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Vishnu VY, Lemmers RJLF, Reyaz A, Mishra R, Ahmad T, van der Vliet PJ, Kretkiewicz MM, Macken WL, Efthymiou S, Dominik N, Morrow JM, Bhatia R, Wilson LA, Houlden H, Hanna MG, Bugiardini E, van der Maarel SM, Srivastava MVP. The first genetically confirmed cohort of Facioscapulohumeral Muscular Dystrophy from Northern India. Eur J Hum Genet 2024; 32:1053-1064. [PMID: 38664571 PMCID: PMC11368952 DOI: 10.1038/s41431-024-01577-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 01/12/2024] [Accepted: 02/21/2024] [Indexed: 09/04/2024] Open
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is the third most common form of hereditary myopathy. Sixty per cent of the world's population lives in Asia, so a significant percentage of the world's FSHD participants is expected to live there. To date, most FSHD studies have involved individuals of European descent, yet small-scale studies of East-Asian populations suggest that the likelihood of developing FSHD may vary. Here, we present the first genetically confirmed FSHD cohort of Indian ancestry, which suggests a pathogenic FSHD1 allele size distribution intermediate between European and North-East Asian populations and more asymptomatic carriers of 4 unit and 5 unit FSHD1 alleles than observed in European populations. Our data provides important evidence of differences relevant to clinical diagnostics and underscores the need for global FSHD participation in research and trial-ready Indian FSHD cohorts.
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Affiliation(s)
- Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Richard J L F Lemmers
- Department of Human Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Alisha Reyaz
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Rinkle Mishra
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Tanveer Ahmad
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Patrick J van der Vliet
- Department of Human Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Marcelina M Kretkiewicz
- Department of Human Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - William L Macken
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Stephanie Efthymiou
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology and the National Hospital of Neurology and Neurosurgery, London, UK
| | - Natalia Dominik
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology and the National Hospital of Neurology and Neurosurgery, London, UK
| | - Jasper M Morrow
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology and the National Hospital of Neurology and Neurosurgery, London, UK
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Lindsay A Wilson
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology and the National Hospital of Neurology and Neurosurgery, London, UK
| | - Henry Houlden
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology and the National Hospital of Neurology and Neurosurgery, London, UK
| | - Michael G Hanna
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, UK.
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK.
| | - Enrico Bugiardini
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology and the National Hospital of Neurology and Neurosurgery, London, UK
| | | | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India.
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2
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Gupta H. Analysis of acute poisoning cases at a tertiary care hospital. J Family Med Prim Care 2024; 13:3457-3458. [PMID: 39228596 PMCID: PMC11368350 DOI: 10.4103/jfmpc.jfmpc_1653_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 03/01/2024] [Accepted: 03/07/2024] [Indexed: 09/05/2024] Open
Affiliation(s)
- Harish Gupta
- Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
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3
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Magesan K, Ahmed A, George AE, Ganesh SK, Biswas J, Dutta Majumder P. An Analysis of the clinical and investigative profile of uveitis in the elderly: First case series from India. Indian J Ophthalmol 2024; 72:S596-S600. [PMID: 38454869 PMCID: PMC11338401 DOI: 10.4103/ijo.ijo_2788_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE To evaluate the spectrum of uveitis occurring after 60 years of age in elderly patients who presented to a tertiary care eye center in India. METHODS Retrospective study of patients who visited a tertiary eye care institute between January 2010 and July 2020. RESULT Eighty-seven patients developed uveitis after 60 years, with only 44.8% having sufficient follow-up documentation and were included in the final analysis. The median age of these patients was 64 (IQR: 62-70) years, and 69% of them were male. Among the identifiable causes of uveitis, infectious uveitis (36%) was the most common and noninfectious uveitis was noted in 23% of patients. The most common subtype of uveitis was anterior uveitis (52%), followed by intermediate uveitis (32%), panuveitis (11%), and posterior uveitis (7%). Tuberculosis (28%) was the most common cause in our cohort, followed by HLA B27 (10%), sarcoid (8%), and Vogt-Koyanagi-Harada disease (5%). In 41% of patients, a definitive diagnosis of uveitis could not be achieved, and the anterior uveitis group had the highest number of undifferentiated uveitis cases. There were no undifferentiated cases of uveitis in the posterior and panuveitis category. The median follow-up period of these patients was 52 (15-91) months and 66% of eyes had recurrence. A statistically significant improvement in vision was seen in anterior uveitis and panuveitis groups, whereas the median visual acuity of the intermediate uveitis group remained stable throughout the follow-up period. CONCLUSION Uveitis in the elderly can have a higher recurrence rate; however, the lack of follow-up in these groups of patients is a major challenge.
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Affiliation(s)
- Kowsigan Magesan
- Department of Optometry, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Arshee Ahmed
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Amala E George
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Sudha K Ganesh
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
- Department of Ocular Pathology, Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
| | - Parthopratim Dutta Majumder
- Department of Uvea, Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India
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Brabahar BS, Kurien R, Panicker R, Rebekah G, Varghese L. Threshold and suprathreshold component analysis in olfactory dysfunction: a retrospective study. J Laryngol Otol 2024; 138:647-651. [PMID: 38058015 DOI: 10.1017/s0022215123002268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To analyse variations in the n-butanol threshold and odour identification scores of the Connecticut Chemosensory Clinical Research Centre test in various grades of olfactory dysfunction and in different nasal conditions leading to olfactory loss. METHOD Retrospective observational study. RESULTS All grades of olfactory dysfunction were predominantly noted among males. In chronic rhinosinusitis, anosmia or severe hyposmia was seen in 87.5 per cent of patients without polyps in comparison with 68 per cent of patients with polyps. In addition, 90 per cent of patients with atrophic rhinitis and post-traumatic loss had anosmia, but only 30.7 per cent of patients with allergic rhinitis had anosmia. Pepper was the most affected smell for all the nasal diseases except atrophic rhinitis, in which asafoetida and baby powder smells were affected more. CONCLUSION In most inflammatory sinonasal conditions, odour identification is relatively preserved even when the threshold is maximally affected. In patients with comparable olfactory dysfunction based on the Connecticut Chemosensory Clinical Research Centre test score, a relatively preserved suprathreshold odour identification score may predict better prognosis.
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Affiliation(s)
| | - Regi Kurien
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - Raga Panicker
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Lalee Varghese
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
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5
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Gupta P, Bharati B, Sundar Sahu K, Mahapatra P, Pati S. Self-reported symptom burden among patients attending public health care facilities in India: Looking through ICPC-3 lens. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001835. [PMID: 38709793 PMCID: PMC11073677 DOI: 10.1371/journal.pgph.0001835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/02/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION The objectives of this study were: 1) to describe the socio-demographics and classify the chief complaints and reasons to encounter facilities of patients presenting to public healthcare facilities; 2) to explore differences in these complaints and: International Classification of Primary Care-3 (ICPC-3) groups across socio-demographic and health system levels. METHODS This is a cross-sectional study conducted in three districts of Odisha, India. Within each district, the district hospital (DH), one Sub-district hospital (SDH) (if available), two Community health centers (CHCs), and two Primary health care centers (PHCs) were selected. Thus, a total of three DHs, three SDHs, six CHCs, and six PHCs were covered. Two tertiary healthcare facilities were also included. Patients aged 18 years and older, attending the Outpatient Departments (OPD) of sampled health facilities were chosen as study participants through systematic random sampling. RESULTS A total of 3044 patients were interviewed. In general, 65% of the sample reported symptoms as their chief complaint for reason of encounter, whereas 35% reported disease and diagnosis. The most common reasons to encounter health facilities were fever, hypertension, abdominal pain, chest pain, arthritis, skin disease, cough, diabetes, and injury. Among the symptoms, the highest number of patients reported the general category (29%), followed by the digestive system (16%). In the disease category, the circulatory system has the highest proportion, followed by the musculatory system. In symptom categories, general, digestive, and musculatory systems were the key systems for the reasons of encounter in outpatient departments irrespective of different groups of the population. In terms of different tiers of health systems, the top three reasons to visit OPD were dominated by the circulatory system, respiratory system, and musculatory system. CONCLUSION This is the first Indian study using the ICPC-3 classification for all three levels of health care. Irrespective of age, socio-economic variables, and tiers of healthcare, the top three groups to visit public health facilities according to the ICPC-3 classification were consistent i.e., general, digestive, and circulatory. Implementation of standard management and referral guidelines for common diseases under these groups will improve the quality and burden at public health facilities in India.
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Affiliation(s)
- Priti Gupta
- Research Department, Centre for Chronic Disease Control, New Delhi, India
| | - Bhavna Bharati
- Department of Public Health, Bhubaneswar Advanced Rehabilitation Center, Bhubaneswar, Odisha, India
| | - Kirti Sundar Sahu
- Department of Public Health, Bhubaneswar Advanced Rehabilitation Center, Bhubaneswar, Odisha, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- Department of Health Research, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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6
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Cornelis SS, IntHout J, Runhart EH, Grunewald O, Lin S, Corradi Z, Khan M, Hitti-Malin RJ, Whelan L, Farrar GJ, Sharon D, van den Born LI, Arno G, Simcoe M, Michaelides M, Webster AR, Roosing S, Mahroo OA, Dhaenens CM, Cremers FPM. Representation of Women Among Individuals With Mild Variants in ABCA4-Associated Retinopathy: A Meta-Analysis. JAMA Ophthalmol 2024; 142:463-471. [PMID: 38602673 PMCID: PMC11009866 DOI: 10.1001/jamaophthalmol.2024.0660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/27/2024] [Indexed: 04/12/2024]
Abstract
Importance Previous studies indicated that female sex might be a modifier in Stargardt disease, which is an ABCA4-associated retinopathy. Objective To investigate whether women are overrepresented among individuals with ABCA4-associated retinopathy who are carrying at least 1 mild allele or carrying nonmild alleles. Data Sources Literature data, data from 2 European centers, and a new study. Data from a Radboudumc database and from the Rotterdam Eye Hospital were used for exploratory hypothesis testing. Study Selection Studies investigating the sex ratio in individuals with ABCA4-AR and data from centers that collected ABCA4 variant and sex data. The literature search was performed on February 1, 2023; data from the centers were from before 2023. Data Extraction and Synthesis Random-effects meta-analyses were conducted to test whether the proportions of women among individuals with ABCA4-associated retinopathy with mild and nonmild variants differed from 0.5, including subgroup analyses for mild alleles. Sensitivity analyses were performed excluding data with possibly incomplete variant identification. χ2 Tests were conducted to compare the proportions of women in adult-onset autosomal non-ABCA4-associated retinopathy and adult-onset ABCA4-associated retinopathy and to investigate if women with suspected ABCA4-associated retinopathy are more likely to obtain a genetic diagnosis. Data analyses were performed from March to October 2023. Main Outcomes and Measures Proportion of women per ABCA4-associated retinopathy group. The exploratory testing included sex ratio comparisons for individuals with ABCA4-associated retinopathy vs those with other autosomal retinopathies and for individuals with ABCA4-associated retinopathy who underwent genetic testing vs those who did not. Results Women were significantly overrepresented in the mild variant group (proportion, 0.59; 95% CI, 0.56-0.62; P < .001) but not in the nonmild variant group (proportion, 0.50; 95% CI, 0.46-0.54; P = .89). Sensitivity analyses confirmed these results. Subgroup analyses on mild variants showed differences in the proportions of women. Furthermore, in the Radboudumc database, the proportion of adult women among individuals with ABCA4-associated retinopathy (652/1154 = 0.56) was 0.10 (95% CI, 0.05-0.15) higher than among individuals with other retinopathies (280/602 = 0.47). Conclusions and Relevance This meta-analysis supports the likelihood that sex is a modifier in developing ABCA4-associated retinopathy for individuals with a mild ABCA4 allele. This finding may be relevant for prognosis predictions and recurrence risks for individuals with ABCA4-associated retinopathy. Future studies should further investigate whether the overrepresentation of women is caused by differences in the disease mechanism, by differences in health care-seeking behavior, or by health care discrimination between women and men with ABCA4-AR.
