Arindam Basu

Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015

Importance Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. Objective To estimate the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. Design A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. Main Outcomes and Measures Mean SBP level, cause-specific deaths, and health burden related to SBP (≥110-115 mm Hg and also ≥140 mm Hg) by age, sex, country, and year. Results Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg increased from 73 119 (95% uncertainty interval [UI], 67 949-78 241) to 81 373 (95% UI, 76 814-85 770) per 100 000, and SBP of 140 mm Hg or higher increased from 17 307 (95% UI, 17 117-17 492) to 20 526 (95% UI, 20 283-20 746) per 100 000. The estimated annual death rate per 100 000 associated with SBP of at least 110 to 115 mm Hg increased from 135.6 (95% UI, 122.4-148.1) to 145.2 (95% UI 130.3-159.9) and the rate for SBP of 140 mm Hg or higher increased from 97.9 (95% UI, 87.5-108.1) to 106.3 (95% UI, 94.6-118.1). Loss of disability-adjusted life-years (DALYs) associated with SBP of at least 110 to 115 mm Hg increased from 148 million (95% UI, 134-162 million) to 211 million (95% UI, 193-231 million), and for SBP of 140 mm Hg or higher, the loss increased from 5.2 million (95% UI, 4.6-5.7 million) to 7.8 million (95% UI, 7.0-8.7 million). The largest numbers of SBP-related deaths were caused by ischemic heart disease (4.9 million [95% UI, 4.0-5.7 million]; 54.5%), hemorrhagic stroke (2.0 million [95% UI, 1.6-2.3 million]; 58.3%), and ischemic stroke (1.5 million [95% UI, 1.2-1.8 million]; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the global DALYs related to SBP of at least 110 to 115 mm Hg. Conclusions and Relevance In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≥110-115 and ≥140 mm Hg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115 mm Hg and 874 million adults had SBP of 140 mm Hg or higher.

Identification of neuroanatomical substrates of set-shifting ability: evidence from patients with focal brain lesions

This work concerns the investigation of executive functions in patients with focal brain lesion. In order to identify the underlying substrates for executive functions, 54 patients with focal cortical (n=30), subcortical (n=13) and cerebellar damage (n=10) (M=9; F=1) in the age range of 24-65 years with a minimum of Class V education have been investigated. The patients were admitted to the Department of Neuromedicine of Bangur Institute of Neurology, Calcutta. Each patient with focal lesion was matched with a healthy normal subject controlling for age and education. The socio-economic background was also taken into consideration. Controls were selected from the families of other patients admitted to the institution and also from individuals who volunteered to act as controls. Here too, rigid criteria have been followed to select the normals. Mini Mental State Examination (MMSE) and General Health Questionnaire (GHQ) were administered to screen out the neurological and psychiatric abnormalities in selection of normal control and Wisconsin Card Sorting Test (WCST) was administered to find out the executive function, in terms of set-shifting ability. Since standard anatomical groupings can obscure more specific brain-behavior relations, group-comparison design does not always allow determination of the effective lesion responsible for a particular deficit (Godefroy et al., 1998). The Classification and Regression Tree (CART) analysis has been used to determine the brain-behavior relationships. The result reveals that the frontal lobes are essential determinants of set-shifting capacity. However, for optimal execution of set-shifting function, the frontal lobes require participation of other cortical, subcortical and cerebellar regions. The result has been discussed in the light of the existing theories and research reports.

Depression among stroke survivors: a community-based, prospective study from Kolkata, India.

