Browsing by Author "Mini, GK"

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    The Adherence to Medications in Diabetic Patients in Rural Kerala, India
    (Asia Pac J Public Health, 2013-02) Sankar, UV; Lipska, K; Mini, GK; Sarma, PS; Thankappan, KR
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    Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016
    (Lancet, 2018-08) Mini, GK; Harikrishnan, S
    Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. Funding Bill & Melinda Gates Foundation.
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    Are Indians shifting from smoking to smokeless tobacco?
    (Respiratory medicine., 2013-10) Mini, GK; Sureshkumar, NB
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    Assessing readiness to integrate tobacco control in medical curriculum: Experiences from five medical colleges in southern India
    (Natl Med J India., 2013-06) Thankappan, KR; Yamini, TR; Mini, GK; Arthur, C; Sairu, P; Leelamoni, K; Sani, M; Unnikrishnan, B; Basha, SR; Nichter, M
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    Assessing the readiness to integrate tobacco control in medical curriculum: Experiences from five medical colleges in southern India
    (NATIONAL MEDICAL JOURNAL OF INDIA, 2013) Thankappan, KR; Yamini, TR; Mini, GK; Arthur, C; Sairu, P; Leelamoni, K; Sani, M; Unnikrishnan, B; Basha, SR; Nichter, M
    Background. Making tobacco cessation a normative part of all clinical practice is the only way to substantially reduce tobacco-related deaths and the burden of tobacco-related morbidity in the short term. This study was undertaken because Information on receptivity to integrate tobacco control education in the medical curriculum is extremely limited in low- and middle-income countries. Methods. From five medical colleges (two government) in southern India, 713 (men 59%) faculty and 2585 (men 48%) students participated in our cross-sectional survey. Information on self-reported tobacco use and readiness to integrate tobacco control education in the medical curriculum was collected from both the faculty and students using a pretested structured questionnaire. Multiple logistic regression analysis was done to find the associated factors. Results. Current smoking was reported by 9.0% (95% CI 6.6-12.1) of men faculty and 13.7% (CI 11.8-15.9) by men students. Faculty who were teaching tobacco-related topics [odds ratio (OR) 2.29; 95% CI 1.65-3.20] compared to those who were not, faculty in government colleges (OR 1.69; CI 1.22-2.35) compared to those in private colleges and medical specialists (OR 1.79; CI 1.23-2.59) compared to surgical and non-clinical specialists were more likely to be ready to integrate tobacco control education in the medical curriculum. Non-smoking students (OR 2.58; CI 2.01-3.33) compared to smokers, and women students (OR 1.80; CI 1.50-2.17) compared to men were more likely to be ready to integrate a tobacco control education in the curriculum. Conclusion. Faculty and students are receptive to introduce tobacco control in the medical curriculum. Government faculty, medical specialists and faculty who already teach tobacco-related topics are likely to be early introducers of this new curriculum.
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    Calculation error in estimating low HDL in women Response
    (INDIAN JOURNAL OF MEDICAL RESEARCH, 2014) Thankappan, KR; Shah, B; Mathur, P; Sarma, PS; Srinivas, G; Mini, GK; Daivadanam, M; Soman, B; Vasan, RS
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    Case-Control Study of Smoking and Death in India
    (New England Journal of Medicine, 2008) Thankappan, KR; Mini, GK
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    Cluster randomised feasibility trial to improve the Control of Hypertension In Rural India (CHIRI): a study protocol
    (BMJ OPEN, 2016) Riddell, MA; Joshi, R; Oldenburg, B; Chow, C; Thankappan, KR; Mahal, A; Thomas, N; Srikanth, VK; Evans, RG; Kalyanram, K; Kartik, K; Maulik, PK; Arabshahi, S; Varma, RP; Guggilla, RK; Suresh, O; Mini, GK; D'Esposito, F; Sathish, T; Alim, M; Thrift, AG
    Introduction: Hypertension is emerging in rural populations of India. Barriers to diagnosis and treatment of hypertension may differ regionally according to economic development. Our main objectives are to estimate the prevalence, awareness, treatment and control of hypertension in 3 diverse regions of rural India; identify barriers to diagnosis and treatment in each setting and evaluate the feasibility of a community-based intervention to improve control of hypertension. Methods and analysis: This study includes 4 main activities: (1) assessment of risk factors, quality of life, socioeconomic position and barriers to changes in lifestyle behaviours in similar to 14 500 participants; (2) focus group discussions with individuals with hypertension and indepth interviews with healthcare providers, to identify barriers to control of hypertension; (3) use of a medicines-availability survey to determine the availability, affordability and accessibility of medicines and (4) trial of an intervention provided by Accredited Social Health Activists (ASHAs), comprising groupbased education and support for individuals with hypertension to self-manage blood pressure. Wards/ villages/hamlets of a larger Mandal are identified as the primary sampling unit (PSU). PSUs are then randomly selected for inclusion in the cross-sectional survey, with further randomisation to intervention or control. Changes in knowledge of hypertension and risk factors, and clinical and anthropometric measures, are assessed. Evaluation of the intervention by participants provides insight into perceptions of education and support of self-management delivered by the ASHAs. Ethics and dissemination: Approval for the overall study was obtained from the Health Ministry's Screening Committee, Ministry of Health and Family Welfare (India), institutional review boards at each site and Monash University. In addition to publication in peer-reviewed articles, results will be shared with federal, state and local government health officers, local healthcare providers and communities.