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Affiliation(s)
- Stéphanie S. Cornelis
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joanna IntHout
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Esmee H. Runhart
- Rotterdam Ophthalmic Institute, The Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | - Olivier Grunewald
- Lille Neuroscience & Cognition, University of Lille, Inserm, CHU Lille, Lille, France
| | - Siying Lin
- National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, United Kingdom
| | - Zelia Corradi
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mubeen Khan
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
- Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands
| | | | - Laura Whelan
- Smurfit Institute of Genetics, School of Genetics and Microbiology, Trinity College Dublin, Dublin, Ireland
| | - G. Jane Farrar
- Smurfit Institute of Genetics, School of Genetics and Microbiology, Trinity College Dublin, Dublin, Ireland
| | - Dror Sharon
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Gavin Arno
- National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, United Kingdom
| | - Mark Simcoe
- National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, United Kingdom
| | - Michel Michaelides
- National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, United Kingdom
| | - Andrew R. Webster
- National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, United Kingdom
| | - Susanne Roosing
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Omar A. Mahroo
- National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, United Kingdom
| | - Claire-Marie Dhaenens
- Lille Neuroscience & Cognition, University of Lille, Inserm, CHU Lille, Lille, France
| | - Frans P. M. Cremers
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
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Das BK, Parida MK, Tripathy SR, Pattanaik SS, Yadav SK, Mishra SK. Addressing disparities in rural and remote access for rheumatology practice through a transformative tele-healthcare delivery system: Experience of a large cohort of patients in eastern India. THE NATIONAL MEDICAL JOURNAL OF INDIA 2024; 37:79-81. [PMID: 39222531 DOI: 10.25259/nmji_182_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Background We present the experience of telerheumatology consultation services carried out in an eastern state of India. Methods We did this prospective, observational study of patients with rheumatological disorders and followed through telemedicine between December 2015 and May 2019. Results During the study period, we provided teleconsultation to 3583 patients with the help of 11 201 telemedicine visits. Patients resided at a median distance of 248 (13 to 510) km from the telemedicine hub. The cumulative savings of the patients as a result of this service were ₹2.4 crore (24 million). The median travel time saved was 7 hours (30 minutes to 12 hours) per patient per visit and a median of ₹6700 was saved per visit per patient. Conclusion Sustained efforts over a long period can lead to the delivery of essential rheumatology services via telemedicine to an under-priviledged population, reduce the financial burden of the poor, and help women to access healthcare services in remote parts of low- and middle-income countries (LMICs).
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Affiliation(s)
- Bidyut Kumar Das
- Department of Rheumatology, SCB Medical College, Cuttack 753007, Odisha, India
| | - Manoj Kumar Parida
- Department of Rheumatology, SCB Medical College, Cuttack 753007, Odisha, India
| | | | | | - Sanjay Kumar Yadav
- Department of Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Saroj K Mishra
- Department of Endocrine Surgery, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
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8
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Srinivasan M, Mathew G, Mathew N, Kumar M, Goyal N, Kamath MS. Technologies that empower women for better access to healthcare in India - A scoping review. Glob Public Health 2024; 19:2318240. [PMID: 38373725 DOI: 10.1080/17441692.2024.2318240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
Women from low- and middle-income countries face challenges in accessing and utilising quality healthcare. Technologies can aid in overcoming these challenges and the present scoping review is aimed at summarising the range of technologies used by women and assessing their role in enabling Indian women to learn about and access healthcare services. We conducted a comprehensive search from the date of inception of database till 2022 in PubMed and Google Scholar. Data was extracted from 43 studies and were thematically analysed. The range of technologies used by Indian women included integrated voice response system, short message services, audio-visual aids, telephone calls and mobile applications operated by health workers. Majority of the studies were community-based (79.1%), from five states (60.5%), done in rural settings (58.1%) and with interventional design (48.8%). Maternal and child health has been the major focus of studies, with lesser representation in domains of non-communicable and communicable diseases. The review also summarised barriers related to using technology - from health system and participant perspective. Technology-based interventions are enabling women to improve awareness about and accessibility to healthcare in India. Imparting digital literacy and scaling up technology use are potential solutions to scale-up healthcare access among women in India.
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Affiliation(s)
- Manikandan Srinivasan
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
- ICMR-NIOH-Regional Occupational Health Centre (South), Bengaluru, India
| | - Geethu Mathew
- ICMR-NIOH-Regional Occupational Health Centre (South), Bengaluru, India
| | - Namrata Mathew
- Department of Medicine, Christian Medical College, Vellore, India
| | - Mohan Kumar
- Department of Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, India
- Foundation for People-centric Health Systems (FPHS), New Delhi, India
| | - Nidhi Goyal
- Society for Applied Studies, New Delhi, India
| | - Mohan S Kamath
- Department of Reproductive Medicine and Surgery, Christian Medical College, Vellore, India
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Prasad S. Variability in neuroimaging research is not always wrong. Nat Hum Behav 2023; 7:2048-2049. [PMID: 37923913 DOI: 10.1038/s41562-023-01767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Affiliation(s)
- Shweta Prasad
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.
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10
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Wilson LA, Macken WL, Perry LD, Record CJ, Schon KR, Frezatti RSS, Raga S, Naidu K, Köken ÖY, Polat I, Kapapa MM, Dominik N, Efthymiou S, Morsy H, Nel M, Fassad MR, Gao F, Patel K, Schoonen M, Bisschoff M, Vorster A, Jonvik H, Human R, Lubbe E, Nonyane M, Vengalil S, Nashi S, Srivastava K, Lemmers RJLF, Reyaz A, Mishra R, Töpf A, Trainor CI, Steyn EC, Mahungu AC, van der Vliet PJ, Ceylan AC, Hiz AS, Çavdarlı B, Semerci Gündüz CN, Ceylan GG, Nagappa M, Tallapaka KB, Govindaraj P, van der Maarel SM, Narayanappa G, Nandeesh BN, Wa Somwe S, Bearden DR, Kvalsund MP, Ramdharry GM, Oktay Y, Yiş U, Topaloğlu H, Sarkozy A, Bugiardini E, Henning F, Wilmshurst JM, Heckmann JM, McFarland R, Taylor RW, Smuts I, van der Westhuizen FH, Sobreira CFDR, Tomaselli PJ, Marques W, Bhatia R, Dalal A, Srivastava MVP, Yareeda S, Nalini A, Vishnu VY, Thangaraj K, Straub V, Horvath R, Chinnery PF, Pitceathly RDS, Muntoni F, Houlden H, Vandrovcova J, Reilly MM, Hanna MG. Neuromuscular disease genetics in under-represented populations: increasing data diversity. Brain 2023; 146:5098-5109. [PMID: 37516995 PMCID: PMC10690022 DOI: 10.1093/brain/awad254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
Neuromuscular diseases (NMDs) affect ∼15 million people globally. In high income settings DNA-based diagnosis has transformed care pathways and led to gene-specific therapies. However, most affected families are in low-to-middle income countries (LMICs) with limited access to DNA-based diagnosis. Most (86%) published genetic data is derived from European ancestry. This marked genetic data inequality hampers understanding of genetic diversity and hinders accurate genetic diagnosis in all income settings. We developed a cloud-based transcontinental partnership to build diverse, deeply-phenotyped and genetically characterized cohorts to improve genetic architecture knowledge, and potentially advance diagnosis and clinical management. We connected 18 centres in Brazil, India, South Africa, Turkey, Zambia, Netherlands and the UK. We co-developed a cloud-based data solution and trained 17 international neurology fellows in clinical genomic data interpretation. Single gene and whole exome data were analysed via a bespoke bioinformatics pipeline and reviewed alongside clinical and phenotypic data in global webinars to inform genetic outcome decisions. We recruited 6001 participants in the first 43 months. Initial genetic analyses 'solved' or 'possibly solved' ∼56% probands overall. In-depth genetic data review of the four commonest clinical categories (limb girdle muscular dystrophy, inherited peripheral neuropathies, congenital myopathy/muscular dystrophies and Duchenne/Becker muscular dystrophy) delivered a ∼59% 'solved' and ∼13% 'possibly solved' outcome. Almost 29% of disease causing variants were novel, increasing diverse pathogenic variant knowledge. Unsolved participants represent a new discovery cohort. The dataset provides a large resource from under-represented populations for genetic and translational research. In conclusion, we established a remote transcontinental partnership to assess genetic architecture of NMDs across diverse populations. It supported DNA-based diagnosis, potentially enabling genetic counselling, care pathways and eligibility for gene-specific trials. Similar virtual partnerships could be adopted by other areas of global genomic neurological practice to reduce genetic data inequality and benefit patients globally.
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Affiliation(s)
- Lindsay A Wilson
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - William L Macken
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Luke D Perry
- Institute of Child Health and Centre for Neuromuscular Diseases, Neurosciences Unit, The Dubowitz Neuromuscular Centre, University College London, UCL Great Ormond Street, Great Ormond Street Hospital, London WC1N 3JH, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Christopher J Record
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Katherine R Schon
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Rodrigo S S Frezatti
- Department of Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Sharika Raga
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Division of Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
| | - Kireshnee Naidu
- Neurology Research Group, Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Division of Neurology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Özlem Yayıcı Köken
- Faculty of Medicine, Department of Pediatric Neurology, Akdeniz University, Antalya, Turkey
| | - Ipek Polat
- Faculty of Medicine, Pediatric Neurology Department, Dokuz Eylül University, Izmir, Turkey
- Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
| | - Musambo M Kapapa
- Department of Physiotherapy, University of Zambia School of Health Sciences & University Teaching Hospital Neurology Research Office, Lusaka, Zambia
| | - Natalia Dominik
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Stephanie Efthymiou
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Heba Morsy
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Melissa Nel
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Neurology Research Group, Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mahmoud R Fassad
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Fei Gao
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Krutik Patel
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Maryke Schoonen
- Focus Area for Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Michelle Bisschoff
- Focus Area for Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Armand Vorster
- Focus Area for Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Hallgeir Jonvik
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Ronel Human
- Department of Paediatrics, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Elsa Lubbe
- Department of Paediatrics, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Malebo Nonyane
- Department of Paediatrics, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Kosha Srivastava
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Richard J L F Lemmers
- Department of Human Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Alisha Reyaz
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Rinkle Mishra
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Ana Töpf
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Christina I Trainor
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elizabeth C Steyn
- Neurology Research Group, Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Amokelani C Mahungu
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Neurology Research Group, Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Patrick J van der Vliet
- Department of Human Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Ahmet Cevdet Ceylan
- Department of Medical Genetics, Ankara Bilkent City Hospital, Ankara, Turkey
- Faculty of Medicine, Department of Medical Genetics, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - A Semra Hiz
- Faculty of Medicine, Pediatric Neurology Department, Dokuz Eylül University, Izmir, Turkey
- Izmir Biomedicine and Genome Center (IBG), Izmir, Turkey
| | - Büşranur Çavdarlı
- Department of Medical Genetics, Ankara Bilkent City Hospital, Ankara, Turkey
| | - C Nur Semerci Gündüz
- Department of Medical Genetics, Ankara Bilkent City Hospital, Ankara, Turkey
- Faculty of Medicine, Department of Medical Genetics, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Gülay Güleç Ceylan
- Department of Medical Genetics, Ankara Bilkent City Hospital, Ankara, Turkey
- Faculty of Medicine, Department of Medical Genetics, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Madhu Nagappa
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Karthik B Tallapaka
- CSIR—Centre for Cellular and Molecular Biology (CCMB), Hyderabad, Telangana, India
| | - Periyasamy Govindaraj
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, Telangana, India
| | | | - Gayathri Narayanappa
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Bevinahalli N Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Somwe Wa Somwe
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
| | - David R Bearden
- University of Zambia Department of Educational Psychology, Lusaka, Zambia
- Department of Neurology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Michelle P Kvalsund
- Department of Neurology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Gita M Ramdharry
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Yavuz Oktay
- Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
- Izmir Biomedicine and Genome Center (IBG), Izmir, Turkey
| | - Uluç Yiş
- Faculty of Medicine, Pediatric Neurology Department, Dokuz Eylül University, Izmir, Turkey
| | | | - Anna Sarkozy
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Enrico Bugiardini
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Franclo Henning
- Division of Neurology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Jo M Wilmshurst
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Division of Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
| | - Jeannine M Heckmann
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Neurology Research Group, Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Robert McFarland
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Robert W Taylor
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Izelle Smuts
- Department of Paediatrics, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | | | | | - Pedro J Tomaselli
- Department of Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Wilson Marques
- Department of Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Ashwin Dalal
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, Telangana, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Sireesha Yareeda
- Department of Neurology, Nizam’s Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Kumarasamy Thangaraj
- CSIR—Centre for Cellular and Molecular Biology (CCMB), Hyderabad, Telangana, India
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rita Horvath
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Patrick F Chinnery
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Robert D S Pitceathly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Francesco Muntoni
- Institute of Child Health and Centre for Neuromuscular Diseases, Neurosciences Unit, The Dubowitz Neuromuscular Centre, University College London, UCL Great Ormond Street, Great Ormond Street Hospital, London WC1N 3JH, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Jana Vandrovcova
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Mary M Reilly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Michael G Hanna
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
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11
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Dolai TK, Jain M, Mahapatra M. Idiopathic Aplastic anemia: Indian Perspective. Indian J Hematol Blood Transfus 2023; 39:357-370. [PMID: 37304471 PMCID: PMC10247658 DOI: 10.1007/s12288-022-01592-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/26/2022] [Indexed: 06/13/2023] Open
Abstract
Aplastic anemia (AA) is a rare immunologically mediated bone marrow failure syndrome, characterized by progressive loss of hematopoietic stem cells resulting in peripheral pancytopenia. Elaborative investigation including molecular tests is required to exclude inherited bone marrow failure syndrome (IMBFS) as the treatment and prognosis vary dramatically between them. Haematopoietic stem cell transplant with a fully matched sibling donor (MSD-HSCT) is still the only curative treatment. Management of AA is a real-time challenge in India, because of the delay in the diagnosis, lack of proper supportive care, limited availability of the expertise centre, and the patient's affordability. Recently, results with intensified immunosuppressive therapy that includes anti-thymocyte globulin with cyclosporine-A (CsA) and eltrombopag, are enough encouraging to consider it as treatment of choice in patients lacking MSD or who are not fit for HSCT. However, limitations in resource constraints settings including the cost of therapy limit its full utilization. Relapse of the disease or evolution to myelodysplasia or paroxysmal nocturnal haemoglobinuria (PNH) in a proportion of patients is another challenge with immunosuppressants. The majority of the AA patients still receive CsA with or without androgens in India, mostly because of increased cost and limited availability of HSCT and ATG. The use of the unrelated or alternative donor is still upcoming in India, with unavailable data in terms of response and survival. Therefore, there is an utmost need for novel agents for the better management of AA having a balanced efficacy and toxicity profile to improve the survival and quality of life.
