets to be reached by 2025. Diabetes and its key risk factors are strongly reflected in the targets and indicators - reduction of exposure to unhealthy diet and physical inactivity, zero rise in the prevalence of diabetes, improved access to treatment and reduction of premature mortality. As part of the 2030 Agenda for Sustainable Development, Member States have set an ambitious target to reduce premature mortality from NCDs - including diabetes - by one third; achieve universal health coverage; and provide access to affordable essential medicines - all by 2030( http://www.un.org/sustainabledevelopment/sustainable-development-goals/).

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Coronavirus disease 2019 (COVID-19) pandemic is the most important global public health event of this century, and India is among the first 15 countries with affected persons. Persons with male gender, older age, and preexisting noncommunicable diseases (NCDs) are found to be associated with severe and fatal disease. Specific treatment modalities for COVID-19 are still elusive. NCDs are reported as presenting symptoms in COVID-19 patients, and preexisting NCD can worsen COVID-19 prognosis. The management of NCDs in the context of COVID-19 infection is challenging. India poses a huge burden of NCDs and their risk factors which could synergize with COVID-19 for serious illness and outcome. This article reviews and proposes a research agenda for COVID-19 and NCDs in the ambit of strategic approach: review of adequacy of existing mechanisms to tackle NCDs and their risk factors, strengthen the evidence base, enable remote access health-care service delivery, strategically revamp health systems to become more responsive, integrated, and universal, encourage all-round innovation through collaborations and partnerships, and empower community actions for home-based care. The key research domains are burden and epidemiology, health-care delivery, use of technology, sectoral approach, surveillance-monitoring-evaluation, behavioral and communication research, and governance and policy. Within each domain, key research priorities are identified which would be cross-cutting across more domains.

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Background: Worldwide India leads in diabetes mellitus and within India Kerala tops the list. Keeping in view increasing the burden of diabetes mellitus in Kerala, it is highly important to know about the awareness of the disease among the general population to chalk out culturally appropriate and need oriented educational strategies. Objective: The objective of this study is to assess the knowledge of diabetes mellitus in a rural populace of Kerala. Materials and Methods: A descriptive cross-sectional study was undertaken in a rural Panchayat of District Ernakulam of Kerala wherein 343 adults were randomly interviewed from six randomly selected wards. The interview schedule had 23 items on knowledge which was assessed in four domains including general awareness of diabetes mellitus, its risk factors, complications, and lifestyle modifications. Each item was given a score. Maximum possible score was 23. Knowledge score of <9 was considered as poor, 9-17 as average and above 17 was taken as good. Data were analyzed using SPSS version 11. Descriptive analysis was done for sociodemographic variables, and t-test and ANOVA were used to ascertain the level of significance of predictors of awareness. Results and Conclusion: Mean age of the participants was 47.7 ± 15.74 years with more than half (55.7%) having completed their high school education. Mean knowledge score was 15.6. Being diabetic, having completed high school education and with family history of diabetes had significantly better knowledge score (P < 0.05). Educating the community on risk factors is the key strategy for the prevention of diabetes and delaying the onset of disease among high-risk individuals.

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Vaccines are essential to ensure that the population is immune to certain diseases, and immunization is one of the most cost-effective interventions to prevent the occurrence of the diseases. Recently, new vaccines such as rotavirus, measles-rubella vaccine, and pneumococcal vaccines are introduced in the universal immunization program of some of the states in India. Human papillomavirus (HPV) vaccine is also introduced in Punjab through its own initiative. This paper documents the experience in terms of implementation plans, issues, and challenges in introducing these vaccines in North Indian states, including Haryana (rotavirus vaccine), Punjab (HPV vaccine), Himachal Pradesh (pneumococcal vaccine), and Chandigarh (measles and rubella vaccination campaign).

