Burden and Correlates of Falls among Rural Elders of South India: Mobility and Independent Living in Elders Study.
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ABSTRACT:
SUBMITTER: Sharma PK
PROVIDER: S-EPMC5485263 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:Anticholinergic cognitive burden (ACB) may be associated with detrimental effects on mobility and physical independence in older adults. We evaluated the incidence of major mobility disability (MMD), persistent major mobility disability (PMMD), and injurious falls among participants within the Lifestyle Interventions for Elders (LIFE) trial according to varied anticholinergic burden levels. Participants aged 70-89 years were randomized to a physical activity (PA) or successful aging (SA) intervention and evaluated by ACB medication use as a summed score of a previously developed ACB scale. Confounders included demographic characteristics, physical function, cognitive function, and fall history. Average participant follow-up was 2.6 years and included outcome assessment for MMD, PMMD, and injurious falls every six months. Adjusted proportional hazards models evaluated the independent effects of ACB scores as well as interaction effects with the intervention. Of the 1635 participants, 986 (60%) used ?1 anticholinergic medication. Compared to those with no burden, participants with an ACB score of 1 demonstrated increased MMD (HR = 1.42 [1.13-1.78]), PMMD (HR = 1.53 [1.12-2.09]), and injurious falls (HR = 1.60 [1.10-2.32]). Results similar in magnitude were observed for all other ACB levels versus the no burden group. Stepwise dose-response comparisons between ACB groupings did not demonstrate significant differences in outcomes. Stratification by PA or SA interventions demonstrated few differences from the combined overall trial results. Compared to those not taking anticholinergic medications, participants taking anticholinergic medications generally demonstrated increased risk of MMD, PMMD, and injurious falls. Total anticholinergic burden was not associated with a stepwise dose-response relationship in mobility disability and may lack sensitivity to capture varied responses.
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Project description:In developing countries, up to 20% of maternal deaths during pregnancy are due to suicide, and being HIV-infected confers additional risk. This manuscript sought to identify perinatal correlates of suicidal ideation among women living with HIV (WLHIV) in rural South Africa. Pregnant WLHIV (N = 681) were recruited and re-assessed at 12-months postpartum. Mean age was 28.3 (SD = 5.7) years and 68% were below the poverty line. Prenatal suicidal ideation was 39%; suicidal ideation continued for 7% at 12 months, 13% experienced incident suicidal ideation, and for 19% suicidal ideation had stopped postnatally. Intimate partner violence (AOR = 1.17) and depression (AOR = 1.14) predicted sustained suicidal ideation. Increased income (AOR = 2.25) and greater stigma (AOR = 1.33) predicted incident suicidal ideation. Younger age (AOR = 0.94), disclosure of HIV status to partner (AOR = 0.60), and greater stigma (AOR = 1.24) predicted postnatal cessation of suicidal ideation. Perinatal care may provide windows of opportunity for identification and treatment of suicidal ideation.
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Project description:Daily mobility, an important aspect of environmental exposures and health behavior, has mainly been investigated in high-income countries. We aimed to identify the main dimensions of mobility and investigate their individual, contextual, and external predictors among men and women living in a peri-urban area of South India. We used 192 global positioning system (GPS)-recorded mobility tracks from 47 participants (24 women, 23 men) from the Cardiovascular Health effects of Air pollution in Telangana, India (CHAI) project (mean: 4.1 days/person). The mean age was 44 (standard deviation: 14) years. Half of the population was illiterate and 55% was in unskilled manual employment, mostly agriculture-related. Sex was the largest determinant of mobility. During daytime, time spent at home averaged 13.4 (3.7) h for women and 9.4 (4.2) h for men. Women's activity spaces were smaller and more circular than men's. A principal component analysis identified three main mobility dimensions related to the size of the activity space, the mobility in/around the residence, and mobility inside the village, explaining 86% (women) and 61% (men) of the total variability in mobility. Age, socioeconomic status, and urbanicity were associated with all three dimensions. Our results have multiple potential applications for improved assessment of environmental exposures and their effects on health.
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Project description:The scholarship on religion has long argued that collective worship helps foster social cohesion. Despite the pervasiveness of this contention, rigorous quantitative evaluations of it have been surprisingly limited. Here, I draw on network data representing the ties of social support among Hindu residents of a South Indian village to evaluate the association between collective religious ritual and social cohesion. I find that those who partake in collective religious rituals together have a higher probability of having a supportive relationship than those who do not. At the structural level, this corresponds to denser connections among co-participants. At the individual level, participants are more embedded in the local community of co-religionists, but are not disassociating themselves from members of other religious denominations. These patterns hold most strongly for co-participation in the recurrent, low-arousal monthly worships at the temple, and are suggestive for co-participation in the intense and dysphoric ritual acts carried out as part of an annual festival. Together, these findings provide clear empirical evidence of the lasting relationship between collective religious ritual and social cohesion.