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Affiliation(s)
- Tuphan Kanti Dolai
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Manisha Jain
- Department of Medical oncology and Haematology, Medanta Medcity, India
| | - Manoranjan Mahapatra
- Department of Haematology, All India Institute of Medical science, New Delhi, India
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12
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Shenoy R, Rao AR, Rane PP, Noronha V, Kumar A, Pillai A, Pathak S, Gattani S, Sehgal A, Kumar S, Castelino R, Dhekale R, Krishnamurthy J, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nokala M, Chitre A, Kapoor A, Gota V, Banavali S, Prabhash K, Ramaswamy A. Validation of the Onco-MPI in predicting short-term mortality in older Indian patients with cancer. J Geriatr Oncol 2023; 14:101550. [PMID: 37327761 DOI: 10.1016/j.jgo.2023.101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The number of older patients with cancer is increasing exponentially worldwide, and a similar trend has also been noted in India. The Multidimensional Prognostic Index (MPI) strongly correlates the presence of individual comorbidities with mortality, and the Onco-MPI prognosticates patients accurately for overall mortality. However, limited studies have evaluated this index in patient populations beyond Italy. We evaluated the performance of the Onco-MPI index in predicting mortality in older Indian patients with cancer. MATERIALS AND METHODS This observational study was conducted between October 2019 and November 2021 in the Geriatric Oncology Clinic at Tata Memorial Hospital in Mumbai, India. The data of patients aged ≥60 years with solid tumors who underwent a comprehensive geriatric assessment was analysed. The study's primary aim was to calculate the Onco-MPI for patients in the study and correlate it with one-year mortality. RESULTS A total of 576 patients aged ≥60 years were included in the study. The median age (range) of the population was 68 (60-90) years, and 429 (74.5%) were male. After a median follow-up of 19.2 months, 366 (63.7%) patients had died. The proportion of patients classified as low risk (0-0.46), moderate risk (0.47-0.63) and high risk (0.64-1.0) were 38% (219 patients), 37% (211 patients) and 25% (145 patients), respectively. There was a significant difference in one-year mortality rates between the low-risk patients compared to medium and high-risk patients (40.6% vs 53.1% vs 71.7%; p < 0.001). DISCUSSION The current study validates the Onco-MPI as a predictive tool for estimating short-term mortality in older Indian patients with cancer. Further prospective studies need to build on this index to obtain a score with greater discrimination in the Indian population.
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Affiliation(s)
- Ramnath Shenoy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Abhijith Rajaram Rao
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anita Kumar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anupa Pillai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shruti Pathak
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shreya Gattani
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Arshiya Sehgal
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Sharath Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Renita Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Ratan Dhekale
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jyoti Krishnamurthy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sarika Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anuradha Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Lekhika Sonkusare
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jayita Deodhar
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nabila Ansari
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjusha Vagal
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Purbi Mahajan
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shivshankar Timmanpyati
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjunath Nokala
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Ankita Chitre
- Department of Physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Akhil Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
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13
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Zhang Y, Guan H, Ding Y, Xue J. Gender differences in vision health-seeking behavior and vision health outcomes among rural Chinese schoolchildren by birth order and family size. Int J Equity Health 2023; 22:87. [PMID: 37179296 PMCID: PMC10183124 DOI: 10.1186/s12939-023-01907-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The gender gap remains a major impediment in the path toward equality, and it is especially wide in low-income countries. Gender differences in health-seeking behaviors may be a factor. Family size and childbirth order are two critical factors affecting family resource allocation. This study examines gender differences in healthcare-seeking behaviors among children with visual impairment in rural China across different family structures (birth order and family size). METHODS We draw on a dataset containing 19,934 observations constructed by combining data from 252 different school-level surveys spanning two provinces. The surveys were all conducted in 2012 using uniform survey instruments and data collection protocols in randomly selected schools across western provinces in rural China. The sample children range in grades from 4 to 5. Our analysis compares rural girls with rural boys regarding vision health outcome and behavior (vision examination and correction). RESULTS The findings revealed that girls have worse vision than boys. Regarding vision health behaviors, girls have a lower overall vision examination rate than boys. There is no gender difference when the sample student is the only child or the youngest child in the family, but there is still a gender difference when the sample student is the oldest child in the family or the middle child in the birth order. When it comes to vision correction behavior, boys are more likely to own eyeglasses than girls are for groups of students with mild visual impairment, even when the sample student is the only child in the family. However, when the sample student has another brother or sister (the sample student is the youngest, the oldest child in the family, or the middle child in the birth order), the gender difference disappears. CONCLUSIONS Gender differences in vision health outcomes are correlated with gender differences in vision health-seeking behaviors among rural children. Depending on the birth order and family size, gender disparities in visual health practices vary. In the future, consideration should be given to providing medical subsidies to reduce the cost of vision health behaviors and to provide information interventions to change gender inequality in households and promote equality in children's vision health behaviors. TRIAL REGISTRATION The trial was approved by the Stanford University Institutional Review Board (Protocol No. ISRCTN03252665). Permission was received from local Boards of Education in each region and the principals of all schools. The principles of the Declaration of Helsinki were followed throughout. Written informed consent was obtained from at least one parent for all child participants.
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Affiliation(s)
- Yunyun Zhang
- Center for Experimental Economics in Education, Shaanxi Normal University, No. 620 West Chang'an Street, Chang'an District, Xi'an, 710119, Shaanxi Province, China
| | - Hongyu Guan
- Center for Experimental Economics in Education, Shaanxi Normal University, No. 620 West Chang'an Street, Chang'an District, Xi'an, 710119, Shaanxi Province, China.
| | - Yuxiu Ding
- Center for Experimental Economics in Education, Shaanxi Normal University, No. 620 West Chang'an Street, Chang'an District, Xi'an, 710119, Shaanxi Province, China
| | - Jing Xue
- Center for Experimental Economics in Education, Shaanxi Normal University, No. 620 West Chang'an Street, Chang'an District, Xi'an, 710119, Shaanxi Province, China
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14
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Putturaj M, Van Belle S, Krumeich A, Ns P, Engel N. "It's like asking for a necktie when you don't have underwear": Discourses on patient rights in southern Karnataka, India. Int J Equity Health 2023; 22:47. [PMID: 36922856 PMCID: PMC10015129 DOI: 10.1186/s12939-023-01850-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Ensuring patient rights is an extension of applying human rights principles to health care. A critical examination of how the notion of patient rights is perceived and enacted by various actors through critical discourse analysis (CDA) can help understand the impediments to its realization in practice. METHODS We studied the discourses and discursive practices on patient rights in subnational policies and in ten health facilities in southern Karnataka, India. We conducted interviews (78), focus group discussions (3) with care-seeking individuals, care-providers, health care administrators and public health officials. We also conducted participant observation in selected health facilities and examined subnational policy documents of Karnataka pertaining to patient rights. We analyzed the qualitative data for major and minor themes. RESULTS Patient rights discourses were not based upon human rights notions. In the context of neoliberalism, they were predominantly embedded within the logic of quality of care, economic, and consumerist perspectives. Relatively powerful actors such as care-providers and health facility administrators used a panoply of discursive strategies such as emphasizing alternate discourses and controlling discursive resources to suppress the promotion of patient rights among care-seeking individuals in health facilities. As a result, the capacity of care-seeking individuals to know and claim patient rights was restricted. With neoliberal health policies promoting austerity measures on public health care system and weak implementation of health care regulations, patient rights discourses remained subdued in health facilities in Karnataka, India. CONCLUSIONS The empirical findings on the local expression of patient rights in the discourses allowed for theoretical insights on the translation of conceptual understandings of patient rights to practice in the everyday lives of health system actors and care-seeking individuals. The CDA approach was helpful to identify the problematic aspects of discourses and discursive practices on patient rights where health facility administrators and care-providers wielded power to oppress care-seeking individuals. From the practical point of view, the study demonstrated the limitations of care-seeking individuals in the discursive realms to assert their agency as practitioners of (patient) rights in health facilities.
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Affiliation(s)
- Meena Putturaj
- Institute of Tropical Medicine, Antwerpen, Belgium.
- Maastricht University, Maastricht, Netherlands.
- Institute of Public Health, Bengaluru, India.
- The University of Transdisciplinary Health Sciences and Technology, Bengaluru, India.
| | | | | | | | - Nora Engel
- Maastricht University, Maastricht, Netherlands
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15
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Chhabra ST, Kaur G, Aggarwal R, Bansal N, Kishore H, Goyal M, Gupta A, Batta A, Singal G, Gupta V, Goyal A, Tandon R, Aslam N, Mohan B, Wander G. Outpatient Attendance in COVID Pandemic Lockdown: An Observational Study. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2023. [DOI: 10.25259/ijcdw_17_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Objectives:
The objectives of this study were to analyze the profile of outpatient department (OPD) attendance of a tertiary care hospital during pre- and post-pandemic lockdown period.
Materials and Methods:
All consecutive patients presenting to OPD from August 1, 2019 to November 23, 2020 were included in the study. The sample was divided into Zone R (Regular domain) and Zone L (Lockdown domain). Zone L was divided into three groups A, B, and C; representing attendance to be <30%, 30–60%, and >60% of previous (i.e., Zone R), respectively. The patient gender, intradepartmental, and inter departmental OPD attendance data were collected and analyzed.
Results:
n = 428,322 patients attended the OPD in the study period. 301,586 patients presented in Zone R and 126,736 presented in Zone L (P = 0.000). Zone L recorded an OPD attendance drop to 42% of Zone R. The least attended an OPD (Group A) was ophthalmology, ENT, dermatology, surgery, and orthopedics versus highest attendance (Group C) was noticed in emergency OPD and oncology with a moderate decline in the rest (P = −0.00, 0.00, and 0.00, respectively). Both male and female attendance in the OPD showed a decline; however, the gender divide was apparent with significantly low women attendance in all the departments (P = 0.00).
Conclusion:
OPD attendance showed a significant reduction in COVID lockdown era hitting the non-emergent medical branches the most. The gender divide significantly widened with less female attendance recorded in most OPDs in pandemic lockdown. Apt administrative measures could prove fruitful by an improved OPD attendance and its psychosocial implications to a society with less disease burden.