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Noncommunicable diseases (NCDs) are the major cause of global mortality, contributing to more than 63% of all-cause mortality. The burden is expected to escalate further, as the impact of NCDs increases, and as population ages. Limited research is being conducted on NCDs in developing countries because of lack of sufficient resources. This article attempts to identify urgent global research priorities for NCDs prevention, management, and control. A literature review was performed in October 2017 to identify published literature discussing research priorities in NCDs. Findings were supplemented with the key themes emerging from a panel discussion on the topic at 1^st World NCD Congress. Results reveal that different researchers and organizations have employed different criteria for setting priorities for investing in NCD-related research and development. Different methodologies for identifications of research priorities have also been adopted, most of which include a mixed method approach, with more reliance on qualitative research methods. For most of the NCDs, country-specific information on extent and patterns of disease and its social impact needs to be identified. Health system-related opportunities related to application of primary and secondary care cost-effective interventions need to be identified and explored. Studies are also required to assess gaps in accessibility and affordability of essential medicines and technologies required for treatment of NCDs. Research to identify effective strategies for improvement of data collection mechanisms for NCD incidence and prevalence is required. The study concludes that multidisciplinary research approaches need to be followed to better elucidate the influence of sociodemographic and economic factors on NCD prevention and control, to enhance availability and accessibility of cost-effective interventions to lower socioeconomic strata, and to increase the uptake of evidence-based research for policy development by policymakers.

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Postsecondary enrollment has been rising globally over the past years, but poor performance and drop-out have also been increasing and have become an academic concern. Most drop-outs tend not to return, which significantly affects their future prospects. Postsecondary student populations are a diverse mix of local, immigrant, and international students but it is unclear if reasons for academic failure differ between groups. The aim of this review was to examine the published literature for contributors to postsecondary academic failure, including drop-out, among local, immigrant, and international students. A search of the literature was conducted using PubMed, ProQuest, EBSCOHOST, and PsycINFO on the topic for all articles published in English up to March 2016. The results showed that almost all data come from the Western countries. Several personal, sociocultural, and academic factors appear to be associated with postsecondary failure among all students. These include gender, low academic engagement, stress, psychological difficulties, low social support, and poor coping abilities. Immigrant and international students face additional challenges, such as loss of social networks, discrimination, acculturation, and language challenges. Limitations of the data include the relatively small body of literature (particularly from low- and middle-income countries), and lack of subgroup comparisons, such as of local, immigrant and international students. Clarification of the relative contribution of these factors to academic failure will facilitate the development of effective retention strategies, particularly those that focus on addressing psychological distress and building resilience.

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Yoga and modern medicine are not exclusive, but complementary systems. Their combination can provide us with a holistic health care. While modern medicine has a lot to offer mankind in its treatment and management of acute illnesses and emergency conditions, yoga offers services in terms of preventive, promotive, and rehabilitative methods in addition to many management methods to tackle modern illnesses. Several published studies have demonstrated the health benefits of yoga. Regular practice of yoga has shown significant improvement in cardiovascular risk factors such as hypertension, diabetes, hyperlipidemia, obesity, metabolic syndrome, and psychological stress. However, there are many limitations with respect to the reported studies. Therefore, large multicentric trials using uniform methodologies and long-term outcomes are needed to confirm the findings. In view of the existing knowledge, yoga is a cost-effective and beneficial supportive/adjunct treatment without side effects. There is a favorable atmosphere for integration of alternate medical systems in resource-strained public health systems.

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Youth have a right to health, but that is not adequately reflected in our societies and health systems. In fact, for cancer, diabetes, chronic lung disease, and cardiovascular diseases - so-called noncommunicable diseases (NCDs) - more than two-thirds of preventable adult deaths are associated with behavior that started in adolescence. Many young people are well aware of how drastically NCDs will affect their generation in the current system and have taken the challenge to change the discourse for a healthier global population. Yet, youth voices are often dismissed or tokenized in political conversations. This is despite the many examples of youth making positive change at all levels of society. This paper provides an overview of the challenges and emerging youth-driven actions to address NCDs at local, national, and global levels.

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Objective: The objective of this study was to compare the pattern and trends in the prevalence of self-reported diabetes mellitus among the elderly in India, 2004–2014. Research Design and Methods: The required data were extracted from National Sample Survey Organization's (NSSO) 60^th round in 2004 and 71^st round in 2014. Self-reported morbidity information of elderly with reference period of 15 days before the survey has been used for the analyses. From NSSO 2004, a total of 35,569 elderly persons were included in the study, and from NSSO 2014, a total of 28,397 elderly persons were included in the study. Age- and sex-standardized prevalence rate was calculated to make valid comparisons across two time periods. Results: The prevalence of self-reported diabetes has increased more among elderly males than among elderly females during 2004–2014.The increase in prevalence percentage is more among young old than the rest. There is a clear-cut rural–urban differential in the burden of diabetes in India. The eastern and southern regions of India marked a higher prevalence as well as increase in diabetes prevalence than the rest of the nation. Those with diabetes are also likely to be burdened by the existence of other chronic conditions such as heart disease and hypertension when compared to persons without diabetes. This burden is higher for women. Conclusion: The prevalence of self-reported diabetes appears to have increased and is higher among males. The apparent rural–urban and regional variations can be attributed to urbanization-induced lifestyle changes, increasing access to screening and treatment and reporting bias.

