PubMed | National Institute of Medical Statistics, Centers for Disease Control and Prevention, World Health Organization, Christian Medical College and National AIDS Control Organization
Type: Journal Article | Journal: Journal of preventive medicine and public health = Yebang Uihakhoe chi | Year: 2016
The survival outcomes of antiretroviral treatment (ART) programs have not been systematically evaluated at the state level in India. This retrospective study assessed the survival rates and factors associated with survival among adult human immunodeficiency virus (HIV)-infected patients in Andhra Pradesh, India.The present study used data from 139 679 HIV patients aged 15 years on ART who were registered from 2007 to 2011 and were followed up through December 2013. The primary end point was death of the patient. Mortality densities (per 1000 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore the factors associated with survival.The overall median follow-up time was 16.0 months (2.0 months for the deceased and 14.0 months for those lost to follow-up). Approximately 13.2% of those newly initiated on ART died during follow-up. Of those deaths, 56% occurred in the first three months. The crude mortality rate was 80.9 per 1000 person-years at risk. The CD4 count (adjusted hazard ratio [aHR],4.88; 95% confidence interval [CI], 4.36 to 5.46 for <100 cells/mmThe study findings revealed that high mortality was observed within the first three months of ART initiation. Patients with poor baseline clinical characteristics had a higher risk of mortality. Expanded testing and counseling should be encouraged, with the goal of ensuring early enrollment into the program followed by the initiation of ART in HIV-infected patients.
Chaturvedi H.K.,National Institute of Medical Statistics |
Mahanta J.,Regional Medical Research Center |
Bajpai R.C.,National Institute of Medical Statistics |
Pandey A.,National Institute of Medical Statistics
BMC Public Health | Year: 2013
Background: Household survey data of Changlang district, Arunachal Pradesh, were used in the present study to assess the prevalence of opium use among different tribes, and to examine the association between sociodemographic factors and opium use. Methods. A sample of 3421 individuals (1795 men and 1626 women) aged 15 years and older was analyzed using a multivariate logistic regression model to determine factors associated with opium use. Sociodemographic information such as age, education, occupation, religion, ethnicity and marital status were included in the analysis. Results: The prevalence of opium use was significantly higher (10.6%) among men than among women (2.1%). It varied according to age, educational level, occupation, marital status and religion of the respondents. In both sexes, opium use was significantly higher among Singpho and Khamti tribes compared with other tribes. Multivariate logistic regression indicated that opium use was significantly associated with age, occupation, ethnicity, religion and marital status of the respondents of both sexes. Multivariate rate ratios (MRR) for opium use were significantly higher (4-6 times) among older age groups (≥35 years) and male respondents. In males, the MRR was also significantly higher in respondents of Buddhist and Indigenous religion, while in females, the MRR was significantly higher in Buddhists. Most of the female opium users had taken opium for more than 5 years and were introduced to it by their husbands after marriage. Use of other substances among opium users comprised mainly tobacco (76%) and alcohol (44%). Conclusions: The study reveals the sociodemographic factors, such as age, sex, ethnicity, religion and occupation, which are associated with opium use. Such information is useful for institution of intervention measures to reduce opium use. © 2013 Chaturvedi et al.; licensee BioMed Central Ltd.
Juneja A.,National Institute of Medical Statistics |
Sharma S.,Institute of Cytology and Preventive Oncology
Journal of Cancer Research and Therapeutics | Year: 2015
Sample size is one of the basics issues, which medical researcher including oncologist faces with any research program. The current communication attempts to discuss the computation of sample size when sensitivity and specificity are being evaluated. The article intends to present the situation that the researcher could easily visualize for appropriate use of sample size techniques for sensitivity and specificity when any screening method for early detection of cancer is in question. Moreover, the researcher would be in a position to efficiently communicate with a statistician for sample size computation and most importantly applicability of the results under the conditions of the negotiated precision.