OBJECTIVE Post-stroke depression (PSD) is a disabling entity among stroke survivors (SS). Longitudinal studies on PSD, essential to determine its prognosis, are lacking from developing countries. This prospective study was undertaken to assess the prevalence, natural history, and correlates of depression among SS in an Indian community. METHODS From a community based stroke registry, SS were assessed annually for cognition, disability, and depression using Bengali validated scales. PSD was diagnosed if score on geriatric depression scale was greater than or equal to 21. Complex sample strategy was considered when calculating prevalence of post stroke depression. An age- and sex-matched case-control study was undertaken to determine the odds of depression in SS. RESULTS Prevalence of PSD was 36.98% (95% confidence interval [CI]: 31.89%-42.06%) among 241 patients assessed at baseline. About 17% developed depression annually and a similar proportion had spontaneous improvement. Peak rate of PSD was beyond 3 months and continued up to 18 months after stroke. Compared to the non-depressed group, PSD subjects were significantly older, had higher age at first stroke, less education, lower socioeconomic status, and greater cognitive impairment and disability. Education had a protective role. Mortality in PSD was nearly twice that in non-depressed patients, though not significant statistically (hazard ratio: 1.84; 95% CI: 0.90-3.77). Compared with controls, odds ratio of PSD was 19.95 (95% CI: 10.09-39.47). CONCLUSIONS Approximately one-third of SS develop PSD, similar to developed countries. Prevalence remains stable annually. Delayed peak of PSD suggested later realization of underlying disability. Predictors of PSD have been described and higher literacy was protective in this study.

Correlates of Functional Outcome among Stroke Survivors in a Developing Country–A Prospective Community-based Study from India

Stroke survivors (SS) are rising with higher incidence of stroke in developing countries. In addition to physical impairment, other factors such as cognition, social interaction, and depression determine the functional outcome after stroke. Considering the paucity of data from developing countries, we planned to determine the change in various functional parameters among SS. This community-based prospective study was carried out in Kolkata, India among 283 SS between 2006 and 2010. Functional outcome was assessed at baseline and at 3 annual follow-up visits using validated tools. A stepwise regression analysis was performed with demographic and stroke-related covariates against various measures of functional outcome. Result showed that mean Barthel Index score at baseline was 76.4 ± 30.8. Bengali version of mental status examination and Geriatric Depression Scale scores trended down over time with a negative regression coefficient of -.2061 (standard error [SE], .0937) and -.4488 (SE, .2145). Other outcomes did not change. Female gender, depression, and cognitive dysfunction had an unfavorable impact, whereas education correlated positively. In conclusions female gender and neuropsychiatric disturbances showed poor functional outcome compared with education, which correlates with better outcome. This information will be helpful for patients in developing countries for planning stroke rehabilitation.

Behavior Problems and Post-traumatic Stress Symptoms in Children Beginning School: A Comparison of Pre- and Post-Earthquake Groups

Introduction: Literature reviews caution that estimating the effects of disasters on the behavior of children following a disaster is difficult without baseline information and few studies report the effects of earthquakes on young children. In addition the relationship between age at the time of disaster and consequential behavior problems have not been reported for young children who experience disaster-related stress during a developmentally sensitive period. Methods: Behavior problems and symptoms of post-traumatic stress (PTS) were reported for two groups of children from nearby neighborhoods during their first term at school, using the Behavior Problem Index by teacher report, following approved informed consent procedures. Data on one group, “Pre-EQ” (N=297), was collected four years before the beginning of the earthquakes on children born 2001-2002. Data on the second group, “Post-EQ” (N=212), was collected approximately three to four years after the beginning of the earthquakes on children born 2007-2009 and living in heavily damaged neighborhoods. The Post-EQ group had significantly more children from high socioeconomic neighborhoods but no other significant differences on main demographic characteristics. Results: The mean behavior problem score was significantly higher in the Post-EQ group (Mean =6.11) as compared to the Pre-EQ group (Mean = 3.78). PTS symptoms were also significantly higher in the Post-EQ group (Mean =2.91) as compared to the Pre-EQ group (Mean=1.98) and more children had high PTS scores (20.9% v. 8.8%, OR= 2.73, 95%CI =1.57, 4.76). Model testing identified that a younger age at the time of exposure was the only significant predictor of high numbers of PTS symptoms in the Post-EQ group. Discussion: Rates of teacher-reported behavior problems in young children more than doubled following the Christchurch earthquakes. Younger children may be more vulnerable to the effects of earthquakes that occur during a developmentally sensitive period. Additional research is needed to consider the effects of age and duration of disaster effects to better understand the effects of disasters on children, their families and communities.