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Project description:Globally, physical inactivity is a concern, and children's independent mobility (CIM) may be an important target behavior for addressing the physical inactivity crisis. The aim of this study was to examine correlates of CIM (8-12 years old) in the Canadian context to inform future interventions. CIM was measured via parent surveys. Individual, social, and environmental correlates of CIM were examined using a social-ecological framework. 1699 participants' data were analyzed using descriptive statistics and gender-stratified linear mixed-effects models while controlling for site, area-level socioeconomic status, and type of urbanization. Individual correlates including child grade (β = 0.612, p < 0.001), language spoken at home (β = -0.503, p < 0.001), car ownership (β = -0.374, p < 0.05), and phone ownership (β = 0.593, p < 0.001) were associated with CIM. For boys, parental gender (β = -0.387, p < 0.01) was negatively associated with CIM. Parents' perceptions of safety and environment were significantly associated with CIM. Location (i.e., site) was significantly associated with CIM (ref: Trois-Rivières; Ottawa (β = -1.188, p < 0.001); Vancouver (β = -1.216, p < 0.001)). Suburban environments were negatively associated with boys' independent mobility (β = -0.536, p < 0.05), while walkability (400 m β = 0.064, p < 0.05; 1600 m β = -0.059, p < 0.05) was significantly associated with girls' independent mobility only. Future research and interventions should consider targeting "modifiable factors" like children's and parents' perceptions of neighborhood safety and environment.
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Project description:PurposeThe purpose of the study was to examine the association between socio-demographic and clinical characteristics and perceived social support among patients with a diagnosis of depression and/or anxiety and co-morbid medical conditions from rural south India.MethodsThe study was conducted in 49 PHCs in Ramanagara district, Karnataka, and included 2481 participants, who were 30 years or older with co-morbid CMD (Common Mental Disorder) and hypertension, diabetes or ischemic heart disease. Socio-demographic characteristics of the participants were collected, and instrumental, emotional and total social support, quality of life, severity of disability, depression and anxiety were measured via face-to-face interviews using structured questionnaires.ResultsThe sample predominantly consisted of Hindu (98.5%) females (75%) in their middle to late adulthood. In multivariate models, age showed a significant curvilinear relation with all forms of social support (B = 0.001 and p < 0.05), and emotional social support (B = - 0.056, p = 0.004) was lower in employed than non-working participants. Household size was positively related to all forms of social support (B = 0.029 for instrumental, B = 0.022 for emotional, B = 0.025 for total social support, all p < 0.001). Quality of life was positively associated with all forms of social support (B = 0.019 for instrumental, B = 0.016 for emotional, B = 0.018 for total social support, all p < 0.001).ConclusionsFor this sample of outpatients diagnosed with both CMD and at least one comorbid medical condition in rural south India, greater household size was associated with better social support. The role of family in providing support can be utilized while designing interventions.Trial registration numberhttp://Clinicaltrials.gov : NCT02310932 registered December 8, 2014 URL: https://clinicaltrials.gov/ct2/show/record/NCT02310932 ; Clinical Trials Registry India: CTRI/2018/04/013001 retrospectively registered on April 4, 2018.
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Project description:Background and objectivesCardiovascular diseases (CVD) accounted for one-third of the deaths in India. We conducted a cohort study to estimate the incidence of CVD and the association of established risk factors with the incident CVD in a rural population in South India.Design, setting and participantsWe conducted a community-based cohort study among 6026 adults aged 25-64 years in five villages in Tiruvallur, Tamil Nadu. We did baseline (2005-2007) and two follow-up surveys in 2008-2009 and 2013-2015. Risk factors studied were tobacco, alcohol, hypertension, self-reported diabetes and central obesity.Outcome measuresOutcome measures were fatal or non-fatal ischaemic heart disease or cerebrovascular event. We estimated HRs for the risk factors and population attributable fraction (PAF).ResultsWe followed up 5641 (94.4%) subjects, and follow-up duration was 33 371 person years. The overall incidence of cardiovascular event or death was 4.6 per 1000 person years. Current smoking (HR 1.6, 95% CI 1.1 to 2.6) and hypertension (HR 2.2, 95% CI 1.5 to 3.4) were the risk factors among men and accounted for 47% of the PAF. Among women, hypertension (HR 1.8, 95% CI 1.0 to 3.4), self-reported diabetes (HR 4.3, 95% CI 2.2 to 8.1) and central obesity (HR 2.2, 95% CI 1.2 to 4.0) were associated with CVD and accounted for more than half of the PAF.ConclusionsWe described the high burden of fatal CVD and identified the role of CVD risk factors such as hypertension, self-reported diabetes, smoking and central obesity. There is an urgent need to implement low-cost interventions such as smoking cessation and treat hypertension and diabetes in primary care settings.