Pandey A.,National Institute of Medical Statistics |
Aggarwal A.,National Institute of Medical Statistics |
Maulik M.,National Institute of Medical Statistics |
Gupta J.,National Institute of Medical Statistics |
Juneja A.,National Institute of Medical Statistics
Pharmaceutical Medicine | Year: 2013
The Clinical Trials Registry - India (CTRI), an online system (www.ctri.nic.in) for the registration of clinical trials being conducted in India, has its secretariat at the National Institute of Medical Statistics of the Indian Council of Medical Research in New Delhi. The primary objective of the CTRI is to ensure that all clinical trials conducted in India are registered in order to bring transparency, accountability and access to clinical trials. Since its launch on 20 July 2007, the CTRI has gone from strength to strength and, as of January 2013, more than 3,300 trials had been registered. Although initiated as a voluntary exercise, registration of trials requiring approval by the drug regulatory authority in India has been made mandatory. Editors from 11 major biomedical journals in India require submission of the clinical trial registration number as a prerequisite for publication. In addition, several ethics committees also insist upon trial registration. The CTRI is a primary registry of the WHO's International Clinical Trials Registry Platform. This article discusses the challenges encountered during the setting up of the CTRI and the strategies adopted, and also explains the steps to trial registration in the CTRI. © 2013 Springer International Publishing Switzerland.
Dhamija M.,Rajiv Gandhi Cancer Institute |
Kapoor G.,National Institute of Medical Statistics |
Juneja A.,National Institute of Medical Statistics
Journal of Pediatric Hematology/Oncology | Year: 2014
Background: Drug administration is a multiprofessional process. The high toxicity and low therapeutic index of chemotherapy drugs make medication errors a significant problem, resulting in excessive patient morbidity and cost. Objective: An audit of the delivery of infusional chemotherapy among pediatric inpatients was planned, with the objective of improving practice and minimizing errors.Method: An observational study was conducted between January and August 2012. Patients were followed up from their premedication until the completion of postchemotherapy hydration and/or rescue drugs. Errors were recorded and classified by error type, cause, severity, unit location, medication involved, and harm caused.Results: A total of 205 observations were made and 23(13.6%) errors recorded, of which 6 were intercepted. No life-threatening adverse drug event was recorded. The most important risk factor predisposing to errors was admission to nonpediatric ward (P=0.004). Documentation errors and incorrect infusion time were the 2 most common errors, whereas the most frequent error node was administration error. Appropriate steps were taken to prevent their reoccurrence.Conclusions: This study helped provide important information about the rate and epidemiology of medication errors, emphasizing on the role of audit in enabling development of appropriate errorreducing strategies, particularly in the context of quality assurance in hospitals. Copyright © 2013 by Lippincott Williams & Wilkins.
Sahu D.,National Institute of Medical Statistics |
Nair S.,National Institute of Medical Statistics |
Singh L.,National Institute of Medical Statistics |
Gulati B.K.,National Institute of Medical Statistics |
Pandey A.,National Institute of Medical Statistics
Indian Journal of Medical Research | Year: 2015
Background & objectives: the level of infant and child mortality is high among Scheduled Tribes particularly those living in rural areas. This study examines levels, trends and socio-demographic factors associated with infant and child mortality among scheduled tribes in rural areas. Methods: Data from the three rounds of the National Family Health Survey (NFHS) of India from 1992 to 2006 were analysed to assess the levels and trends of infant and child mortality. Univariate and multivariate Cox proportional hazard model were used to understand the socio-economic and demographic factors associated with mortality during 1992–2006. Results: Significant change was observed in infant and child mortality over the time period from 1992-2006 among Scheduled Tribes in rural areas. After controlling for other factors, birth interval, household wealth, and region were found to be significantly associated with infant and child mortality. Hazard of infant mortality was highest among births to mothers aged 30 yr or more (HR=1.3, 95% CI=1.1-1.7) as compared with births to the mother’s aged 20-29 yr. Hazard of under-five mortality was 42 per cent (95% CI=1.3-1.6) higher among four or more birth order compared with the first birth order. The risk of infant dying was higher among male children (HR = 1.2, 95% CI=1.1-1.4) than among female children while male children were at 30 per cent (HR=0.7, 95% CI=0.6-0.7) less hazard of child mortality than female children. Literate women were at 40 per cent (HR=0.6, 95% CI=0.50-0.76) less hazard of child death than illiterate women. Interpretation & conclusions: Mortality differentials by socio-demographic and economic factors were observed over the time period (1992-2006) among Scheduled Tribes (STs) in rural India. Findings support the need to focus on age at first birth and spacing between two births. © 2015, Indian Council of Medical Research. All rights reserved.
