Aim/hypothesis: Five subgroups were described in European diabetes patients using a data driven machine learning approach on commonly measured variables. We aimed to test the applicability of this phenotyping in Indian individuals with young-onset type 2 diabetes. Methods: We applied the European-derived centroids to Indian individuals with type 2 diabetes diagnosed before 45 years of age from the WellGen cohort (n = 1612). We also applied de novo k-means clustering to the WellGen cohort to validate the subgroups. We then compared clinical and metabolic-endocrine characteristics and the complication rates between the subgroups. We also compared characteristics of the WellGen subgroups with those of two young European cohorts, ANDIS (n = 962) and DIREVA (n = 420). Subgroups were also assessed in two other Indian cohorts, Ahmedabad (n = 187) and PHENOEINDY-2 (n = 205). Results: Both Indian and European young-onset type 2 diabetes patients were predominantly classified into severe insulin-deficient (SIDD) and mild obesity-related (MOD) subgroups, while the severe insulin-resistant (SIRD) and mild age-related (MARD) subgroups were rare. In WellGen, SIDD (53%) was more common than MOD (38%), contrary to findings in Europeans (Swedish 26% vs 68%, Finnish 24% vs 71%, respectively). A higher proportion of SIDD compared with MOD was also seen in Ahmedabad (57% vs 33%) and in PHENOEINDY-2 (67% vs 23%). Both in Indians and Europeans, the SIDD subgroup was characterised by insulin deficiency and hyperglycaemia, MOD by obesity, SIRD by severe insulin resistance and MARD by mild metabolic-endocrine disturbances. In WellGen, nephropathy and retinopathy were more prevalent in SIDD compared with MOD while the latter had higher prevalence of neuropathy. Conclusions /interpretation: Our data identified insulin deficiency as the major driver of type 2 diabetes in young Indians, unlike in young European individuals in whom obesity and insulin resistance predominate. Our results provide useful clues to pathophysiological mechanisms and susceptibility to complications in type 2 diabetes in the young Indian population and suggest a need to review management strategies. Graphical

Monitoring the progress of the Integrated Disease Surveillance (IDS) strategy is an important component to ensure its sustainability in the state of Maharashtra in India. The purpose of the study was to document the baseline performance of the system on its core and support functions and to understand the challenges for its transition from an externally funded “project” to a state owned surveillance “program”. Multi-centre, retrospective cross-sectional evaluation study to assess the structure, core and support surveillance functions using modified WHO generic questionnaires. All 34 districts in the state and randomly identified 46 facilities and 25 labs were included in the study. Case definitions were rarely used at the periphery. Limited laboratory capacity at all levels compromised case and outbreak confirmation. Only 53% districts could confirm all priority diseases. Stool sample processing was the weakest at the periphery. Availability of transport media, trained staff, and rapid diagnostic tests were main challenges at the periphery. Data analysis was weak at both district and facility levels. Outbreak thresholds were better understood at facility level (59%) than at the district (18%). None of the outbreak indicator targets were met and submission of final outbreak report was the weakest. Feedback and training was significantly better (p < 0.0001) at district level (65%; 76%) than at facility level (15%; 37%). Supervision was better at the facility level (37%) than at district (18%) and so were coordination, communication and logistic resources. Contractual part time positions, administrative delays in recruitment, and vacancies (30%) were main human resource issues that hampered system performance. Significant progress has been made in the core and support surveillance functions in Maharashtra, however some challenges exist. Support functions (laboratory, transport and communication equipment, training, supervision, human and other resources) are particularly weak at the district level. Structural integration and establishing permanent state and district surveillance officer positions will ensure leadership; improve performance; support continuity; and offer sustainability to the program. Institutionalizing the integrated disease surveillance strategy through skills based personnel development and infrastructure strengthening at district levels is the only way to avoid it from ending up isolated! Improving surveillance quality should be the next on agenda for the state.

The rising prevalence of non-communicable diseases (NCDs) in young Indians underscores a compelling need to instil healthy lifestyles in adolescents and young adults. The present study aimed to assess the health-promoting lifestyles of freshmen admitted to institutes under seven different faculties of an international university in India. The study was conducted across five Indian cities and recruited 4253 participants pursuing both undergraduate and postgraduate programmes. Information on socio-demographic factors and health-promoting lifestyle behaviours using a modified Health-Promoting Lifestyle Profile (HPLP) scale was collected. The total HPLP and sub-scale scores for six domains were estimated. Univariate and age and gender-adjusted multivariate analyses were conducted to identify the determinants of health-promoting lifestyle scores. Gender-wise distribution of total HPLP and subscale scores indicated significant differences between female and male university students except for spiritual growth (P = 0.300). Overall, female students secured significantly higher total HPLP scores than male students (139.8 vs 137.6, P=0.000). Multivariate models showed that students from the faculties of Management and Law 3.15 (CI: 1.61, 4.68) and Humanities and Social sciences 4.90 (CI: 3.24, 6.58) had lower total HPLP scores compared to students of Science, Technology, Engineering and Mathematics (STEM) faculty. The faculty, zone, and residential status predicted nutrition sub-scale scores. Interestingly, students from North zone campuses (b − 0.62 (CI: −0.92, −0.32)) than west zone, and international students (b − 1.18 (CI: −2.11, −0.24)) compared to domestic students had lower nutrition sub-scale scores. Gender and faculty-specific targeted interventions could promote the healthy lifestyles of young Indian University students.

Urban heat islands (UHIs) increase the energy consumption of cities and impact the health of its residents. In light of the correlation between energy consumption and health and UHI variations observed at a local level within the canopy layer, satellite-derived land surface temperatures (LSTs) may be insufficient to provide comprehensive information about these deleterious effects. For both LST and air temperatures to be collected in a spatially representative and continuous manner, and for the process to be affordable, on-ground temperature and humidity sensors must be strategically placed. This study proposes a strategy for placing on-ground sensors that utilizes the spatial variation of measurable factors linked to UHI (i.e., seasonal variation in LSTs, wind speed, wind direction, bareness, and local climate zones), allowing for the continuous measurement of UHI within the canopy layer. As a representative city, Pune, India, was used to demonstrate how to distribute sensors based on the spatial variability of UHI-related variables. The proposed method may be helpful for any city requiring local-level observations of UHI, regardless of the climate zone. Further, we evaluate the placement of low-cost technology sensors that use LoRaWAN technology for this purpose, in order to overcome the problem of high costs associated with traditional in-situ weather stations.

Malaria control is based on early treatment of cases and on vector control. The current measures for malaria vector control in Africa are mainly based on long-lasting insecticidal nets (LLINs) and ...