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The coronavirus disease (COVID-19) has critically impacted global health systems and economies both in developed and developing world, but especially in developing countries, already struggling to address the preexisting burden of diseases with limited resources, the situation has become even more challenging. The COVID-19 pandemic is the most serious public health challenge today and is responsible for two concurrent global crises: the health crisis and an economic crisis. Only an appropriate policy response will determine the impact of pandemic on human health and economic well-being. It is clear that the pandemic will seriously undermine global efforts to attain the sustainable development goals. Among the major challenges are increased indoor time leading to increased exposure of other behavioral risk factors for noncommunicable diseases (NCDs) such as unhealthy diet, alcohol use, stress, inadequate access to essential medicines. Further travel or transport restrictions leading to inaccessibility to health care centres, early detection and laboratory testing for NCD patients and increased susceptibility in health care settings for chronic disease patients. Thus, the strategies are required to address this comorbidity which may include integration and convergence of the existing communicable and NCD programs, strengthening primary health care for universal health coverage, updating guidelines, enhancing surge capacity, and multisectoral participation. It is essential to assess the prevalent gaps, mobilization of resources, evidence-based policymaking, strengthen health systems financing and leadership and effective partnerships for addressing health disparities and inequities which are further accentuated by the COVID-19 pandemic.

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Background: Achieving target blood pressure (BP) control has become an important management challenge, as the prevalence of hypertension increases in adult Nigerians. Overweight/obesity and lack of lifestyle behaviors are associated with difficulty in achieving target BP control. This study aim at determine the effect of nutritional counseling on body mass index (BMI) of adult hypertensive attending general outpatient clinic. Materials and Methods: An interventional study was performed on 322 adult patients (161 in the intervention group and 161 in the control group) with hypertension who had been on treatment for at least 3 months. Relevant data were collected using interviewer-administered the semi-structured questionnaire and clinical parameters were measured pre- and post-intervention. The intervention group was given nutritional counseling. Results: The mean BMI in the intervention group decreased to a statistically significant level (P < 0.001), from 25.42 ± 3.99 to 24.89 ± 3.64 compared to an increase in the control group from 25.36 ± 3.73 to 25.39 ± 3.74. The mean change in BMI of the intervention group (−0.53 ± 0.59) was higher than the mean change in BMI of the control group (0.03 ± 0.45), which was statistically significant (P < 0.001). More than two-third of the intervention group 135 (83.9%) had good BP control, compared to 68 (42.2%) of the control group. Conclusion: The nutritional status of the respondents in the intervention group is better than in the control group at the end of the study. Improved nutritional status led to better BMI. Family physicians will do well to counsel hypertensive patients on nutritional and lifestyle behavior with a view to improving BP control in them.

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The global epidemic of noncommunicable diseases (NCDs) was recognized by the United Nations and is addressed by the Sustainable Development Goals (SDGs) to be achieved by 2030. This review article describes the proceedings of the plenary session “SDGs and NCDs: Roadmap till 2030” of the first “World NCD Congress 2017” held at Chandigarh, India. The plenary session emphasized the need for political commitment to take up NCD agenda at the national level to prevent and reduce the premature NCD deaths. Establishing the national action plan and monitoring framework for prevention and control of NCDs are the major initial initiatives to implement the best buy NCD interventions. Primary prevention of four common and shared risk factors and health system strengthening are the important interventions to achieve the SDG goal 3.4. The implementation strategies at subnational level and engagement of sectors other than health on prevention and control of NCDs can be reviewed and further researched for effective implementation of the identified interventions.