Rastogi M.,SASTRA University |
Ojha R.P.,SASTRA University |
Devi B.P.,SASTRA University |
Aggarwal A.,National Institute of Medical Statistics |
And 2 more authors.
Neurochemical Research | Year: 2012
Bacopa monnieri (L.) is a revered medicinal plant of traditional Indian system of medicine effective against cognitive impairment in ageing and SDAT. In our previous study, long term administration of bacosides was found to exhibit remarkable anti ageing effect, ameliorate age associated neurochemical and neurobehavioral deficits and prevent hippocampal neuronal degeneration in middle aged and aged rat brain cortex. In continuation to the previous study, the present study aims to investigate the neuroprotective effect of bacosides against age related chronic neuroinflammation in Wistar rat brain on 3 months treatment. Recently, neuroinflammation has gained considerable interest in age associated neurodegeneration and pathologies like SDAT due to its slow onset and chronic nature. The results of the present study demonstrated the significant attenuation of age dependant elevation of pro inflammatory cytokines, iNOS protein expression, total nitrite and lipofuscin content in middle aged and aged rat brain cortex on long term oral administration of bacosides. Thus, the present results suggest that bacosides possess immense potential to act as a neuroprotective agent due to its pleiotropic action for the prevention of ageing complications and SDAT progression. © Springer Science+Business Media, LLC 2011.
PubMed | National Health Research Institute, University of California at San Diego, National Institute of Medical Statistics and Population Council
Type: | Journal: Journal of interpersonal violence | Year: 2016
Husbands alcohol use has been associated with family-level stress and intimate partner violence (IPV) against women in India. Joint family systems are common in India and IPV often co-occurs with non-violent family maltreatment of wives (e.g., nutritional deprivation, deprivation of sleep, blocking access to health care). Alcohol use increases for some parents following the birth of a child. This study examined 1,038 postpartum womens reports of their husbands alcohol use and their own experiences of IPV (by husband) and non-violent maltreatment from husbands and/or in-laws. We analyzed cross-sectional, quantitative data collected in 2008, from women (ages 15-35) seeking immunizations for their infants <6 months at three large urban health centers in Mumbai, India. Crude and adjusted logistic regression models estimated associations between the independent variable (husbands past month use of alcohol) and two dependent variables (postpartum IPV and maltreatment). Overall, 15% of husbands used alcohol, ranging from daily drinkers (10%) to those who drank one to two times per week (54%). Prevalence of postpartum IPV and family maltreatment was 18% and 42%, respectively. Prevalence of IPV among women married to alcohol users was 27%. Most abused womens husbands always (27%) or sometimes (37%) drank during violent episodes. Risk for IPV increased with a mans increasing frequency of consumption. Women who lived with a husband who drank alcohol, relative to non-drinkers, were more likely to report postpartum IPV, aOR = 2.0, 95% confidence interval (CI) = [1.3, 3.1]. Husbands drinking was marginally associated with increased risk for family maltreatment, aOR = 1.4, 95% CI = [1.0, 2.1]. Our findings suggest that mens alcohol use is an important risk factor for postpartum IPV and maltreatment. Targeted services for Indian women contending with these issues are implicated. Postpartum care offers an ideal opportunity to screen for IPV, household maltreatment, and other health risks, such as husbands use of alcohol. There is need to scale up proven successful interventions for reducing mens alcohol use and design strategies that provide at-risk women protection from alcohol-related IPV.
News Article | November 16, 2016
A controversial experiment to revive brain-dead accident victims has been scrapped. The Indian Council of Medical Research’s (ICMR) National Institute of Medical Statistics officially removed the “ReAnima” trial from India’s clinical trial registry on Nov. 11. The experiment began in May when Himanshu Bansal, an orthopedic surgeon at Anupam Hospital in the north Indian state of Uttarakhand, announced plans to give approximately 20 brain-dead people a mix of interventions including injections of mesenchymal stem cells, peptides, transcranial laser stimulation and median nerve stimulation. Transcranial laser stimulation is a process that involves shinning pulses of near-infrared light in the brain, while median nerve stimulation is the electrical stimulation of a major nerve that runs from the neck to the arm. Both techniques have been proven to improve cognition in patients with traumatic brain injury. The ICMR identified several regulatory lapses in the trial that led to the decision, including a failure to seek permission to proceed from the Drug Controller General of India, a requirement for all clinical trials in India. Bansal previously described his aim as bringing brain-dead individuals back to a minimally conscious state where patients show flickers of consciousness like moving their eyes to track objects. While there is little evidence to show that brain-dead people can recover with function, Bansal has maintained that there is a significant number of cases of people who have recovered full consciousness from a minimally conscious state. However, other researchers have doubted the project, claiming that situations where brain-dead individuals on life support who return to a fully functional state is hard to interpret and often lack evidence of brain death such as the apnea test, a measure of whether the person’s brain stem is making an effort to breathe. Other concerns raised by scientists and physicians include whether the trial is ethically justified and that the mix of interventions has not been tested in animal models. In a press statement, Bansal defended the proposal, saying there is no good animal models for human brain death.