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    Complementary and alternative medicine use by diabetes patients in Kerala, India
    (Global health, epidemiology and genomics, 2017-05) Thankappan, KR; Vishnu, N; Mini, GK
    The study assessed: (1) the prevalence of exclusive use of complementary and alternative medicine (CAM), exclusive use of modern medicine and combined use; (2) the factors associated with exclusive CAM use; and (3) the expenditure for CAM use among type-2 diabetes patients in rural Kerala. We surveyed 400 diabetes patients selected by multi-stage cluster sampling. Exclusive CAM use was reported by 9%, exclusive modern medicine by 61% and combined use by 30%. Patients without any co-morbidity were four times, those having regular income were three times and those who reported regular exercise were three times more likely to use exclusive CAM compared with their counterparts. Expense for medicines was not significantly different for CAM compared with modern medicine both in government and private sector. Patients with any co-morbidity were less likely to use CAM indicating that CAM use was limited to milder cases of diabetes.
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    Confirmation of self-reported non-smoking status by salivary cotinine among diabetes patients in Kerala, India
    (Clinical Epidemiology and Global Health, 2014-05) Mini, GK; Nichter, M; Radhakrishnan, RN; Thankappan, KR
    Problem considered: There are no studies of tobacco cessation reported from low and middle income countries that have tested cotinine against self report in a patient population. We confirmed the accuracy of self report of smoking cessation by matching self reports against salivary cotinine test in diabetes patients. Methods: The study was part of a randomized controlled trial among 224 diabetes patients in Kerala. Salivary cotinine level was measured among 35 diabetes patients who claimed to have not smoked even a single cigarette/bidi in the last 30 days before the test. Biochemical analysis of salivary cotinine was done using the Enzyme-Linked Immunosorbent Assay kit from Salimetrics. Cotinine value of >15 ng/ml was used as the cut-off point. Results: Among the 35 patients, 26 (74%) were found to have a saliva cotinine level 15 ng/ ml confirming self reports of non smoking status. Among the remaining nine patients, four reported being routinely exposed to secondhand smoke in their household or work place prior to cotinine testing. Interviews revealed that 12% of the variance between self report and the cotinine test results was attributable to routine exposure to second hand smoke. Conclusion: Self report of non-smoking by diabetes patients in India was fairly reliable when validated against a cotinine test. Larger clinical trials are warranted to further evaluate the validity of self reported non-smoking status in different patient populations having different education levels.
