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Salahuddin S.,All India Institute of Medical Sciences | Prabhakaran D.,Center for Chronic Disease Control | Prabhakaran D.,Asia Risk Centre | Roy A.,All India Institute of Medical Sciences
Global Heart | Year: 2012

Cigarette smoking is a leading preventable risk factor for the development and progression of cardiovascular diseases (CVDs). Epidemiologic studies conclusively prove that both active smoking and secondhand smoke contribute significantly to morbidity and mortality related to CVD. Cigarette smoke is a mixture of several toxic chemicals, of which nicotine, carbon monoxide, and oxidant chemicals are most commonly implicated in the pathogenesis of cardiovascular disease. Tobacco causes endothelial dysfunction, inflammation, insulin resistance, alteration of lipid profile, hemodynamic alterations, and a hypercoagulable state. All of these act synergistically as pathobiologic mechanisms of atherothrombosis in tobacco users. © 2012 World Heart Federation (Geneva). Published by Elsevier Ltd. All rights reserved.

Choudhry N.K.,Harvard University | Choudhry N.K.,Brigham and Womens Hospital | Dugani S.,Brigham and Womens Hospital | Shrank W.H.,Brigham and Womens Hospital | And 6 more authors.
Health Affairs | Year: 2014

Statin use has increased substantially in North America and Europe, with resultant reductions in cardiovascular mortality. However, little is known about statin use in lower-income countries. India is of interest because of its burden of cardiovascular disease, the unique nature of its prescription drug market, and the growing globalization of drug sales. We conducted an observational study using IMS Health data for the period February 2006-January 2010. During the period, monthly statin prescriptions increased from 45.8 to 84.1 per 1,000 patients with coronary heart disease-an increase of 0.80 prescriptions per month. The proportion of the Indian population receiving a defined daily statin dose increased from 3.35 percent to 7.78 percent. Nevertheless, only a fraction of those eligible for a statin appeared to receive the therapy, even though there were 259 distinct statin products available to Indian consumers in January 2010. Low rates of statin use in India may reflect problems with access to health care, affordability, underdiagnosis, and cultural beliefs. Because of the growing burden of cardiovascular disease in lower-income countries such as India, there is an urgent need to increase statin use and ensure access to safe products whose use is based on evidence. Policies are needed to expand insurance, increase medications' affordability, educate physicians and patients, and improve regulatory oversight. © 2014 Project HOPE- The People-to-People Health Foundation, Inc.

Mendenhall E.,Georgetown University | Norris S.A.,University of Witwatersrand | Shidhaye R.,Indian Institute of Public Health and Public Health Foundation of India | Prabhakaran D.,Asia Risk Centre
Diabetes Research and Clinical Practice | Year: 2014

Eighty percent of people with type 2 diabetes reside in low- and middle-income countries (LMICs). Yet much of the research around depression among people with diabetes has been conducted in high-income countries (HICs). In this systematic review we searched Ovid Medline, PubMed, and PsychINFO for studies that assessed depression among people with type 2 diabetes in LMICs. Our focus on quantitative studies provided a prevalence of comorbid depression among those with diabetes. We reviewed 48 studies from 1,091 references. We found that this research has been conducted primarily in middle-income countries, including India (n=8), Mexico (n=8), Brazil (n=5), and China (n=5). There was variation in prevalence of comorbid depression across studies, but these differences did not reveal regional differences and seemed to result from study sample (e.g., urban vs rural and clinical vs population-based samples). Fifteen depression inventories were administered across the studies. We concluded that despite substantial diabetes burden in LMICs, few studies have reviewed comorbid depression and diabetes. Our review suggests depression among people with diabetes in LMICs may be higher than in HICs. Evidence from these 48 studies underscores the need for comprehensive mental health care that can be integrated into diabetes care within LMIC health systems. © 2014 Elsevier Ireland Ltd.

Pradeepa R.,Dr Mohans Diabetes Specialities Center | Prabhakaran D.,Asia Risk Centre | Mohan V.,Dr Mohans Diabetes Specialities Center
Diabetes Technology and Therapeutics | Year: 2012

Diabetes and cardiovascular diseases (CVDs) are increasing in epidemic proportions globally, with the most marked increase in emerging economies. Among emerging economies, China and India have the highest numbers of people with diabetes and CVD. Over the last two decades, 80% of CVD and diabetes mortality occurred in low- and middle-income countries, suggesting that these disorders have become a leading threat to public health in most of the developing countries. The burden of CVD and diabetes in the developing countries affects the productive younger age group, and this has serious economic implications. Diabetes shares many characteristics and risk factors with CVD, and thus the risk for CVD also escalates with the increase in prevalence of diabetes. Both genetic and environmental factors play a major role in causation of diabetes and CVD. However, the major drivers of this dual epidemic are demographic changes with increased life expectancy, lifestyle changes due to rapid urbanization, and industrialization. To reduce the burden of diabetes and CVD in the coming decades, emerging economies need to set national goals for early diagnosis, effective management, and primary prevention of these disorders. In order to curb the epidemic of diabetes and CVD, population-based, multisectoral, multidisciplinary, and culturally relevant approaches including various departments of the government as well as non-governmental agencies are required. © 2012 Mary Ann Liebert, Inc.

Mandryk M.,Wageningen University | Reidsma P.,Wageningen University | Kartikasari K.,Wageningen University | van Ittersum M.,Wageningen University | And 2 more authors.
Environmental Science and Policy | Year: 2015

Institutional feasibility defined as the ability of institutions to support adaptive capacity, is an important aspect of climate adaptation, through its influence on the implementation of adaptation measures to climate change. The objective of this study is to create a framework for assessing institutional preconditions that enable or constrain climate change adaptation measures in agriculture and to apply the framework to a case study in agriculture.We adopted and modified the Procedure for Institutional Compatibility Assessment (PICA). Institutions in our framework are characterized by a set of crucial institutional preconditions (CIPs) and indicators linked to each CIP. CIPs refer to both institutional incentives and constraints for implementation of adaptation measures (here to climate change). We applied a combination of ranking and scoring techniques based on information from workshops, interviews and a literature review to assess institutional incentives and constraints for adaptation measures, together indicating the institutional feasibility of implementation of adaptation measures. We selected and assessed three adaptation measures relevant to agriculture in Flevoland, a province in the Netherlands: (1) improvement of water management and irrigation facilities; (2) relocation of farms; and (3) development of new crop varieties.The two main constraining CIPs for the implementation of the measures were found to be (1) heterogeneity of actors' interests and (2) availability of resources. Based on the institutional feasibility analysis, the implementation of water management and improvement of irrigation facilities will potentially face fewer institutional constraints compared to the other two measures. We conclude that our approach proves applicable for institutional analyses of adaptation measures for current and future (climate) challenges at different levels of implementation, but that more applications are needed to test its validity and robustness. © 2015 Elsevier Ltd.

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