Relationship of Vitamin D Status with Muscle Mass and Muscle Strength in Young Indian Adults – Evidence from Andhra Pradesh Children and Parents Study Cohort.

Objectives: Positive relationship of vitamin D status with muscle mass and strength has been observed in studies from the developed countries but evidence from the developing countries is sparse. This study assessed the relationship of vitamin D status with muscle mass and muscle strength in rural young adults from Hyderabad, India. Methods: The study participants (n=956; age 18-20 years; 42% women) were a part of Andhra Pradesh Children and Parents Study cohort which was established to assess the long term impact of early nutrition supplementation provided through a government programme. Their serum 25- hydroxyvitamin D was assessed using HPLC, appendicular skeletal muscle mass (ASM) was assessed using dual energy X-ray absorptiometry and grip strength was assessed using grip dynamometer. Results: The participants were lean with average body mass index of 19.5 kg/m2. Prevalence of vitamin D deficiency (serum 25(OH) vitamin D3 < 20 ng/ml) was 33.6% in men and 51.4% in women. Vitamin D deficiency was associated with lower ASM (β (95% CI): - 0.38 (-0.72 to -0.05) kg; p = 0.02) with a trend of lower muscle strength in unadjusted analyses. After adjustment for relevant confounders, the relationship of vitamin D deficiency with lower ASM (β (95% CI): -0.21 (- 0.37 to - 0.05) kg; p =0.01) persisted but not with lower grip strength. Conclusions: Prevalence of vitamin D deficiency was high in these rural young adults. Vitamin D deficiency was associated with lower muscle mass but not with lower muscle strength in this cohort. Alleviation of vitamin D deficiency may improve muscle mass.

Health technology assessment in India: The potential for improved healthcare decision-making.

Health technology assessment (HTA) is a multidisciplinary approach that uses clinical effectiveness, cost-effectiveness, policy and ethical perspectives to provide evidence upon which rational decisions on the use of health technologies can be made. It can be used for a single stand-alone technology (e.g. a drug, a device), complex interventions (e.g. a rehabilitation service) and can also be applied to individual patient care and to public health. It is a tool for enabling the assessment and comparison of health technologies using the same metric of cost-effectiveness. This process benefits the patient, the health service, the healthcare payer and the technology producer as only technologies that are considered cost-effective are promoted for widespread use. This leads to greater use of effective technologies and greater health gain. The decision-making process in healthcare in India is complex owing to multiplicity of organizations with overlapping mandates. Often the decision-making is not evidence-based and there is no mechanism of bridging the gap between evidence and policy. Elsewhere, HTA is a frequently used tool in informing policy decisions in both resource-rich and resource-poor countries. Despite national organizations producing large volumes of research and clinical guidelines, India has not yet introduced a formal HTA programme. The incremental growth in healthcare products, services, innovation in affordable medical devices and a move towards universal healthcare, needs to be underpinned with an evidencebase which focuses on effectiveness, safety, affordability and acceptability to maximize the benefits that can be gained with a limited healthcare budget. Establishing HTA as a formal process in India, independent of healthcare providers, funders and technology producers, together with a framework for linking HTA to policy-making, would help ensure that the population gets better access to appropriate healthcare in the future.

Prevalence of type 2 diabetes and impaired fasting glucose: cross-sectional study of multiethnic adult population at the United States-Mexico border / Prevalencia de diabetes tipo 2 y de alteración de la glucosa en ayunas: estudio transversal de una población adulta multiétnica en la frontera México-Estados Unidos