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    Developing a fully integrated tobacco curriculum in medical colleges in India
    (BMC Medical Edcucation, 2015-05) Yamini, TR; Nichter, M; Mimi Nichter Sairu, MP; Aswati, S; Leelamoni, K; Unnikrishnan, B; Prasanna Mithra, PP; Thapar, R; Basha, SR; Jayasree, AK; Mayamol, TR; Muramoto, M; Mini, GK; Thankappan, KR
    Background This paper describes a pioneering effort to introduce tobacco cessation into India’s undergraduate medical college curriculum. This is the first ever attempt to fully integrate tobacco control across all years of medical college in any low and middle income country. The development, pretesting, and piloting of an innovative modular tobacco curriculum are discussed as well as challenges that face implementation and steps taken to address them and to advocate for adoption by the Medical Council of India. Methods In-depth interviews were conducted with administrators and faculty in five medical colleges to determine interest in and willingness to fully integrate smoking cessation into the college curriculum. Current curriculum was reviewed for present exposure to information about tobacco and cessation skill training. A modular tobacco curriculum was developed, pretested, modified, piloted, and evaluated by faculty and students. Qualitative research was conducted to identify challenges to future curriculum implementation. Results Fifteen modules were successfully developed focusing on the public health importance of tobacco control, the relationship between tobacco and specific organ systems, diseases related to smoking and chewing tobacco, and the impact of tobacco on medication effectiveness. Culturally sensitive illness specific cessation training videos were developed. Faculty and students positively evaluated the curriculum as increasing their competency to support cessation during illness as a teachable moment. Students conducted illness centered cessation interviews with patients as a mandated part of their coursework. Systemic challenges to implementing the curriculum were identified and addressed. Conclusions A fully integrated tobacco curriculum for medical colleges was piloted in 5 colleges and is now freely available online. The curriculum has been adopted by the state of Kerala as a first step to gaining Medical Council of India review and possible recognition.
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    Developing a smoke free homes initiative in initiative in Kerala, India
    (BMC Public Health., 2015-05) Nichter, M; Padmajam, S; Nichter, M; Sairu, P; Aswathy, S; Mini, GK; Bindu, VC; Pradeepkumar, AS; Thankappan, KR
    Background: Results of the Global Adult Tobacco Survey in Kerala, India found that 42 % of adults were exposed to second hand smoke (SHS) inside the home. Formative research carried out in rural Kerala suggests that exposure may be much higher. Numerous studies have called for research and intervention on SHS exposure among women and children as an important component of maternal and child health activities. Methods: Community-based participatory research was carried out in Kerala. First, a survey was conducted to assess prevalence of SHS exposure in households. Next, a proof of concept study was conducted to develop and test the feasibility of a community-wide smoke free homes initiative. Educational materials were developed and pretested in focus groups. After feasibility was established, pilot studies were implemented in two other communities. Post intervention, surveys were conducted as a means of assessing changes in community support. Results: At baseline, between 70 and 80 % of male smokers regularly smoked inside the home. Over 80 % of women had asked their husband not to do so. Most women felt powerless to change their husband’s behavior. When women were asked about supporting a smoke free homes intervention, 88 % expressed support for the idea, but many expressed doubt that their husbands would comply. Educational meetings were held to discuss the harms of second hand smoke. Community leaders signed a declaration that their community was part of the smoke free homes initiative. Six months post intervention a survey was conducted in these communities; between 34 and 59 % of men who smoked no longer smoked in their home. Conclusions: The smoke free homes initiative is based on the principle of collective efficacy. Recognizing the difficulty for individual women to effect change in their household, the movement establishes a smoke free community mandate. Based on evaluation data from two pilot studies, we can project that between a 30 and 60 % reduction of smoking in the home may be achieved, the effect size determined by how well the smoke free home steps are implemented, the characteristics of the community, and the motivation of community level facilitators.
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    Developing a smoke free homes initiative in Kerala, India
    (BMC PUBLIC HEALTH, 2015) Nichter, M; Padmajam, S; Nichter, M; Sairu, P; Aswathy, S; Mini, GK; Bindu, VC; Pradeepkumar, AS; Thankappan, KR
    Background: Results of the Global Adult Tobacco Survey in Kerala, India found that 42 % of adults were exposed to second hand smoke (SHS) inside the home. Formative research carried out in rural Kerala suggests that exposure may be much higher. Numerous studies have called for research and intervention on SHS exposure among women and children as an important component of maternal and child health activities. Methods: Community-based participatory research was carried out in Kerala. First, a survey was conducted to assess prevalence of SHS exposure in households. Next, a proof of concept study was conducted to develop and test the feasibility of a community-wide smoke free homes initiative. Educational materials were developed and pretested in focus groups. After feasibility was established, pilot studies were implemented in two other communities. Post intervention, surveys were conducted as a means of assessing changes in community support. Results: At baseline, between 70 and 80 % of male smokers regularly smoked inside the home. Over 80 % of women had asked their husband not to do so. Most women felt powerless to change their husband's behavior. When women were asked about supporting a smoke free homes intervention, 88 % expressed support for the idea, but many expressed doubt that their husbands would comply. Educational meetings were held to discuss the harms of second hand smoke. Community leaders signed a declaration that their community was part of the smoke free homes initiative. Six months post intervention a survey was conducted in these communities; between 34 and 59 % of men who smoked no longer smoked in their home. Conclusions: The smoke free homes initiative is based on the principle of collective efficacy. Recognizing the difficulty for individual women to effect change in their household, the movement establishes a smoke free community mandate. Based on evaluation data from two pilot studies, we can project that between a 30 and 60 % reduction of smoking in the home may be achieved, the effect size determined by how well the smoke free home steps are implemented, the characteristics of the community, and the motivation of community level facilitators.