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Affiliation(s)
- Shibba Takkar Chhabra
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India,
| | - Gurleen Kaur
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India,
| | - Riya Aggarwal
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India,
| | - Namita Bansal
- Research and Developement Centre, Dayanand Medical College and Hospital, Punjab, India
| | - Harsh Kishore
- Research and Developement Centre, Dayanand Medical College and Hospital, Punjab, India
| | - Mamta Goyal
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India,
| | - Anshuman Gupta
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India,
| | - Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India,
| | - Gautam Singal
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India,
| | - Vivek Gupta
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India,
| | - Abhishek Goyal
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India,
| | - Rohit Tandon
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India,
| | - Naved Aslam
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India,
| | - Bishav Mohan
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India,
| | - Gurpreet Wander
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India,
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T Sathyapalan D, V Nair C, Moni M, Edathadathil F, A A, Prasanna P, Pushpa Raghavan R, Jayant A. Incidence and characterisation of post-COVID-19 symptoms in hospitalized COVID-19 survivors: A single centre, prospective observational cohort study to recognize the syndemic connotations in India. JMIR Form Res 2023; 7:e40028. [PMID: 36920842 PMCID: PMC10131721 DOI: 10.2196/40028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 01/03/2023] [Accepted: 01/20/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Long COVID or post-COVID-19 syndrome is the persistence of signs and symptoms that develop during or after COVID-19 infection for more than 12 weeks and are not explained by an alternative diagnosis. In spite of health care recouping to pre pandemic states, post-COVID-19 state tends to be less recognised from low middle income country settings and holistic therapeutic protocols do not exist. Owing to the syndemic nature of the COVID 19, it is important to characterise post-COVID-19 syndrome. OBJECTIVE We aimed to determine the incidence of post-COVID-19 symptoms in a cohort of inpatients who recovered from COVID-19 from February 2021 to July 2021 from a tertiary care centre in South India. In addition, we aimed at comparing the prevalence of post-COVID-19 manifestations in non-ICU and ICU patients, assessing the persistence, severity and characteristics of post-COVID-19 manifestations and elucidating the risk factors associated with the presence of post-COVID-19 manifestations. METHODS 120 adult patients admitted with COVID-19 in the specified time frame were recruited into the study after informed written consent. The cohort included 50 patients requiring Intensive care unit and 70 patients with non-intensive care. The follow-up was conducted on the second and sixth week after discharge with a structured questionnaire. The questionnaire was filled by the patient/family member of the patient during their visit to the hospital for follow-up at 2 weeks and through telephone follow up at 6 weeks. RESULTS : Mean age of the cohort was 55 years and 55% were males. Only (5%) of the cohort had taken the first dose of COVID-19 vaccination.58.3% had mild COVID-19 and 41.7% had moderate to severe COVID-19 infection. 60.8% (n=73) of patients had at least one persistent symptom at sixth week of discharge. 50 (41.7%) patients required intensive care during their inpatient stay. Presence of persistent symptoms at 6 weeks was not associated with severity of illness, age or requirement for intensive care. Fatigue was the most common reported persistent symptom with a prevalence of 55.8% followed by dyspnoea (20%) and weight loss (16.7%). Female sex (OR 2.4, 95% CI: 1.03-5.58, P=.04) and steroid administration during hospital stay (OR: 4.43; 95% CI: 1.9-10.28, P=.001), were found to be significant risk factors for the presence of post-COVID-19 symptoms at 6 weeks as revealed by logistic regression analysis. CONCLUSIONS 60.8% of inpatients treated for COVID-19 had post-COVID-19 symptoms at 6 week's post- discharge from hospital. Incidence of post-COVID-19 syndrome in the cohort did not significantly differ across the mild, moderate and severe COVID-19 severity categories. Female sex and steroid administration during hospital stay were identified as predictors of persistence of post-COVID-19 symptoms at 6 weeks. CLINICALTRIAL
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Affiliation(s)
- Dipu T Sathyapalan
- Division of Infectious Disease, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Chithira V Nair
- Division of Infectious Disease, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Merlin Moni
- Division of Infectious Disease, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Fabia Edathadathil
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Appukuttan A
- Division of Infectious Disease, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Preetha Prasanna
- Department of Medical Administration, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | | | - Aveek Jayant
- Department of Anaesthesia, Critical Care and Pain, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, IN
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Renal Outcomes in Neonates and Infants with Transposition Physiology Undergoing Arterial Switch Procedure. Pediatr Cardiol 2022; 43:1770-1783. [PMID: 35569085 DOI: 10.1007/s00246-022-02914-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/14/2022] [Indexed: 10/18/2022]
Abstract
Acute kidney injury (AKI) in children with Transposition of Great arteries (TGA) undergoing Arterial Switch operation (ASO) is an important complication in the post-operative period associated with worse outcomes. AKI in children post open cardiac surgery has been well studied, with lesser data in literature pertaining to TGA and its sub-types specifically. This was a prospective, observational study enrolling infants with TGA undergoing ASO at a single center over a span of a decade from January 2010 to December 2020. The infants were followed during the duration of ICU and hospital stay, with documentation of baseline and intraoperative parameters as well as post-operative course. Out of 145 infants enrolled in the study, 83.1% developed AKI with majority (83.9%) having stage 1 AKI. Higher odds of AKI were seen in infants requiring Norepinephrine [odds ratio - 16.76 (95% CI 2.19-128.2), p < 0.001] and those who developed gram-negative infections [2.81 (1.04-7.56), p - 0.036]. Infants with AKI had significantly higher vasoactive-inotropic support at day 1 than those without AKI [16 (12.5-21.50 vs 13 (10.25-15.75), p - 0.014]. Seventeen infants in the AKI group (14%) died as opposed to none in the non-AKI group (p = 0.076). Median hours of ventilator support required were significantly higher in those with AKI than those who did not develop AKI (48 vs 45.5 p = 0.015). The infants with ASO + ASD + PDA (53% of neonates who died) were younger, had less weight at admission, more gram-negative sepsis and need for dopamine, as compared to ASO + VSD + ASD (23.5% of mortality) and ASO + ASD + VSD + aortic arch repair (23.5% of mortality). AKI in infants with TGA undergoing ASO is common and associated with poorer outcomes. In this subpopulation, AKI development is associated most commonly with hemodynamic instability and infections. This is the first study, looking at outcomes of TGA depending on the sub-types of ASO surgeries done in the infants [ASO with ASD + PDA or ASD + VSD or ASD + VSD + Arch Repair].
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Harikrishnan S, Bahl A, Roy A, Mishra A, Prajapati J, Manjunath C, Sethi R, Guha S, Satheesh S, Dhaliwal R, Sarma M, Ganapathy S, Jeemon P. Clinical profile and 90 day outcomes of 10 851 heart failure patients across India: National Heart Failure Registry. ESC Heart Fail 2022; 9:3898-3908. [PMID: 36214477 PMCID: PMC9773752 DOI: 10.1002/ehf2.14096] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Limited data on the uptake of guideline-directed medical therapies (GDMTs) and the mortality of acute decompensated HF (ADHF) patients are available from India. The National Heart Failure Registry (NHFR) aimed to assess clinical presentation, practice patterns, and the mortality of ADHF patients in India. METHODS AND RESULTS The NHFR is a facility-based, multi-centre clinical registry of consecutive ADHF patients with prospective follow-up. Fifty three tertiary care hospitals in 21 states in India participated in the NHFR. All consecutive ADHF patients who satisfied the European Society of Cardiology criteria were enrolled in the registry. All-cause mortality at 90 days was the main outcome measure. In total, 10 851 consecutive patients were recruited (mean age: 59.9 years, 31% women). Ischaemic heart disease was the predominant aetiology for HF (72%), followed by dilated cardiomyopathy (18%). Isolated right HF was noted in 62 (0.6%) participants. In eligible HF patients, 47.5% received GDMT. The 90 day mortality was 14.2% (14.9% and 13.9% in women and men, respectively) with a re-admission rate of 8.4%. An inverse relationship between educational class based on years of education and 90 day mortality (high mortality in the lowest educational class) was observed in the study population. Patients with HF with reduced ejection fraction and HF with mildly reduced ejection fraction who did not receive GDMT experienced higher mortality (log-rank P < 0.001) than those who received GDMT. Baseline educational class, body mass index, New York Heart Association functional class, ejection fraction, dependent oedema, serum creatinine, QRS > 120 ms, atrial fibrillation, mitral regurgitation, haemoglobin levels, serum sodium, and GDMT independently predicted 90 day mortality. CONCLUSION One of seven ADHF patients in the NHFR died during the first 90 days of follow-up. One of two patients received GDMT. Adherence to GDMT improved survival in HF patients with reduced and mildly reduced ejection fractions. Our findings call for innovative quality improvement initiatives to improve the uptake of GDMT among HF patients in India.
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Affiliation(s)
| | - Ajay Bahl
- CardiologyPostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
| | - Ambuj Roy
- CardiologyAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | - Animesh Mishra
- CardiologyNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS)ShillongIndia
| | - Jayesh Prajapati
- CardiologyUN Mehta Institute of Cardiology and Research Centre (UNMICRC)AhmedabadIndia
| | - C.N. Manjunath
- CardiologySri Jayadeva Institute of Cardiovascular Sciences and Research (SJICR)BangaloreIndia
| | - Rishi Sethi
- CardiologyKing George's Medical University (KGMU)LucknowIndia
| | - Santanu Guha
- CardiologyMedical College Hospital (MCH)KolkataIndia
| | - Santhosh Satheesh
- CardiologyJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PondicherryIndia
| | - R.S. Dhaliwal
- Division of Non‐Communicable DiseasesIndian Council of Medical Research (ICMR)New DelhiIndia
| | - Meenakshi Sarma
- Division of Non‐Communicable DiseasesIndian Council of Medical Research (ICMR)New DelhiIndia
| | - Sanjay Ganapathy
- CardiologySree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)TrivandrumIndia
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science StudiesSree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)Trivandrum695011KeralaIndia
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Datta B, Pandey A, Tiwari A. Child Marriage and Problems Accessing Healthcare in Adulthood: Evidence from India. Healthcare (Basel) 2022; 10:1994. [PMID: 36292439 PMCID: PMC9601764 DOI: 10.3390/healthcare10101994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/04/2022] Open
Abstract
The association between child marriage and the access to or utilization of maternal and antenatal healthcare has been widely studied. However, little is known about child brides' access to healthcare for illnesses later in life. Using data on 496,283 married women aged 18 to 49 years from the India National Family and Health Survey 2015-2016, we developed an 11-point composite score (ranging from 0 to 10) outlining the extent of problems accessing healthcare, as follows: (i) no/little problem (score 0 to 2), (ii) some problems (score 3 to 6), and (iii) big problems (score 7 to 10). The differences between child brides and their peers married as adults were assessed by the relative risk ratios obtained from multinomial logistic regressions. The adjusted risk of having "some problems" and "big problems" accessing healthcare relative to "no/little problem" for child brides was found to be 1.22 (95% CI: 1.20-1.25) and 1.26 (95% CI: 1.22-1.29) times that of those married as adults, respectively. These findings highlight the disproportionate barriers to healthcare access faced by women married as children compared to women married as adults and the need for further research to inform policies regarding effective public health interventions to improve healthcare access.
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Affiliation(s)
- Biplab Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Ajay Pandey
- Department of Biological Sciences, Augusta University, Augusta, GA 30912, USA
| | - Ashwini Tiwari
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA
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20
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Samanta T, Gopalan K, Devi T. Blocked by Gender: Disparities in COVID19 infection detection in Tamil Nadu, India. Front Public Health 2022; 10:966490. [PMID: 36249186 PMCID: PMC9561920 DOI: 10.3389/fpubh.2022.966490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/08/2022] [Indexed: 01/24/2023] Open
Abstract
Globally, a gender gap in COVID-19 has been noted with men reporting higher share of both morbidity and deaths compared to women. While the gender gap in fatalities has been similar across the globe, there have been interesting disparities in the detection of COVID-19 cases in men and women. While wealthier, more developed nations have generally seen similar case detection in men and women, LMICs especially in Asia have seen far greater proportion of COVID-19 cases among men than women. We utilize age and sex-disaggregated data from the southern Indian state of Tamil Nadu across two waves of the pandemic (May 2020 - Nov 2020, and March 2021, to June 2021) and find that there were only ~70% as many detected COVID-19 cases among women as there were among men. Our initial reading suggested that this might be a protective effect of lower labor force participation rates among women across much of South Asia. However, subsequent sero-prevalence results from Tamil Nadu conducted on October-November 2020, and June-July, 2021 suggest that infection incidence has been similar among men and women; as is the case in countries with better health infrastructure. This empirical puzzle suggests that reduced case detection among women cannot be immediately associated with limited public exposure, but rather evidence of a chronic neglect of women in healthcare access. Overall, we contend that an attention to the gender context holds promise to effective interventions in detection and prevention that goes beyond the traditional epidemiological logic of diseases.