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Project description:AimsMetabolic Syndrome (MetS) is a strong predictor of Coronary Heart Disease (CHD). Studies in urban India have found about one-third of Indians suffer from MetS. Less is known about the prevalence of MetS in rural areas, where 70% of the population reside. This study examined the prevalence of Metabolic Syndrome in a population of rural women in India.MethodsData were gathered in a community-based study of 500 rural and tribal women residing in the Mysore district, between the age of 30-59 years. The study used the WHO STEPS approach, in which information on demographics and behavioral risk factors were collected. Along with anthropometric measurements, blood pressure, blood glucose, lipids were measured. A harmonized definition of MetS recommended by International Diabetes Federation Task Force on Epidemiology and Prevention was used in this study.ResultsThree out of five study participants were found to have MetS (47.1%, n = 223). Of those, 56.5% met 3 of the 5 criteria, 32.2% met 4 criteria, and 11.2% met all 5 criteria. Among the entire sample, low HDL was the most prevalent criterion (88.4%), followed by elevated glucose (57.9%), elevated triglycerides (49.3%), elevated BP (41.5%), and increased waist circumference (15.3%). In this sample, women with METS were generally older (p < 0.001), housewives (p = 0.001), that consumed salty highly processed foods (p = 0.020) and had low physical activity (p = 0.015).ConclusionsThis study showed a high prevalence of MetS in rural women. There is a compelling need for interventions aimed at reducing CHD risk factors in this population.
| S-EPMC7772584 | biostudies-literature
Project description:BackgroundCommunity knowledge is a critical input for relevant health programmes and strategies. How community perceptions of risk reflect the burden of mortality is poorly understood.ObjectiveTo determine the burden of mortality reflecting community-nominated health risk factors in rural South Africa, where a complex health transition is underway.MethodsThree discussion groups (total 48 participants) representing a cross-section of the community nominated health priorities through a Participatory Action Research process. A secondary analysis of Verbal Autopsy (VA) data was performed for deaths in the same community from 1993 to 2015 (n = 14,430). Using population attributable fractions (PAFs) extracted from Global Burden of Disease data for South Africa, deaths were categorised as 'attributable at least in part' to community-nominated risk factors if the PAF of the risk factor to the cause of death was >0. We also calculated 'reducible mortality fractions' (RMFs), defined as the proportions of each and all community-nominated risk factor(s) relative to all possible risk factors for deaths in the population .ResultsThree risk factors were nominated as the most important health concerns locally: alcohol abuse, drug abuse, and lack of safe water. Of all causes of deaths 1993-2015, over 77% (n = 11,143) were attributable at least in part to at least one community-nominated risk factor. Causes of attributable deaths, at least in part, to alcohol abuse were most common (52.6%, n = 7,591), followed by drug abuse (29.3%, n = 4,223), and lack of safe water (11.4%, n = 1,652). In terms of the RMF, alcohol use contributed the largest percentage of all possible risk factors leading to death (13.6%), then lack of safe water (7.0%), and drug abuse (1.3%) .ConclusionA substantial proportion of deaths are linked to community-nominated risk factors. Community knowledge is a critical input to understand local health risks.
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Project description:BACKGROUND: We conducted a survey to estimate point prevalence of bacteriologically positive pulmonary TB (PTB) in a rural area in South India, implementing TB program DOTS strategy since 2002. METHODS: Survey was conducted among persons ≥ 15 years of age in fifteen clusters selected by simple random sampling; each consisting of 5-12 villages. Persons having symptoms suggestive of PTB or history of anti-TB treatment (ATT) were eligible for sputum examination by smear microscopy for Acid Fast Bacilli and culture for Mycobacterium tuberculosis; two sputum samples were collected from each eligible person. Persons with one or both sputum specimen positive on microscopy and/or culture were labeled suffering from PTB. Prevalence was estimated after imputing missing values to correct for bias introduced by incompleteness of data. In six clusters, registered persons were also screened by X-ray chest. Persons with any abnormal shadow on X-ray were eligible for sputum examination in addition to those with symptoms and ATT. Multiplication factor calculated as ratio of prevalence while using both screening tools to prevalence using symptoms screening alone was applied to entire study population to estimate prevalence corrected for non-screening by X-ray. RESULTS: Of 71,874 residents ≥ 15 years of age, 63,362 (88.2%) were screened for symptoms and ATT. Of them, 5120 (8.1%) - 4681 (7.4%) with symptoms and an additional 439 (0.7%) with ATT were eligible for sputum examination. Spot specimen were collected from 4850 (94.7%) and early morning sputum specimens from 4719 (92.2%). Using symptom screening alone, prevalence of smear, culture and bacteriologically positive PTB in persons ≥ 15 years of age was 83 (CI: 57-109), 152 (CI: 108-197) and 196 (CI :145-246) per 100,000 population respectively. Prevalence corrected for non-screening by X-ray was 108 (CI: 82-134), 198 (CI: 153-243) and 254 (CI: 204-301) respectively. CONCLUSION: Observed prevalence suggests further strengthening of TB control program.
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