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    Doctors' self-reported physical activity, their counselling practices and their correlates in urban Trivandrum, South India: should a full-service doctor be a physically active doctor?
    (BRITISH JOURNAL OF SPORTS MEDICINE, 2015) Patra, L; Mini, GK; Mathews, E; Thankappan, KR
    Background Doctors' self-reported physical activity (PA) is associated with their propensity for prescribing PA. Methods We surveyed 146 doctors (median age 42 years; men 58.9%), selected by multistage random sampling. Information on demographic details, selfreported PA and counselling offered to their patients was collected using a pretested, structured, self-administered questionnaire. Multivariate logistic regression analysis was carried out to find the predictors of PA and PA counselling offered to the patients. Results Moderate PA was reported by 37.7% (95% CI 29.8 to 45.5) of the doctors and the remaining 62.3% reported being inactive. Doctors who were motivated to perform PA (OR 4.01, 95% CI 1.82 to 8.86), who used exercise equipment at home (OR 3.97, CI 1.68 to 9.36) and who used a neighbourhood facility for PA (OR 2.36, CI 1.11 to 5.02) were more likely to perform moderate PA compared with their counterparts. 25% of the doctors always asked and advised their patients on PA. Doctors who believed that their own healthy lifestyle influenced advice practices (OR 9.13, CI 2.49 to 33.41), who consulted less than 30 patients/day (OR 5.35, CI 1.41 to 20.25) and who reported previous participation in sports activities (OR 4.22, CI 1.77 to 10.04) were more likely to always ask and advise their patients on PA compared with their counterparts. Conclusions A majority of the doctors in our study were inactive and did not ask or advise their patients on PA. Measures are warranted to enhance doctors' own PA and their counselling practices.
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    Doctors’ self reported physical activity, their counseling practices and their correlates in urban Trivandrum, South India: should a full-service doctor be a physically active doctor?
    (Br J Sports Med., 2013-06) Patra, L; Mini, GK; Mathews, E; Thankappan, KR
    Background :- Doctors’ self-reported physical activity (PA) is associated with their propensity for prescribing PA. Methods:- We surveyed 146 doctors (median age 42 years; men 58.9%), selected by multistage random sampling. Information on demographic details, self-reported PA and counselling offered to their patients was collected using a pretested, structured, self-administered questionnaire. Multivariate logistic regression analysis was carried out to find the predictors of PA and PA counselling offered to the patients. Results:- Moderate PA was reported by 37.7% (95% CI 29.8 to 45.5) of the doctors and the remaining 62.3%reported being inactive. Doctors who were motivated to perform PA (OR 4.01, 95% CI 1.82 to 8.86), who used exercise equipment at home (OR 3.97, CI 1.68 to 9.36) and who used a neighbourhood facility for PA (OR 2.36, CI 1.11 to 5.02) were more likely to perform moderate PA compared with their counterparts. 25% of the doctors always asked and advised their patients on PA. Doctors who believed that their own healthy lifestyle influenced advice practices (OR 9.13, CI 2.49 to 33.41), who consulted less than 30 patients/day (OR 5.35, CI 1.41 to 20.25) and who reported previous participation in sports activities (OR 4.22, CI 1.77 to 10.04) were more likely to always ask and advise their patients on PA compared with their counterparts. Conclusions:- A majority of the doctors in our study were inactive and did not ask or advise their patients on PA. Measures are warranted to enhance doctors’ own PA and their counselling practices.