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Affiliation(s)
- Tannistha Samanta
- Department of Sociology, FLAME University, Pune, Maharashtra, India,*Correspondence: Tannistha Samanta
| | - Kaushik Gopalan
- Department of Computer Science, FLAME University, Pune, Maharashtra, India
| | - Tanmay Devi
- Department of Computer Science, FLAME University, Pune, Maharashtra, India,Department of Social Sciences, Rice University, Houston, TX, United States
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21
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Gamage S, Biswas RK, Bhowmik J. Health awareness and skilled birth attendance: An assessment of sustainable development goal 3.1 in south and south-east Asia. Midwifery 2022; 115:103480. [PMID: 36116336 DOI: 10.1016/j.midw.2022.103480] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 08/06/2022] [Accepted: 09/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The United Nation's Sustainable Development Goal 3.1 aims to reduce maternal mortality worldwide to 70 per 100,000 live births by 2030, which requires greater skilled birth attendant (SBA) coverage and increased health awareness. By evaluating relevant sociodemographic factors, this study aimed to identify different groups of women who lack health awareness and access to SBA services in eight selected low-and-middle-income countries (LMICs) of South and South-East Asia (SSEA), namely, Afghanistan, India, Indonesia, Myanmar, Nepal, Pakistan, Philippines, and Timor-Leste. METHODS Nationally representative Demographic and Health Surveys (DHS) on women aged 15-49 years were analysed with a pooled sample of 95,521. Complex survey-adjusted logistic regression models were fitted to assess sociodemographic factors, SBA coverage, and health awareness. RESULTS Women with higher health awareness were 44.4% (95% CI:1.32-1.58, p<0.001) more likely to access SBAs compared to the rest. Women and/or their partners with no or primary-level education, who were poorer, became young mothers (≤20 years), not involved in decision-making, or hardly exposed to media were less likely to seek SBAs and have higher health awareness. Women in rural areas with more children were also less likely to use SBAs. Timor-Leste, Afghanistan, Myanmar, and Nepal underperformed on SBA coverage amongst the selected LMICs of the SSEA region. CONCLUSION Health education and mass-media-driven awareness could be an interventional avenue for LMICs to increase SBA coverage. Future studies comparing health policies within the SSEA region are required to identify reasons behind some nations' underperformance, while others are on track to achieve SDG 3.1.
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Affiliation(s)
- Sasindu Gamage
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Australia
| | - Raaj Kishore Biswas
- Transport and Road Safety (TARS) Research Centre, School of Aviation, University of New South Wales, Sydney, Australia; Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jahar Bhowmik
- Department of Health Science and Biostatistics, Swinburne University of Technology, John Street, Hawthorn, Melbourne, VIC 3122, SA
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22
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Karthikeya K. Electrocardiogram as a Tool to Predict Diastolic Dysfunction in the Early Hypertensive Patients and its Comparison in Males and Females. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2022. [DOI: 10.25259/mm_ijcdw_423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives:
Heart failure with preserved ejection fraction continues to be a major healthcare challenge. Assessment of diastolic dysfunction (DD) is an integral part of the routine cardiologic examination, however little is known about ECG changes in diastolic dysfunction. several resting ECG parameters have been investigated to predict left ventricular diastolic dysfunction (LVDD). The study aims to assess diastolic dysfunction in recently diagnosed hypertensive patients by echocardiography and to find the value of ECG-derived parameters in predicting diastolic dysfunction.
Materials and Methods:
One hundred and fifty hypertensive patients of less than 1-year duration were divided into two groups based on the presence or absence of diastolic dysfunction. ECG parameters such as P wave dispersion, QT and QTc interval, ventricular activation time, Tend P, Tend Q were analyzed in all patients, and correlation was done with echo parameters to assess diastolic dysfunction in both males and females.
Results:
In both men and women a significant correlation was found between p wave dispersion, ventricular activation time, Corrected QT interval, TendP, and, Tend Q in ECG with diastolic dysfunction on bivariate regression analysis. Multivariate regression analysis showed that p wave dispersion had a greater correlation with diastolic dysfunction when compared with other ECG parameters (r=0.88, R2=0.78).
Conclusion:
Analysis of certain ECG parameters especially p wave dispersion is of great value in predicting diastolic dysfunction in both men and women.
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Affiliation(s)
- Kapil Karthikeya
- Department of Cardiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India,
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23
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Vora K, Saiyed S, Mavalankar D, Baines LS, Jindal RM. Trust Deficit in Surgical Systems in an Urban Slum in India Under Universal Health Coverage: A Mixed Method Study. Int J Public Health 2022; 67:1604924. [PMID: 35910432 PMCID: PMC9334907 DOI: 10.3389/ijph.2022.1604924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives: We carried out a mixed method study to understand why patients did not avail of surgical care in an urban slum in India. Methods: In our earlier study, we found that out of 10,330 people, 3.46% needed surgery; 42% did not avail of surgery (unmet needs). We conducted a follow-up study to understand reasons for not availing surgery, 141 in met needs, 91 in unmet needs. We administered 2 instruments, 16 in-depth interviews and 1 focused group discussion. Results: Responses from the 2 groups for “the Socio-culturally Competent Trust in Physician Scale for a Developing Country Setting” scale did not have significant difference except for, prescription of medicines, patients with unmet needs were less likely to agree (p = 0.076). Results between 2 groups regarding “Patient perceptions of quality” did not show significant difference except for doctors answering questions where a higher proportion of unmet need group agreed (p = 0.064). Similar observations were made in the in depth interviews and focus group. Conclusion: There is a need for understanding trust issues with health service delivery related to surgical care for marginalized populations.
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Affiliation(s)
- Kranti Vora
- Indian Institute of Public Health, Gandhinagar, India
| | - Shahin Saiyed
- Indian Institute of Public Health, Gandhinagar, India
| | | | - Lyndsay S. Baines
- Head of School (Health and Social Care), Anglia Ruskin University, London, United Kingdom
| | - Rahul M. Jindal
- Professor of Surgery and Global Health, Uniformed Services University, Bethesda, MD, United States
- Adjunct Indian Institute of Public Health, Gandhinagar, India
- *Correspondence: Rahul M. Jindal,
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Liblik K, Dhali A, Kipkorir V, Avanthika C, Manan MR, Găman M. Underrepresentation and undertreatment of women in hematology: An unsolved issue. Res Pract Thromb Haemost 2022; 6:e12767. [PMID: 35873219 PMCID: PMC9301474 DOI: 10.1002/rth2.12767] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 11/08/2022] Open
Abstract
Gender disparity is pervasive and persisting in research. Despite gender being recognized as one of the primary determinants of health, inadequate representation of women in clinical trials has resulted in a deficit pertaining to equity in health care. This gross underrepresentation has exposed women to unforeseen health-related outcomes, and as evident through historic records, unequal distribution of opportunities has further widened this gender gap in health care.
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Affiliation(s)
| | - Arkadeep Dhali
- Institute of Postgraduate Medical Education and ResearchKolkataIndia
| | - Vincent Kipkorir
- Department of Human Anatomy and PhysiologyUniversity of NairobiNairobiKenya
| | | | | | - Mihnea‐Alexandru Găman
- Faculty of Medicine"Carol Davila" University of Medicine and PharmacyBucharestRomania
- Department of HematologyCenter of Hematology and Bone Marrow Transplantation, Fundeni Clinical InstituteBucharestRomania
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25
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Yu CY, Ford RL, Wester ST, Shriver EM. Update on thyroid eye disease: Regional variations in prevalence, diagnosis, and management. Indian J Ophthalmol 2022; 70:2335-2345. [PMID: 35791115 PMCID: PMC9426067 DOI: 10.4103/ijo.ijo_3217_21] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/20/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022] Open
Abstract
Thyroid eye disease (TED) is a rare disease that can lead to decreased quality of life, permanent disfigurement, and vision loss. Clinically, TED presents with exophthalmos, periorbital edema, extraocular muscle dysfunction, and eyelid retraction, and can lead to vision-threatening complications such as exposure to keratopathy and dysthyroid optic neuropathy (DON). Over the last several years, significant advancements have been made in the understanding of its pathophysiology as well as optimal management. Ethnic variations in the prevalence, clinical presentation, and risk of vision-threatening complications of TED are summarized, and risk factors associated with TED are discussed. Additionally, significant advances have been made in the management of TED. The management of TED traditionally included anti-inflammatory medications, orbital radiation therapy, orbital surgical decompression, and biologic therapies. Most recently, targeted therapies such as teprotumumab, an insulin-like growth factor-1 receptor antagonist, have been studied in the context of TED, with promising initial data. In this review, updates in the understanding and management of TED are presented with a focus on the international variations in presentation and management.
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Affiliation(s)
- Caroline Y Yu
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Rebecca L Ford
- Department of Ophthalmology, Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sara T Wester
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Erin M Shriver
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
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Gadsden T, Downey LE, Vilas VDR, Peiris D, Jan S. The impact of COVID-19 on essential health service provision for noncommunicable diseases in the South-East Asia region: A systematic review. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 1:100010. [PMID: 35769108 PMCID: PMC9069231 DOI: 10.1016/j.lansea.2022.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background COVID-19 has had a profound impact on the health systems of the 11 countries of the WHO South East Asia Region. We conducted a systematic review of studies that used quantitative and comparative approaches to assess the impact of the pandemic on the service provision of four noncommunicable diseases (NCDs) (cancer, cardiovascular disease, chronic respiratory diseases, and diabetes) in the region. Methods A systematic search was conducted in PubMed, Embase, MedRxiv, and WHO COVID-19 databases in December 2021. The quality of studies was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist and the ROBINS-I risk of bias tool. A narrative synthesis was conducted following the 'synthesis without meta-analysis' reporting guidelines. Findings Two review authors independently screened 5,397 records with 31 studies included, 26 which were cross-sectional studies. Most studies (n=24, 77%) were conducted in India and 19 (61%) were single-site studies. Compared to a pre-pandemic period, 10/17 cancer studies found a >40% reduction in outpatient services, 9/14 cardiovascular disease found a reduction of 30% or greater in inpatient admissions and 2 studies found diagnoses and interventions for respiratory diseases reduced up to 78.9% and 83.0%, respectively. No eligible studies on the impact of COVID-19 on diabetes services were found. Interpretation COVID-19 has substantially disrupted the provision of essential health services for NCDs in the WHO South East Asia Region, particularly cancer and cardiovascular disease. This is likely to have serious and potentially long-term downstream impacts on health and mortality of those living with or at risk of NCDs in the region. Funding This work was supported by the WHO Sri Lanka Country Office.
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Affiliation(s)
- Thomas Gadsden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Laura E Downey
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Public Health, Imperial College London, London, United Kingdom
| | - Victor Del Rio Vilas
- World Health Organization (WHO) South East Asia Regional Office (SEARO), New Delhi, India
| | - David Peiris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, Australia
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van Os S, Syversen A, Whitaker KL, Quaife SL, Janes SM, Jallow M, Black G. Lung cancer symptom appraisal, help-seeking and diagnosis - rapid systematic review of differences between patients with and without a smoking history. Psychooncology 2022; 31:562-576. [PMID: 34766413 DOI: 10.1002/pon.5846] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/09/2021] [Accepted: 10/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death in the world. A significant minority of lung cancer patients have never smoked (14% in the UK, and ranging from 10% to 25% worldwide). Current evidence suggests that never-smokers encounter delays during the diagnostic pathway, yet it is unclear how their experiences and reasons for delayed diagnoses differ from those of current and former smokers. This rapid review assessed literature about patient experiences in relation to symptom awareness and appraisal, help-seeking, and the lung cancer diagnostic pathway, comparing patients with and without a smoking history. METHODS MEDLINE, PsychINFO and Google Scholar were searched for studies (2010-2020) that investigated experiences of the pathway to diagnosis for patients with and without a smoking history. Findings are presented using a narrative synthesis. RESULTS Analysis of seven quantitative and three qualitative studies revealed that some delays during symptom appraisal and diagnosis are unique to never-smokers. Due to the strong link between smoking and lung cancer, and low awareness of non-smoking related lung cancer risk factors and symptoms, never-smokers do not perceive themselves to be at risk. Never-smokers are also likely to evaluate their experiences in comparison with other non-smoking related cancers, where prognosis is likely better, potentially leading to lower satisfaction with healthcare. CONCLUSION Never-smokers appear to have different experiences in relation to symptom appraisal and diagnosis. However, evidence in relation to help-seeking, and what is driving diagnostic delays for never-smoker patients specifically is lacking.