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Introduction: In India, implementation of Health Promotion activities follows a vertical approach at district level. A Health Promotion project was therefore implemented for 3 years in Hoshiarpur and Ambala districts of Northern India, with objectives to develop, implement, and assess the effectiveness of integrated health promotion model. Materials and Methods: Situation analysis in two districts was followed by a state level stakeholders workshop in which detailed layout of model and a health promotion manual (Hindi, English, and Punjabi) was developed for capacity building of workforce. The effectiveness of model was assessed using mix of quantitative as well as qualitative methods. Results: The key features of model included integration and convergence within National Health Programs, multitasking, multisectoral involvement, and community empowerment, using digital media and advocacy tools. The facility assessment survey revealed improvements in implementation of activities as per annual activity calendar of IEC/BCC activities, better display of IEC material, with improved reporting, monitoring, and supervision. At community level, the awareness levels of the community members regarding communicable/noncommunicable diseases and key Reproductive and Child Health issues improved significantly (P < 0.05). Similarly, the client exit survey showed that dissemination of health information by MO/ANM increased in 3 years from 8% to 80% and 7.3% to 75% in districts Hoshiarpur and Ambala, respectively (P < 0.05). In-depth interview with key stakeholders and focused group discussion with Village Health and Sanitation Committee/Village Level Core Committee has shown their active involvement and improvements in their functioning. Based on indicative costing, per capita costs of National Health Mission for IEC/BCC/Health promotion activities need to be increased from INR 0.7 (USD 0.01) to INR 4 (USD 0.06), which requires increase in budget allocation from 1% to minimum of 4%. Conclusion: Model was found to be effective and feasible on pilot implementation. District level human and financial resources, however, must be augmented to implement health promotion activities effectively.

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The world is experiencing a second tobacco consumption pandemic in the form of increasing hookah use among youths. Post-1990s, there has been an unprecedented increase in the number of hookah smokers across the world. Despite having a well-formulated tobacco control policy, India has one of the highest numbers of tobacco users in the world. The increase in the proportion of hookah smokers to the levels currently seen in Middle Eastern countries would prove disastrous for India's demographic dividend. However, compared to rest of the world, India is witnessing a slightly different problem in the form of an increase in the number of “tobacco-free” hookah users. This article reviews global hookah smoking trend and how India is ill prepared to counter the increasing hookah use among youths and suggests what government needs to do to prevent global hookah smoking pandemic to spread in India.

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Background: Among noncommunicable diseases, hypertension is one of the most important risk factors, the control of which imposes a huge financial burden on the healthcare system and the society. Objectives: The objective of this study was to measure the monthly cost incurred in care of hypertension in urban Puducherry and to estimate the total annual cost required to provide care for the adults with hypertension in a typical primary health center (PHC) of India. Materials and Methods: The study was conducted in the service area of urban health center (UHC) in Puducherry, functioning under the Department of Preventive and Social Medicine, JIPMER. A sample of 238 adults ≥ 18 years identified through a baseline survey conducted in 2014 was interviewed using a pretested semi-structured questionnaire. The questionnaire collected information on sociodemographic data, place of seeking hypertension care, and its duration and various direct and indirect costs incurred. Recall period was fixed as 1 month for OP care and 1 year for hospitalization. A prevalence-based approach was used for calculating the cost of illness. Average monthly and annual direct and indirect costs were calculated and were compared across the type of facility of care and with the presence or absence of comorbidities. The cost of care from UHC and other government hospitals were calculated from standard rates. The average annual cost from UHC was used to calculate the annual amount required to provide care of hypertension in a typical PHC of India. Results: Among the 238 participants, 73.5% (n = 175) were female, and the mean (standard deviation) age was 58 (11.7) years. Majority (72%, n = 172) took care for their hypertension from UHC, JIPMER. Half of them (n = 119) had associated comorbidities. Average monthly direct cost of care for hypertension was 223.2 (198.0–329.4) Indian national rupees. There was statistically significant difference in the cost of care among participants utilizing public and private facilities, and also among participants with comorbidities and without comorbidities. The estimation of annual cost of hypertension care for a typical PHC comes around 1.07 crores. Conclusion: The control of hypertension in a community leads to a significant load on health system; however, it is essential for preventing further catastrophic costs as a result of complications and mortality. This cost could be saved if we could prevent the population from becoming hypertensives by preventive measures, and it will further lead to reduction in mortality and morbidity and the associated costs.

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Noncommunicable diseases (NCDs) remain significant health and developmental challenge in the United Arab Emirates (UAE). The four main NCDs accounted for 77% of all deaths in UAE and 17% of premature deaths (30–70 years). The UAE National Agenda 2021 reflects high-level political commitment demonstrating strong leadership to address the national challenge and meet the global commitments providing a clear roadmap to guide planning, implementation, multisectoral response, and accountability for NCD Prevention and Control. This paper, therefore, aims to present the national response to NCD highlighting the strong leadership of the government at the highest level in the UAE, together with multisectoral engagements, thus establishing a national accountability framework.