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    Does increased knowledge of risk and complication of smoking on diabetes affect quit rate: Findings from a randomized controlled trial in Kerala, India
    (Tobacco Use Insights, 2014-12) Mini, GK; Nichter, M; Thankappan, KR
    BACKGROUND: Data on quit rates among diabetes patients are limited. PURPOSE: To find whether positive change in knowledge on smoking-related complications is associated with increased quit rates among diabetes patients. METHODS: We randomized 224 male diabetes patients into intervention groups 1 and 2. Both groups received a standard diabetic-specific smoking cessation message from a doctor. Intervention group 2 additionally received counseling. We compared the positive change in knowledge and the quit rates between the two groups at 6 months. RESULTS: Positive change in knowledge in group 2 was two times higher than that in group 1. The odds of quitting among patients who reported a positive change in knowledge was 2.65 times higher compared to those who reported no positive change in knowledge. CONCLUSIONS: Increasing the knowledge of persons with diabetes about the risks of developing severe complications if they continue smoking leads to significantly higher quit rates.
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    Evaluation of a training program of hypertension for accredited social health activists (ASHA) in rural India.
    (BMC Health Service Research, 2018-06) Abdel-All, M; Thrift, AG; Riddell, M; Thankappan, KR; Mini, GK; Chow, CK; Maulik, PK; Mahal A, A; Guggilla, R
    Background: Hypertension is a major risk factor for cardiovascular disease, a leading cause of premature death and disability in India. Since access to health services is poor in rural India and Accredited Social Health Activists (ASHAs) are available throughout India for maternal and child health, a potential solution for improving hypertension control is by utilising this available workforce. We aimed to develop and implement a training package for ASHAs to identify and control hypertension in the community, and evaluate the effectiveness of the training program using the Kirkpatrick Evaluation Model. Methods: The training program was part of a cluster randomised feasibility trial of a 3-month intervention to improve hypertension outcomes in South India. Training materials incorporated details on managing hypertension, goal setting, facilitating group meetings, and how to measure blood pressure and weight. The 15 ASHAs attended a five-day training workshop that was delivered using interactive instructional strategies. ASHAs then led community-based education support groups for 3 months. Training was evaluated using Kirkpatrick’s evaluation model for measuring reactions, learning, behaviour and results using tests on knowledge at baseline, post-training and post-intervention, observation of performance during meetings and post-intervention interviews. Results: The ASHAs’ knowledge of hypertension improved from a mean score of 64% at baseline to 76% post-training and 84% after the 3-month intervention. Research officers, who observed the community meetings, reported that ASHAs delivered the self-management content effectively without additional assistance. The ASHAs reported that the training materials were easy to understand and useful in educating community members. Conclusion: ASHAs can be trained to lead community-based group educational discussions and support individuals for the management of high blood pressure. Trial Registration: The feasibility trial is registered with the Clinical Trials Registry - India (CTRI) CTRI/2016/02/006678 (25/02/2016).
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    Falls among Older Adults: A Community-Based Study in Rural Kerala, India
    (Global Journal of Health Science., 2017-11) Rekha, MR; Mini, GK; Kutty, VR
    The study examined the frequency and correlates of falls among community dwelling older adults (≥60 years) in rural Kerala. We did a cross-sectional survey among 202 older adults using a pre-tested structured interview schedule. Falls in the previous year was reported by 27%, among them, 20% fell more than once making a total of 74 falls. Injuries were reported among 58% of the fallers. Slips were the frequent cause of fall (25.6%). Most falls happened outdoors (77%). Age-sex adjusted results of multivariate logistic regression analysis showed that those having any morbidity, those with a history of previous falls and those with no formal education were more likely to fall compared to their counterparts. Awareness programs on the risk of falls for older adults and their close relatives are required in this population. Prevention strategies should focus on those having any morbidity, those with a history of previous falls and those without formal education.
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    FEASIBILITY OF DISEASE CENTERED SMOKING CESSATION AMONG DIABETES PATIENTS
    (RESPIRATORY MEDICINE, 2013) Thankappan, KR; Mini, GK; Daivadanam, M; Vijayakumar, G; Sarma, PS; Nichter, M