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Affiliation(s)
- Sandra van Os
- Department of Applied Health Research, University College London, London, UK
| | - Aron Syversen
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | | | - Samantha L Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Mbasan Jallow
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Georgia Black
- Department of Applied Health Research, University College London, London, UK
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Jain R, Dupas P. The effects of India's COVID-19 lockdown on critical non-COVID health care and outcomes: Evidence from dialysis patients. Soc Sci Med 2022; 296:114762. [PMID: 35151150 PMCID: PMC8816957 DOI: 10.1016/j.socscimed.2022.114762] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 11/16/2021] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
India's COVID-19 lockdown, one of the most severe in the world, is widely believed to have disrupted critical non-COVID health services. However, linking these disruptions to effects on health outcomes has been difficult due to the lack of reliable, up-to-date health outcomes data. We identified all dialysis patients under a statewide health insurance program in Rajasthan, India (N = 2110), and conducted surveys to examine the effects of the lockdown on non-COVID care access and health outcomes. Post-lockdown mortality was our primary outcome and morbidity and hospitalization were secondary outcomes. 63% of patients experienced a disruption to their care. Transport barriers, hospital service disruptions, and difficulty obtaining medicines were the most common causes. We compared monthly mortality in the four months after the lockdown with pre-lockdown mortality trends, as well as with mortality trends for a similar cohort in the previous year. Mortality in May 2020, after a month of exposure to the lockdown, was 1.70 percentage points (95% CI 0.01–0.03) or 64% higher than in March 2020 and total excess mortality between April and July was estimated to be 22%. A 1SD increase in an index of care disruptions was associated with a 0.17SD (95% CI 0.13–0.22) increase in a morbidity index, a 3.1 percentage point (95% CI 0.012–0.051) increase in hospitalization, and a 2.1 percentage point (95% CI 0.00–0.04) increase in probability of death between May and July. Females, socioeconomically disadvantaged groups, and patients living far from the health system faced worse outcomes. The results highlight the unintended consequences of the lockdown on critical, life-saving non-COVID health services that must be taken into account in the implementation of future policy efforts to control the spread of pandemics. India's nationwide COVID-19 lockdown severely disrupted critical chronic care. Non-COVID-19 morbidity and mortality increased sharply in the subsequent months. Socioeconomically disadvantaged patients were worst affected. Indirect health effects increase the toll of pandemics and worsen health inequality. Pandemic control policies must ensure critical health services continue.
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Affiliation(s)
- Radhika Jain
- Shorenstein APARC, Stanford University, Stanford, CA, 94305-6055, USA.
| | - Pascaline Dupas
- Department of Economics, Stanford University, Stanford, CA, 94305-6055, USA.
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Jones SP, Baqai K, Clegg A, Georgiou R, Harris C, Holland EJ, Kalkonde Y, Lightbody CE, Maulik PK, Srivastava PMV, Pandian JD, Kulsum P, Sylaja PN, Watkins CL, Hackett ML. Stroke in India: A systematic review of the incidence, prevalence, and case fatality. Int J Stroke 2022; 17:132-140. [PMID: 34114912 PMCID: PMC8821978 DOI: 10.1177/17474930211027834] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The burden of stroke is increasing in India; stroke is now the fourth leading cause of death and the fifth leading cause of disability. Previous research suggests that the incidence of stroke in India ranges between 105 and 152/100,000 people per year. However, there is a paucity of available data and a lack of uniform methods across published studies. AIM To identify high-quality prospective studies reporting the epidemiology of stroke in India. SUMMARY OF REVIEW A search strategy was modified from the Cochrane Stroke Strategy and adapted for a range of bibliographic databases from January 1997 to August 2020. From 7717 identified records, nine studies were selected for inclusion; three population-based registries, a further three population-based registries also using community-based ascertainment and three community-based door-to-door surveys. Studies represented the four cities of Mumbai, Trivandrum, Ludhiana, Kolkata, the state of Punjab, and 12 villages of Baruipur in the state of West Bengal. The total population denominator was 22,479,509 and 11,654 (mean 1294 SD 1710) people were identified with incident stroke. Crude incidence of stroke ranged from 108 to 172/100,000 people per year, crude prevalence from 26 to 757/100,000 people per year, and one-month case fatality rates from 18% to 42%. CONCLUSIONS Further high-quality evidence is needed across India to guide stroke policy and inform the development and organization of stroke services. Future researchers should consider the World Health Organization STEPwise approach to Surveillance framework, including longitudinal data collection, the inclusion of census population data, and a combination of hospital-registry and comprehensive community ascertainment strategies to ensure complete stroke identification.
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Affiliation(s)
| | - Kamran Baqai
- University of Central Lancashire, Preston, Lancashire, UK
| | - Andrew Clegg
- University of Central Lancashire, Preston, Lancashire, UK
| | | | - Cath Harris
- University of Central Lancashire, Preston, Lancashire, UK
| | | | - Yogeshwar Kalkonde
- Society for Education, Action and Research in Community Health, Gadchiroli, India
| | | | - Pallab K Maulik
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
- Manipal University, Manipal, India
| | | | | | - Patel Kulsum
- University of Central Lancashire, Preston, Lancashire, UK
| | - PN Sylaja
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | - Maree L Hackett
- University of Central Lancashire, Preston, Lancashire, UK
- The George Institute for Global Health, University of New South Wales, New South Wales, Australia
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Tendulkar P, Pandey P, Panda PK, Bhadoria AS, Kulshreshtha P. Descriptive Epidemiology of COVID-19 Deaths during the First Wave of Pandemic in India: A Single-center Experience. Indian J Crit Care Med 2022; 26:71-75. [PMID: 35110848 PMCID: PMC8783237 DOI: 10.5005/jp-journals-10071-24085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background With the looming threat of recurrent waves of coronavirus disease-2019 (COVID-19) in the presence of mutated strains, it is of paramount importance to understand the demographic and clinical attributes of COVID-19 related mortalities in each pandemic wave. This could help policy makers, public health experts, and clinicians to better plan preventive and management strategies to curb COVID-19 related mortality. Materials and methods This was a hospital record-based, retrospective cross-sectional descriptive study, at a tertiary care hospital in Rishikesh, India. The study included all deceased patients between March 2020 and January 2021 (first wave) who had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) and were hospitalized. The study was done to describe demography, clinical presentation, laboratory parameters, treatment given, and associated complications of all COVID-19 deaths. Result Out of 424 mortalities, 298 (70.38%) were males and 126 (29.62%) were females. Mean age of patients was 55.85 ± 16.24 years, out of which 19.5% were less than 45 years old, 33.6% were 45–60 years old, and 41.8% were more than 60 years old. Comorbidity in the form of type II diabetes mellitus was present in 41.4% [95% CI (41.4–51.1)], hypertension in 39.8% [95% CI (35.1–44.6)], and coronary artery disease (CAD) in 15.2% [95% CI (11.8–18.8)]. At the time of presentation, shortness of breath was present in 73.6% [95% CI (69.1–77.7)], fever in 64.92% [95% CI (60.1–69.4)], and cough in 46.1%, [95% CI (41.1–50.8)]. Deranged laboratory parameters were lymphopenia in 90.2% [95% CI (86.8–92.7)], transaminitis in 59.7% [95% CI (54.8–64.3)], and hypercreatinemia in 37.7% [95% CI (33.1–42.5)]. Complications manifested were acute respiratory distress syndrome (ARDS) in 78.3% [95% CI (74–82.1)] and shock in 54.7% [95% CI (49.8–59.5)]. Median time duration between onset of symptom and hospital admission was 5 days (interquartile range (IQR) = 3–5 days) and median length of hospital stay was 9 days (IQR = 4–14 days). Conclusion During the first pandemic wave, COVID-19 related mortality was 2.37 times higher among males, 2.14 times in the age group >60 than <45 years. The most common associated comorbidities (>40%) were type II diabetes mellitus and hypertension. The most common associated symptoms (>60%) were shortness of breath and fever. Lymphopenia was seen in >90% cases while liver involvement in 60% and kidney in 38% cases. Median hospital stay was doubled the prehospital illness. How to cite this article Tendulkar P, Pandey P, Panda PK, Bhadoria AS, Kulshreshtha P. Descriptive Epidemiology of COVID-19 Deaths during the First Wave of Pandemic in India: A Single-center Experience. Indian J Crit Care Med 2022;26(1):71–75.
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Affiliation(s)
- Prakash Tendulkar
- Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pragya Pandey
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prasan K Panda
- Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Prasan K Panda, Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India, Phone: +91 9868999488, e-mail:
| | - Ajeet S Bhadoria
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poorvi Kulshreshtha
- Department of Physiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Ramaprasannakumar S, Karan N, Pruthi N, Kamath S. Access to pain medicines and follow-up consultation after radiofrequency ablation for trigeminal neuralgia during the COVID-19 pandemic. Saudi J Anaesth 2022; 16:406-411. [PMID: 36337383 PMCID: PMC9630670 DOI: 10.4103/sja.sja_288_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/09/2022] [Accepted: 05/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background: In the recent coronavirus disease 2019 (COVID-19) pandemic, follow-up of patients with trigeminal neuralgia post radio-frequency ablation (RFA) of the Gasserian ganglion was restricted because of closure of pain clinic services (PCSs) at our institution, travel restrictions, and fear of contracting COVID-19 infection by hospital visit. Periodic follow-ups are a must in this group of patients. Because the access to pain medications and consultations remained restricted, we tried identifying the factors predisposing to these difficulties in patients. Methods: We had contacted patients telephonically, who underwent RFA at our institution in the past 5 years as the PCS had not re-started to follow up with in-person consultation. Demographics, socio-economic factors, clinical factors, literacy status, distance to the health care system, and current health status were noted. Collected data were analyzed descriptively, and correlations were calculated between the predictors for difficulty in follow-up to access the medications and consultations. Results: Out of 121 patients who underwent RFA in the past 5 years, 73 were accessible on phone. Of these, 42.46% (31/73) patients had difficulty in accessing either medications or consultation. The literacy status of the patient was the strongest predictor (0.044) with a negative correlation (-1.216). Difficulty in accessing PCS was associated with a poor health status (p-0.032) and higher pain scores (0.066). Conclusion: Along with the clinical factors, we have to overlook other factors in predicting difficulty to access PCS in trigeminal neuralgia patients post the RFA status. Difficulty in access to pain medicines and/or consultations was associated with a poor health status and higher pain scores.
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Verberk WJ, Goswami N. Cardiovascular risk factors of airport visitors in India: results from a nation-wide campaign. J Clin Hypertens (Greenwich) 2021; 24:74-82. [PMID: 34904364 PMCID: PMC8783355 DOI: 10.1111/jch.14413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
Cardiovascular diseases have become the major cause of death in India, but overall awareness is still low. Therefore, the initiative was undertaken to set up health care screening booths at eight airports and one hospital throughout India to increase awareness and to determine cardiovascular risk factors. Participants were screened for hypertension (systolic blood pressure (BP) ≥140 mmHg or diastolic BP≥90 mmHg), diabetes [fasting blood glucose (FBG) level ≥126 or ≥200 mg/dL for random blood glucose (RBG)], and body mass index (BMI). Among 100 107 participants screened (46 ± 13 years; 17% women), prevalence of diabetes was 12 571 (15%), hypertension: 30 345 (33%) and overweight: 61 219 (65%). Diabetes was treated more often than hypertension (44% vs 11%). Hypertension and diabetes prevalence values were relatively high in young obese adults; BMI correlated significantly (p < .001) stronger to both systolic BP and RBG for subjects younger than 40 years than for those who were older (r = 0.27 vs r = 0.06 and r = 0.15 vs r = 0.03, respectively). Among obese women aged 60 years and older the hypertension prevalence was higher than 40%, in obese men this prevalence value was already seen from the group of 30 to 40 years old. For participants older than 50 years with hypertension, diabetes prevalence was 20%. These results show that screening initiatives like these are highly needed to increase the overall awareness of diabetes and particularly of hypertension. Systematic screening programs also help to identify specific patient populations and cope with undertreatment of those at the highest cardiovascular risk. The fact that women were underrepresented in the present screening campaign suggests actions are needed to encourage them to participate in health care programs.
