BackgroundWith changing demographic patterns in the context of a high tuberculosis (TB) burden country, like India, there is very little information on the clinical and demographic factors associated with poor treatment outcome in the sub-group of older TB patients. The study aimed to assess the proportion of older TB patients (60 years of age and more), to compare the type of TB and treatment outcomes between older TB patients and other TB patients (less than 60 years of age) and to describe the demographic and clinical characteristics of older TB patients and assess any associations with TB treatment outcomes.MethodsA retrospective cohort study involving a review of records from April to June 2011 in the 12 selected districts of Tamilnadu, India. Demographic, clinical and WHO defined disease classifications and treatment outcomes of all TB patients aged 60 years and above were extracted from TB registers maintained routinely by Revised National TB Control Program (RNTCP).ResultsOlder TB patients accounted for 14% of all TB patients, of whom 47% were new sputum positive. They had 38% higher risk of unfavourable treatment outcomes as compared to all other TB patients (Relative risk (RR)-1.4, 95% CI 1.2–1.6). Among older TB patients, the risk for unfavourable treatment outcomes was higher for those aged 70 years and more (RR 1.5, 95% CI 1.2–1.9), males (RR 1.5, 95% CI 1.0–2.1), re-treatment patients (RR 2.5, 95% CI 1.9–3.2) and those who received community-based Direct Observed Treatment (RR 1.4, 95% CI 1.1–1.9).ConclusionTreatment outcomes were poor in older TB patients warranting special attention to this group – including routine assessment and recording of co-morbidities, a dedicated recording, reporting and monitoring of outcomes for this age-group and collaboration with National programme of non-communicable diseases for comprehensive management of co-morbidities.

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In a defined geographic area in rural India (1,60,000 population), osteoporosis detection and calcium and vitamin D supplementation program was instituted. Of the eligible 15,386 subjects, 5,992 (38%) participated in the program; 2,882 (48%) had osteopenia and osteoporosis; supervised calcium and vitamin D supplementation was instituted; 2,113 (73.3% of those identified) completed 2 years of supplementation. The mean duration of the follow-up was 5 years (range 2–8 years). On follow-up, three groups emerged; those who were regular, those who were irregular, and those who did not take supplements. In those who were regular with calcium and vitamin D supplementation, we found a significant reduction in fractures (RR 0.27, 95% CI 0.09–0.81) compared with those who did not take supplements. There was no significant difference in falls between the three groups. Mortality was significantly lower (RR 0.53, 95% CI 0.31–0.91) in those who were regular with calcium and vitamin D supplements compared to those who did not take supplements. While the reduction in fractures was probably due to calcium and vitamin D supplementation, the reduction in mortality was probably because those who took regular supplements accessed healthcare services more readily for other comorbidities as part of their follow-up program.

Fast pace of urbanisation and population growth is an imminent global challenge. The World Urbanisation Prospects of the United Nations suggest that more than 75% of the global population will concentrate in cities by the year 2050. The pressure of this population rise on our cities and the natural systems are bound to increase in the near future. Floods, cyclones, earthquakes, wildfires and heat waves made the year 2015 a devastating one for millions around the world, with 150 major natural disasters being recorded. Asia bore the brunt of these disasters with massive earthquakes in Nepal, floods in Chennai, heat waves hitting South India and Typhoon Komen inundating the Indian subcontinent, to cite a few examples. The changes in climate and the failures of physical systems make our cities vulnerable to disasters of various kinds leading to physical collapse of the city. This paper deals with the concept of disaster resilience in this context and how this can be applied at the city, neighbourhood as well as the individual level. The intent of the paper is to develop a framework of strategies for an emergency response programme, taking the case of the Indian city of Chennai. The initial approach surveys in detail the way the city functions with respect to the natural systems and looks into the city's growth through the ages. The paper proposes an initial theory around the creation of an ideal emergency response model consisting of physical and technological networks that will come into play once a risk situation arises within a city. This model was first produced at a generic level where it can be applied on to any city of any context. The paper articulates the model in the city of Chennai considering its intricate labyrinth and functions.