News Article | November 14, 2016
BENGALURU, INDIA—The Indian Council of Medical Research (ICMR) has derailed a controversial experiment that would seek to revive brain-dead accident victims. On 11 November, ICMR’s National Institute of Medical Statistics removed the “ReAnima” trial from India’s clinical trial registry. In May, Himanshu Bansal, an orthopedic surgeon at Anupam Hospital in the north Indian state of Uttarakhand, announced plans to give around 20 brain-dead people a mix of interventions including injections of mesenchymal stem cells and peptides, and transcranial laser stimulation and median nerve stimulation. Transcranial laser stimulation involves shining pulses of near-infrared light into the brain; median nerve stimulation is the electrical stimulation of a major nerve that runs from the neck to the arm. Both techniques have been shown to improve cognition in patients with traumatic brain injury. Bioquark, a biotech firm based in Philadelphia, Pennsylvania, had agreed to supply the trial with peptides that are said to help regenerate brain cells. In interviews with Indian media in the spring, Bansal described his aim as bringing brain-dead individuals back to a “minimally conscious state” in which patients show flickers of consciousness, such as moving their eyes to track objects. Although there is scant evidence that brain-dead people can recover such function, Bansal says the medical literature describes a significant number of cases of people who have recovered full consciousness from a minimally conscious state. Other researchers point out that it is improbable that the ReAnima trial—which hasn’t yet begun—would achieve its goals. “While there have been numerous demonstrations in recent years that the human brain and nervous system may not be as fixed and irreparable as is typically assumed, the idea that brain death could be easily reversed seems very far-fetched,” Dean Burnett, a neuroscientist at the United Kingdom’s Cardiff University, told . Medical journals have on occasion carried reports of brain-dead individuals on life support returning to a fully functional state, but researchers have argued that such cases are hard to interpret and often lack evidence of brain death such as the apnea test, a measure of whether the person’s brain stem is making an effort to breathe. Scientists and physicians are also raising concerns about whether the ReAnima trial is ethically justified. One concern is that the mix of interventions has not been tested in animal models. On their own, the treatments the ReAnima trial would use have shown promise in people with traumatic brain injury, says Amar Jesani, editor of the in Mumbai. “But once brain stem death has taken place, and there is no cognition or consciousness, one cannot rely on a few disconnected studies. Why couldn’t they combine these interventions and do proper animal studies?” And even if the experiment were to succeed, he asserts, bringing a brain-dead person back to a minimally conscious state would traumatize family members. In a press statement, Bansal argued that there are no good animal models for human brain death. Asked in a June interview for what he planned to do if patients were brought back to a minimally conscious state but did not regain further function, Bansal responded that his team “had not planned for it” initially, but that he had since purchased an insurance policy to cover the costs of full-time care of such patients. Still, the ReAnima team has struggled to convince family members to allow brain-dead accident victims to be enrolled in the trial, says Ira Pastor, chief executive officer of Bioquark. ICMR identified several regulatory lapses in the trial, including a failure to seek permission to proceed from the Drug Controller General of India, a requirement for all clinical trials in India. Now that ICMR has deregistered ReAnima, the Drug Controller General of India G. N. Singh must stop the trial immediately, says ICMR Deputy Director General Geeta Jotwani in New Delhi. Bansal told that “ICMR has nothing to do with the trial,” and says the matter rests with the drug controller. Singh’s office did not respond to questions from . Bioquark’s Pastor says that the setback ultimately won’t stop the project, and if necessary the team would pursue the trial outside India. “We are in no major rush, in that it represents a ‘Google Moonshot’–style project,” he says. “Many road blocks, no doubt, will pop up. But the project will go on.”