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Affiliation(s)
- Willem J Verberk
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
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Datta BK, Husain MJ, Kostova D. Hypertension in women: the role of adolescent childbearing. BMC Public Health 2021; 21:1481. [PMID: 34325686 PMCID: PMC8323295 DOI: 10.1186/s12889-021-11488-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/09/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adolescent childbearing is associated with various health risks to the mother and child, and potentially with adverse socioeconomic outcomes. However, little is known about the role of adolescent childbearing in maternal health outcomes in adulthood. This study investigates the link between childbirth in adolescence and later-life risk of hypertension among women in India. METHODS We obtained nationally representative data on demographic and health outcomes for 442,845 women aged 25 to 49 from the India National Family Health Survey (NFHS) 2015-16. We assessed the difference in hypertension prevalence between women who gave birth in adolescence (age 10 to 19) and those who did not, for the full sample and various sub-samples, using linear probability models with controls for individual characteristics, hypertension risk factors, and geographic fixed effects. RESULTS Nearly 40% of the women in the sample gave birth in adolescence. The adjusted probability of being hypertensive in adulthood was 2.3 percentage points higher for this group compared to women who did not give childbirth in adolescence. This added probability was larger for women who gave birth earlier in adolescence (4.8 percentage points) and for women who gave birth more than once in adolescence (3.4 percentage points). CONCLUSIONS Adolescent childbearing was strongly associated with a higher probability of adult female hypertension in India. This finding illustrates the intertemporal relationship between health risk factors during the life cycle, informing the importance of addressing adverse early life events (e.g. child marriage and adolescent childbirth) for hypertension outcomes among women in India.
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Affiliation(s)
- Biplab K Datta
- Global Noncommunicable Diseases Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, 30329, GA, USA
- Present Address: Institute of Public and Preventive Health, Augusta University, 1120 15th Street, Augusta, 30912, GA, USA
| | - Muhammad J Husain
- Global Noncommunicable Diseases Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, 30329, GA, USA.
| | - Deliana Kostova
- Global Noncommunicable Diseases Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, 30329, GA, USA
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Abstract
The use of machine learning (ML) in healthcare raises numerous ethical concerns, especially as models can amplify existing health inequities. Here, we outline ethical considerations for equitable ML in the advancement of healthcare. Specifically, we frame ethics of ML in healthcare through the lens of social justice. We describe ongoing efforts and outline challenges in a proposed pipeline of ethical ML in health, ranging from problem selection to postdeployment considerations. We close by summarizing recommendations to address these challenges.
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Affiliation(s)
- Irene Y Chen
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Emma Pierson
- Microsoft Research, Cambridge, Massachusetts 02143, USA
| | - Sherri Rose
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, California 94305, USA
| | | | - Kadija Ferryman
- Department of Technology, Culture, and Society, Tandon School of Engineering, New York University, Brooklyn, New York 11201, USA
| | - Marzyeh Ghassemi
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- Institute for Medical and Evaluative Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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Sarker C, Radhakrishnan VS, Mandal P, Kumar J, Bhave S, Achari R, Dey D, Arun I, Latif Z, Arora N, Mishra D, Chandy M, Nair R. Outcomes of diffuse large B-cell lymphoma in elderly patients-real-world experience from a middle-income country setting. Ecancermedicalscience 2021; 15:1242. [PMID: 34267798 PMCID: PMC8241458 DOI: 10.3332/ecancer.2021.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Indexed: 11/17/2022] Open
Abstract
Background Diffuse large B-cell lymphoma (DLBCL) is the commonest subtype of lymphoma in the elderly and poses unique challenges in this group of patients. There is a need for more information on real-world outcomes across economic disparities. Methods Electronic Medical Record of 3,087 lymphomas (>18 years) were evaluated retrospectively, of which 842 (27%) patients were ≥65 years. Two hundred and twelve patients who were ≥65 years received first line treatment for DLBCL between May 2011 and Dec 2016. Demography, clinical features, associated co-morbidities, first line treatment outcomes and hospital costs were analysed. Patients were followed up till March 2020. Results The median age at presentation was 71 years. Gender ratio was 2.5:1. 38% patients presented with early-stage disease, 37% with low and low-intermediate International prognostic index, 49% with nodal disease. One or more co-morbidities were present in 58%. The commonest extra nodal site was gastro-intestinal (29%). Two-thirds of the patients presented with non-Germinal centre B subtype. The overall response (OR) to treatment was 72.5%. Patients who received anthracycline-based therapy (n = 124) and rituximab-based therapy (n = 159) had a median progression free survival (PFS), not reached and 47.0 months, respectively, versus 10 months and 7.9 months, respectively, for patients receiving non-anthracycline and non-rituximab therapies. At a median follow-up of 24 months, the 5-year overall survival and PFS are 44% and 41%, respectively, for the entire cohort. Conclusions DLBCL is a curable lymphoma in elderly patients with standard anthracycline and rituximab-based therapies. Improvement in outcomes largely depends on social and financial support to complete the scheduled treatments.
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Affiliation(s)
- Chandrayee Sarker
- Department of Clinical Hematology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Vivek S Radhakrishnan
- Department of Clinical Hematology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India.,https://orcid.org/0000-0001-9484-5669
| | - Payal Mandal
- Department of Clinical Hematology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Jeevan Kumar
- Department of Clinical Hematology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Saurabh Bhave
- Department of Clinical Hematology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Rimpa Achari
- Department of Radiation Oncology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Debdeep Dey
- Department of Pathology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Indu Arun
- Department of Pathology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Zameer Latif
- Department of Pathology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Neeraj Arora
- Department of Hemato Pathology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Deepak Mishra
- Department of Hemato Pathology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Mammen Chandy
- Department of Clinical Hematology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Reena Nair
- Department of Clinical Hematology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
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Malhotra S, Rahi M, Das P, Chaturvedi R, Chhibber-Goel J, Anvikar A, Shankar H, Yadav CP, Meena J, Tewari S, Gopinath SV, Chhabra R, Sharma A. Epidemiological profiles and associated risk factors of SARS-CoV-2 positive patients based on a high-throughput testing facility in India. Open Biol 2021; 11:200288. [PMID: 34062097 PMCID: PMC8169211 DOI: 10.1098/rsob.200288] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We describe the epidemiological characteristics and associated risk factors of those presenting at a large testing centre for SARS-CoV-2 infection. This is a retrospective record review of individuals who underwent SARS-CoV-2 testing by reverse transcription–polymerase chain reaction (RT-PCR) at a high-throughput national-level government facility located in the north of India. Samples collected from 6 April to 31 December 2020 are included in this work and represent four highly populous regions. Additionally, there was a prospective follow-up of 1729 cases through telephone interviews from 25 May 2020 to 20 June 2020. Descriptive analysis has been performed for profiling clinic-epidemiological aspects of suspect cases. Multivariable logistic regression analysis was undertaken to determine risk factors that are associated with SARS-CoV-2 test positivity and symptom status. A total of 125 600 participants' details have been included in this report. The mean (s.d.) age of the participants was 33.1 (±15.3) years and 66% were male. Among these tested, 9515 (7.6%) were positive for COVID-19. A large proportion of positive cases were asymptomatic. In symptomatic positive cases, the commonest symptoms were cough and fever. Increasing age (groups 20–59 and ≥60 years compared to age group less than 5 years), male sex, history of international travel, symptoms for SARS-CoV-2, and participants from Delhi and Madhya Pradesh were positively associated with SARS-CoV-2 test positivity. Having co-morbidity, risk behaviours and intra-familial positivity were associated with a positive odds ratio for exhibiting SARS-CoV-2 symptoms. Intensified testing and isolation of cases, identification of both asymptomatic and symptomatic individuals and additional care of those with co-morbidities and risk behaviours will all be collectively important for disease containment in India. Reasons for differentials in testing between men and women remain an important area for in-depth study. The increased deployment of vaccines is likely to impact the trajectory of COVID-19 in the coming time, and therefore our data will serve as a comparative resource as India experiences the second wave of infection in light of newer variants that are likely to accelerate disease spread.
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Affiliation(s)
- Sumit Malhotra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Manju Rahi
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi 110029, India
| | - Payal Das
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi 110029, India
| | - Rini Chaturvedi
- Molecular Medicine, International Centre for Genetic Engineering and Biotechnology, New Delhi 110067, India
| | - Jyoti Chhibber-Goel
- Molecular Medicine, International Centre for Genetic Engineering and Biotechnology, New Delhi 110067, India
| | - Anup Anvikar
- ICMR-National Institute of Malaria Research, New Delhi 110077, India
| | - Hari Shankar
- ICMR-National Institute of Malaria Research, New Delhi 110077, India
| | - C P Yadav
- ICMR-National Institute of Malaria Research, New Delhi 110077, India
| | - Jaipal Meena
- National Institute of Biologicals, Institutional Area, Noida, Uttar Pradesh 201309, India
| | - Shalini Tewari
- National Institute of Biologicals, Institutional Area, Noida, Uttar Pradesh 201309, India
| | - Sudha V Gopinath
- National Institute of Biologicals, Institutional Area, Noida, Uttar Pradesh 201309, India
| | - Reba Chhabra
- National Institute of Biologicals, Institutional Area, Noida, Uttar Pradesh 201309, India
| | - Amit Sharma
- Molecular Medicine, International Centre for Genetic Engineering and Biotechnology, New Delhi 110067, India.,ICMR-National Institute of Malaria Research, New Delhi 110077, India
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Gupta H, Nigam N. Risk factor profile of our society is different. J Family Med Prim Care 2021; 10:1501-1502. [PMID: 34041203 PMCID: PMC8140279 DOI: 10.4103/jfmpc.jfmpc_1933_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/27/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Harish Gupta
- Department of Medicine, KG's Medical University, Lucknow, Uttar Pradesh, India
| | - Nitu Nigam
- CFAR (Cytogenetics Unit), KG's Medical University, Lucknow, Uttar Pradesh, India
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Suman S, Kumar A, Rathod HU, Yadav T. Bilateral severe microphthalmos with bilateral colobomatus orbitopalpebral cyst: accessibility of speciality eye-care and rehabilitation services in low and middle-income countries. BMJ Case Rep 2021; 14:e241783. [PMID: 34031083 PMCID: PMC8149316 DOI: 10.1136/bcr-2021-241783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/04/2022] Open
Abstract
A 12-year-old girl presented with an unusually large mass under the right lower eyelid and a smaller mass under the left lower lid since the last 6 months. The parents had noticed the absence of the right eyeball and a very small left eyeball and no vision in both eyes since birth but did not approach the healthcare system. The patient was diagnosed as a case of bilateral severe microphthalmos with colobomatous cyst with late presentation and was treated surgically. The parents were counselled for education and training of the child in schools for visually impaired. Early treatment and rehabilitation help patients lead a normal life in these cases. In rural areas, patients face challenges in getting access to the specialty eye-care services due to several barriers, including lack of availability and affordability. This case highlights the disparities in essential health services in low and middle-income countries.
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Affiliation(s)
- Suwarna Suman
- Ophthalmology, All India Institute of Medical Sciences Jodphur, Jodhpur, India
| | - Arushi Kumar
- Dr S N Medical College and MDM Hospital, Jodhpur, Rajasthan, India
| | | | - Taruna Yadav
- Diagnostic and Interventional Radiology, All India Institute of Medical Sciences Jodphur, Jodhpur, India
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Olickal JJ, Suryanarayana BS, Chinnakali P, Saya GK, Ganapathy K, Vivekanandhan T, Subramanian S, Subrahmanyam DKS. Decentralizing diabetes care from tertiary to primary care: how many persons with diabetes can be down-referred to primary care settings? J Public Health (Oxf) 2021; 44:663-670. [PMID: 33993293 DOI: 10.1093/pubmed/fdab156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/04/2021] [Accepted: 04/30/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In a cohort of persons with diabetes (PWDs) seeking care at a tertiary care center, we aimed to determine the proportion of PWDs eligible and willing for down referral to primary health centers (PHCs). METHODS We conducted a cross-sectional analytical study among PWDs on treatment for at least 1 year. PWDs with stable blood sugar, no history of cardiovascular events and proliferative retinopathy were considered as 'eligible' for primary care management. RESULTS Of the total 1002 PWDs, mean (SD) age was 56 (12) years; 62% were male and 81% were from rural areas. About half (49%) of them were on insulin, and 52% had comorbidities. In total, 45.6% (95% CI: 42.3-48.8%) were eligible to be managed at PHCs. Among those who were eligible, 46.6% were willing to go back to PHCs. Males (APR = 1.16), people with diabetes for more than 10 years (APR = 1.23), and the presence of comorbidities (APR = 1.13) were significantly associated with unwillingness. Quality of medicines (46%) and poor facilities (40%) at PHCs were the main reasons for unwillingness. CONCLUSIONS About half of the PWDs availing care at tertiary hospitals can be managed at primary care settings; of those, only half were willing to receive care at PHCs.