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Objective: To assess the effectiveness of visual inspection of cervix with acetic acid (VIA test) as an accepted method for screening of cervical Cancer. Materials and Methods: Two hundred women attending the Cervical and Breast Cancer Screening Program and outpatient department (OPD) of Department of Obstetrics and Gynecology at our center were examined by both Pap smear and VIA tests. Results: Patients were aged between 21 and 70 years (mean 35.8 years). Nearly 45% got married between 16 and 20 years and 44% before 15 years of age. Oral contraceptives users were 23%. Nearly 14% of the women tested positive by VIA. Pap smear showed atypical squamous cells of undetermined significance in 9.5%, low-grade lesion in 6%, and high-grade lesions in 1.5%. Colposcopy showed cervical intraepithelial neoplasia (CIN-I) in 9%, 2% had CIN-II/III, invasive cancer in 1%, and 7% had unsatisfactory colposcopy findings. Thirty-six women required biopsy for histopathological confirmation. Among them, 7.5% had chronic cervicitis/koilocytic changes, 4.5% had CIN-I, 2% had CIN-II, 1.5% had CIN-III, 0.5% had invasive cancer, and 2% had normal result. Sensitivity of VIA was 76.5% and specificity was 91.8%. Sensitivity of Pap smear was 64.7% and specificity was 87.4%. Conclusion: Sensitivity and specificity of VIA was higher than that of Pap smear test. VIA can be used as an effective screening test to detect the precancerous and cancerous lesions of the cervix in Bangladesh.

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Research shows that risk factors for noncommunicable diseases (NCDs) are associated with behaviors that either begin or are reinforced during adolescence. Yet, focus on this age group in national NCDs policies globally or regionally in South-East Asia Region (SEAR) has not been adequately addressed. This overview of strategies to prevent NCDs among adolescents in SEAR countries provides a benchmark against which policy response can be assessed and strengthened. We reviewed all publically available documented strategies issued by governments in the 11 SEAR member countries of the World Health Organization on NCDs, published between January 1, 2002, and December 31, 2015. NCDs are currently a policy priority in many of the countries with school-based campaigns on healthy lifestyles; alcohol and tobacco-free environment and public ban on advertisements glamorizing unhealthy food among others. However, major challenges such as lack of specific focus on adolescents, lack of recognition of all major risk factors in national policies/programs, weak surveillance, unavailability of age disintegrated data, inefficient program management, low community awareness, and absence of multistakeholder policies persist. Of the countries reviewed, only 54.5% (6/11) proposed a policy that addressed all four of the main NCD risk factors - alcohol and tobacco use, physical inactivity, and obesity. This review demonstrates the disconnection between NCDs, adolescent health, and national policies.

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Background: Poor patient knowledge of recommended diabetic self-care practices is a major barrier toward attainment of good glycemic control and prevention of diabetic complications. Materials and Methods: We assessed the knowledge of diabetes self-care practices through a short 7-item pretested questionnaire among diabetes mellitus patients attending special clinics in three government hospitals. Results: The average diabetes knowledge score attained by the patients was 3.79 ± 1.77 (maximum score = 7). Lifetime treatment requirement for diabetes mellitus, plasma glucose levels for good glycemic control, and symptoms of hypoglycemia were correctly reported by 89%, 74%, and 38.5% of the patients, respectively. Low educational status and female gender were significantly associated with poor knowledge of diabetes (P < 0.05). Low level of knowledge of diabetes was a predictor of poor glycemic control but not medication adherence. Conclusion: Knowledge of diabetes in patients attending government hospitals in India is low. Future studies should explore low-cost health education interventions feasible in the Indian health-care context for improving patient knowledge of diabetes.

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Himachal Pradesh (HP) is one of the states of India with a population of 6,864,602 and density of 123/km². In the first healthy states, progressive India report on the ranks of states and union territories, HP scores overall 5th rank in health index based on reference year 2015-2016. Similarly, in first of its kind, “Health of nation states” report published recently revealed disease burden status of respective states and HP falls under highest epidemiological transition levels with epidemiological ratio of <0.31 in 2016 which was 1.14 in 1990. Particularly, the leading causes of disability-adjusted life years were reported as ischemic heart disease and chronic obstructive pulmonary disease for HP. These above-stated factual indicators reflect on high expenditure being incurred by an average resident of state suffering from any form of noncommunicable diseases while assessing health-care services. Sustainable development goal 3 and 3.8 of financial risk protection is being addressed through various government-sponsored schemes envisaging National Health Policy-2017 goals. Government of HP had taken major strides for Universal Health Coverage (UHC) and extended the similar benefits of Ayushman Bharat scheme to all sections of society with notification of Himachal Health Care scheme on December 29, 2018. Being a hilly state, HP is having its own challenges of inaccessibility and disparities, but its journey and direction on path of UHC is well directed and aptly supported by government policies.