OBJETIVE: To estimate prevalence of type 2 diabetes (diabetes) and impaired fasting glucose (IFG) in the border region between the United States of America and Mexico, by ethnic origin and country of residence; identify risk factors associated with both conditions; and explore the extent to which these factors account for cross-border or ethnic disparities in prevalence. METHODS: From April 2001 to November 2002, Phase I of the U.S.-Mexico Border Diabetes Prevention and Control Project, a prevalence study of diabetes and its risk factors, was conducted at the U.S.-Mexico border using multistage cluster sampling. A questionnaire was administered on diabetes (self-reported) and lifestyle and a physical examination and blood sample were obtained. A total of 4 027 adults participated in the study: 2 120 Hispanics from the Mexican side of the border and 1 437 Hispanics and 470 non-Hispanics (of whom 385 were classified as "white") from the U.S. side of the border. RESULTS: The age-adjusted prevalence of self-reported and unrecognized diabetes in Hispanics was 15.4 percent (16.6 percent on the Mexican side of the border and 14.7 percent on the U.S. side). The age-adjusted prevalence of IFG was similar on both sides of the border (14.1 percent on the Mexican side and 13.6 percent on the U.S. side). CONCLUSIONS: Established risk factors for diabetes (e.g., age, obesity, and family history) were relevant and there was an inverse relationship between diabetes and education and socioeconomic level. While diabetes prevalence is high on both sides of the U.S.-Mexico border, one-fourth of the cases remain undiagnosed, suggesting a need for development and implementation of a public health program for prevention, diagnosis, and control of diabetes in the region.

OBJETIVO: Calcular la prevalencia de la diabetes de tipo 2 (diabetes) y de la alteración de la glucosa en ayunas en la zona fronteriza entre México y los Estados Unidos, por origen étnico y país de residencia; identificar los factores de riesgo asociados a ambas afecciones, y explorar en qué grado estos factores explican las diferencias transfronterizas o étnicas en la prevalencia. MÉTODOS: Entre abril del 2001 y noviembre del 2002, se realizó la fase I del Proyecto de Prevención y Control de la Diabetes en la Frontera México-Estados Unidos, un estudio de prevalencia de la diabetes y sus factores de riesgo, mediante un muestreo por conglomerados en varias fases. Se utilizó un cuestionario acerca de la diabetes (autonotificada) y el modo de vida, se realizó una exploración física y se extrajo una muestra de sangre. En total, participaron 4 027 adultos en el estudio: 2 120 hispanos del lado mexicano de la frontera, y 1 437 y 470 no hispanos (de los cuales, 385 se clasificaron como "blancos") del lado estadounidense de la frontera. RESULTADOS: La prevalencia (ajustada según la edad) de la diabetes autonotificada y no diagnosticada en los hispanos fue de 15,4 por ciento (16,6 por ciento en el lado mexicano de la frontera y 14,7 por ciento en el lado estadounidense). La prevalencia (ajustada según la edad) de la alteración de la glucosa en ayunas fue similar en ambos lados de la frontera (14,1 por ciento en el lado mexicano y 13,6 por ciento en el lado estadounidense). CONCLUSIONES: Los factores de riesgo conocidos para la diabetes (por ejemplo edad, obesidad y antecedentes familiares) resultaron relevantes y hubo una relación inversa entre la diabetes y el nivel socioeconómico y la escolaridad. Si bien la prevalencia de la diabetes es alta en ambos lados de la frontera entre México y los Estados Unidos, un cuarto de los casos sigue sin diagnóstico, lo que indica la necesidad de crear y ejecutar un programa de salud pública para la prevención, el diagnóstico y el control de la diabetes en la zona.

Determining public health priorities for an ageing population: the value of a disability survey.

In order to determine which diseases and health problems were most strongly associated with long-term disability among the Thai elderly and to determine their public health priority, a national cross-sectional multistage random sampling survey was conducted in 1997. Four thousand and forty-eight Thai older persons aged 60 years and over were recruited and interviewed by trained interviewers. Overall, 769 (19%) people reported having a long-term disability. Participants with long-term disability (LD) reported having between one and 21 long-term diseases or health problems. Eighteen of these problems were independently associated with LD in logistic regression analysis. Nearly half of the cases with LD (46.4%) suffered from two or more health problems. The odds of LD increased with the number of problems suffered. The problems contributing most to the population burden of disease as assessed by population attributable risk fractions were hemiparesis, arthritis, accidents (unintentional injuries), blindness and other eye diseases, kyphosis, weakness of limbs, deafness, and hypertension. This ranking of public health priority differs from conventional approaches using mortality statistics and disability adjusted life years (DALYs). In conclusion, national disability surveys provide a valuable means of assessing the population burden of disability and determining the underlying causes of disability. These methods provide a direct assessment of disability prevalence and disease priorities for rapidly ageing transitional countries where death certification may be incomplete or inaccurate.