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The coronavirus disease (COVID-19) pandemic has been one of the greatest health challenges that humanity has witnessed in recent times. Diabetes mellitus is one of the most common noncommunicable diseases and its prevalence is very high in evlderly people. COVID-19 also has a worse prognosis in elderly people. Hence, most of the data, both nationally and internationally, have shown that people with uncontrolled diabetes have worse outcomes compared to people without diabetes. This article reviews the connection between diabetes and COVID-19 and suggests various precautions to be taken for people with diabetes, the management strategies for diabetes and lays down a strategic framework for managing people with diabetes and COVID-19.

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Research is an essential component of the fight against noncommunicable disease (NCD) as it provides the evidence for effective prevention and control interventions. While the biological causes and manifestations of NCDs have been studied in depth, we are still trying to understand the best ways of implementing effective control policies. Exploring which interventions work in different settings is fundamental to the attainment of international targets set out in the Global Action Plan and the Sustainable Development Goals. The vast majority of NCD research comes from high-income countries and interventions that work in these settings are not necessarily effective in the Global South. Translational research is needed alongside wider engagement with social scientists: the most significant drivers of NCD epidemics are political, social, economic, and behavioral. Collaborative research spanning these domains is required for the development of effective, evidence-based NCD prevention, and control policies. This short article provides an overview of the role research has to play in the global NCD response and highlights areas in need of investment.

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Context: Nepal is currently experiencing a rapid growth in noncommunicable diseases (NCDs). Depression has previously been associated with NCDs in South Asia; however, data regarding its prevalence and risk factors are lacking in Nepal. Aims: This study aims to describe the prevalence of and risk factors for depressive symptoms in a suburban population of adults within Nepal. Setting and Design: We conducted a cross-sectional analysis of baseline data collected from participants enrolled in the Dhulikhel Heart Study, a population-based, longitudinal cohort study investigating cardiovascular risk factors in Dhulikhel, a suburban town outside Kathmandu. Subjects and Methods: Baseline questionnaire data from 1073 adults age 18 years and older included the Center for Epidemiologic Studies Depression Scale (CES-D). A score of 16 or greater on the CES-D has been shown to indicate major depressive symptomatology. Statistical Analysis: Using STATA 13, we conducted Pearson's Chi-square tests and multiple logistic regressions to examine associations between the binary CES-D score and gender, age, education, marital status, body mass index, physical activity, and hypertensive status. Results: The mean CES-D score in the sample was 11.7 (standard deviation: 5.3), with 21.3% scoring 16 or greater. Age over 60 and lack of formal education were associated with increased risk of depressive symptoms. Being physically active was associated with decreased risk of depressive symptoms. Conclusions: The estimated prevalence of depression among adults in Dhulikhel was 21.3%. Significant risk factors for increased depressive symptoms included lack of formal education, age over 60, and physical inactivity.

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Background: Co-occurrence of mental health and addictions disorders occurs at a high rate, posing significant costs to affected individuals and society if left untreated. Although decades of research and policy reports have argued the necessity of integrated mental health and addiction services to effectively treat this population, it appears as though relatively little integration has been achieved. Methods: This exploratory study used key informant interviews to investigate the current state of integrated treatment in Ontario, Canada, potential models for integrated treatment and barriers to their implementation. Interview transcripts were analyzed inductively, and thematic analysis used to identify emerging themes. Results: Five domains were identified: organizational barriers, system barriers, historical barriers, barriers related to stigma and discrimination, and knowledge barriers. A key challenge is the absence of provincial direction and limited evidence on the relative effectiveness of the different integrated treatment models. Discussion and Conclusion: Insights from interviews with research, policy and provider experts clarify the relevant factors affecting the implementation of integrated treatment in Ontario. In identifying potential models of integration and the barriers to their implementation, further research is required to assess the relative effectiveness of the different integration models and to identify the critical organizational and system factors needed for successful implementation of integrated care. Avenues that merit further exploration are the fields of implementation science and complex adaptive systems.

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