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Affiliation(s)
- Jeby Jose Olickal
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - B S Suryanarayana
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - Ganesh Kumar Saya
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - Kalaiselvan Ganapathy
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry 605107, India
| | - T Vivekanandhan
- District Program Officer NCD, Villupuram District, Tamil Nadu 605602, India
| | - Sadhana Subramanian
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - D K S Subrahmanyam
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
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Thati S. Gender Differences in Osteoarthritis of Knee: An Indian Perspective. J Midlife Health 2021; 12:16-20. [PMID: 34188421 PMCID: PMC8189341 DOI: 10.4103/jmh.jmh_35_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The global burden of knee osteoarthritis (KOA) is on the rise with advancing age, as life expectancy is improving worldwide. The literature shows a higher prevalence and incidence of KOA in women. The gender differences are seen not only in the developing world but also in the developed world. KOA at advanced stage can be quite disabling affecting the individuals' functioning capacity. The available treatment modalities can improve the quality of life significantly. The aim of this review is to study the gender differences in epidemiological and clinical aspects of KOA in Indian population. METHODS The keywords "knee osteoarthritis, Gender, India," "knee osteoarthritis, Sex, India," and "knee osteoarthritis, Prevalence, India" are used for data search for retrieving data from Indian studies in MEDLINE and Google Scholar. The broad inclusion criteria were clinical and radiological diagnosis of KOA, inclusive of both men and women and excluded articles with rheumatoid arthritis, inflammatory arthritis, and secondary causes of arthritis. RESULTS A total of 18 articles were found to fulfill the broad inclusive criteria. Majority of the articles were cross-sectional prevalence studies either done in a community setup or in tertiary care hospitals. The overall prevalence of KOA in these studies ranges from 27.1% to 66.1%, depending on the lower age limit of the study population. Postmenopausal women are affected more than premenopausal women. High body mass index, hypertension, diabetes mellitus, and osteoporosis were the common comorbid conditions. DISCUSSION & CONCLUSION The gender difference in the incidence and prevalence is seen in several cross-sectional studies and case series in the Indian literature. However, there is a paucity of data on clinical presentation, progression of the diseases, disability scoring at various stages of the KOA, and management.
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Affiliation(s)
- Srinivas Thati
- Department of Orthopaedics and Trauma, AIG Hospitals, Hyderabad, Telangana, India
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Gender specific differences in COVID-19 knowledge, behavior and health effects among adolescents and young adults in Uttar Pradesh and Bihar, India. PLoS One 2020; 15:e0244053. [PMID: 33332461 PMCID: PMC7746145 DOI: 10.1371/journal.pone.0244053] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/25/2020] [Indexed: 11/19/2022] Open
Abstract
On March 24, 2020 India implemented a national lockdown to prevent spread of the novel Coronavirus disease (COVID-19) among its 1.3 billion people. As the pandemic may disproportionately impact women and girls, this study examines gender differences in knowledge of COVID-19 symptoms and preventive behaviors, as well as the adverse effects of the lockdown among adolescents and young adults. A mobile phone-based survey was implemented from April 3–22, 2020 in Uttar Pradesh and Bihar among respondents randomly selected from an existing cohort study. Respondents answered questions related to demographics, COVID-19 knowledge, attitudes, and preventive behaviors practiced, and impacts on social, economic and health outcomes. Descriptive analyses and linear probability regression models were performed for all participants and separately for men and women. A total of 1,666 adolescents and young adults (18–24 years old) were surveyed; 70% were women. While most participants had high awareness of disease symptoms and preventive behaviors, there was variation by gender. Compared to men, women were seven percentage points (pp) less likely to know the main symptoms of COVID-19 (coeff = -0.071; 95% confidence interval: -0.122 - -0.021). Among women, there was variation in knowledge by education level, urban residence, and household wealth. Women were 22 pp less likely to practice key preventive behaviors compared to men (coeff = -0.222; 95% CIL -0.263, -0.181). Women were also more likely to report recent depressive symptoms than men (coeff = 0.057; 95% CI: 0.004, 0.109). Our findings underscore that COVID-19 is already disproportionately impacting adolescent girls and young women and that they may require additional targeted, gender-sensitive messaging to foster behavior change. Gender-sensitive information campaigns and provision of health services must be accessible and provide women and girls with needed resources and support during the pandemic to ensure gains in public health and gender equity are not lost.
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Mondschein S, Quinteros M, Yankovic N. Gender bias in the Chilean public health system: Do we all wait the same? PLoS One 2020; 15:e0239445. [PMID: 32971530 PMCID: PMC7515657 DOI: 10.1371/journal.pone.0239445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 09/04/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In 2002, Chile introduced a major health reform, designed to level out inequities in healthcare coverage, access and opportunities. In particular, the opportunity guarantees ensure a maximum time to receive the appropriate diagnosis and treatment, and thus, gender bias should not be observed. OBJECTIVE To explore the existence of differences in the timeliness of treatment between women and men under the Chilean public health insurance system. We controlled by other observable variables, including age, insurance holder status, provider complexity and health district. METHODS We used an individual level database that includes all interactions for the diseases covered under the national plan from 2014 to 2019. We excluded from the analysis the diseases affecting only men, women, and infants. To study the waiting time differences between women and men, we first perform a Welch two sample t-test. Then, we used a multilevel hierarchical regression model to further explore the impact of gender in waiting time. At the individual level, we included gender, insurance holder status, age, and the interaction between gender and age. For the aggregate levels, we used the specific opportunity guarantee, the type of provider, and health district. RESULTS From the Welch two sample t-test, we found significant differences in waiting times between women and men, in seven opportunity guarantees. From the multilevel regression, the individual variables: holder status, ages between 35 and 49, and the interaction between gender and age for ages between 40 and 54 were statistically significant at 95% level. We remark that the major differences in waiting times between women and men were observed for individuals between ages from 40 to 54, with women waiting significantly longer. CONCLUSION Results show the existence of bias in the timeliness of treatment, proving that universal guarantees are not enough to reduce gender inequalities in health care.
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Affiliation(s)
- Susana Mondschein
- Industrial Engineering Department, Universidad de Chile, Santiago, Chile
- Instituto Sistemas Complejos de Ingeniería, Santiago, Chile
| | - Maria Quinteros
- Facultad de Ingeniería y Ciencias, Universidad Adolfo Ibañez, Santiago, Chile
- Universidad Finis Terrae, Santiago, Chile
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Ahmed P, Chaudhry QUN, Satti TM, Mahmood SK, Ghafoor T, Shahbaz N, Khan MA, Satti HS, Akram Z, Iftikhar R. Epidemiology of aplastic anemia: a study of 1324 cases. ACTA ACUST UNITED AC 2020; 25:48-54. [PMID: 31906834 DOI: 10.1080/16078454.2019.1711344] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective: Prevalence of aplastic anemia (AA) is high in the Asian population. This study was done to explore the etiology and association of AA with various socio-economic and environmental factors.Study design and setting: Study included 1324 consecutive AA cases registered at Armed Forces Bone Marrow Transplant Centre Rawalpindi, Pakistan, from March 2001 to August 2016. The study questionnaire was completed through an interview. It included patients' socio-demographic details, personal and family medical history, environmental attributes and clinico-hematological features.Results: The median age of patients was 20 years, 997 were male and 327 female. Distribution of non-severe, severe and very severe AA was 230 (17.4%); 598 (45.2%) and 496 (37.4%), respectively. The majority of patients were from low (n = 761, 57.5%) or middle socioeconomic class (n = 543, 41%). Consanguinity among patients (n = 806, 61%) was slightly higher than the national statistics. History of chemical exposures included fertilizers (n = 116, 8.7%), pesticides (n = 56, 4.2%) and industrial chemicals (n = 37, 2.8%). PNH clone was found in 63 of AA patients. After excluding 298 patients undergoing HSCT and 660 deaths/lost to follow-up, disease evolution was observed in 38(10.4%) patients out of 366 evaluable patients. These included PNH = 18, MDS = 11 and AML = 9.Discussion: Due to lack of funding and adequate human resource at the center, age and sex-matched controls could not be included. Other limitations were a lack of molecular testing to exclude the possibility of inherited bone marrow failure syndromes on a genetic basis.Conclusion: Younger age, male predominance and higher consanguinity point toward genetic factors in AA etiology among the South Asian population.
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Affiliation(s)
- Parvez Ahmed
- Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan.,Bone Marrow Transplant Unit, Quaid-e-Azam International Hospital, Rawalpindi, Pakistan
| | - Qamar Un Nisa Chaudhry
- Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
| | - Tariq Mahmood Satti
- Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
| | - Syed Kamran Mahmood
- Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
| | - Tariq Ghafoor
- Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
| | - Nighat Shahbaz
- Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
| | - Mehreen Ali Khan
- Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
| | - Humayoon Shafique Satti
- Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan.,Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Zaineb Akram
- Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
| | - Raheel Iftikhar
- Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
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Kaul U, Bhagwat A, Omboni S, Pancholia AK, Hardas S, Bardoloi N, Davidson D, Sivakadaksham PR, Mohan JC, Vaidyanathan PR, Natarajan S, Kapardhi LNP, Reddy KS, Solanki D, Makkar JS, Viswanathan M, Arambam P, Suvarna V, Verberk WJ. Blood pressure and heart rate related to sex in untreated subjects: the India ABPM study. J Clin Hypertens (Greenwich) 2020; 22:1154-1162. [PMID: 32558208 PMCID: PMC8029965 DOI: 10.1111/jch.13894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 12/24/2022]
Abstract
Women are underrepresented in groups of patients seeking hypertension care in India. The present paper reports trends in office and ambulatory blood pressure measurement (OBPM, ABPM) and 24-h heart rate (HR) with sex in 14,977 subjects untreated for hypertension (aged 47.3 ± 13.9 years, males 69.4%) visiting primary care physicians. Results showed that, for systolic blood pressure (SBP), females had lower daytime ABPM (131 ± 16 vs. 133 ± 14 mm Hg, P < .001) but higher nighttime ABPM (122 ± 18 vs. 121 ± 16 mm Hg, P < .001) than males. Females had higher HR than men at daytime (80 ± 11 vs 79 ± 11.5 bpm) and nighttime (71 ± 11 vs 69 ± 11), respectively (all P < .001). Dipping percentages for SBP (7.4 ± 7.3 vs 9.3 ± 7.4%), DBP (10.1 ± 8.6 vs. 12.3 ± 8.9%), and HR (10.7 ± 7.9 vs. 12.8 ± 9.2%) were lower (P < .001) for females than for males, respectively. Females more often had isolated nighttime hypertension as compared to males (14.9%, n = 684% vs 10.6%, n = 1105; P < .001). BP patterns and HR showed clear differences in sex, particularly at nighttime. As females were more often affected by non-dipping and elevated nighttime SBP and HR than males, they should receive ABPM, at least, as frequently as men to document higher risk necessitating treatment.
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Affiliation(s)
- Upendra Kaul
- Batra Hospital and Medical Research CentreNew DelhiIndia
| | | | - Stefano Omboni
- Clinical Research UnitItalian Institute of TelemedicineVareseItaly
- Scientific Research Department of Cardiology, Science and Technology Park for BiomedicineSechenov First Moscow State Medical UniversityMoscowRussia
| | | | - Suhas Hardas
- Hospital: Poona Hospital and Research CenterPune & Clinic: Hardas Heart CarePuneIndia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Willem J. Verberk
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
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Devasenapathy N, Malhotra R, Mittal K, Garg B, Kumar V, Zodpey S, Dogra H, Maddison R, Belavy DL. Higher Disability in Women Than Men Scheduled for Total Knee Arthroplasty for Degenerative Osteoarthritis: A Cross-Sectional Analysis From India. ACR Open Rheumatol 2020; 2:309-319. [PMID: 32386129 PMCID: PMC7301870 DOI: 10.1002/acr2.11137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/24/2020] [Indexed: 01/27/2023] Open
Abstract
Objective Higher level impairments and activity limitation among those scheduled for total knee arthroplasty (TKA) is known. Sex differences in participation restriction which is the final domain of disablement pathway is not known. No data from developing countries exist on sex differences in disability levels at the time of TKA. Methods In a cross‐sectional analysis of 240 patients (188 women; 72 men) scheduled for TKA, impairment (pain, symptoms, quadricep muscle strength, and knee range of motion [ROM]), activity limitation (self‐reported and objective performance‐based measurements), and participation restriction were compared. Multivariable regression analyses were used to adjust for key sociodemographic and clinical characteristics. Associations between impairments and participation restriction were analyzed. Results Compared with men, women were more likely to have higher levels of impairment (knee injury and osteoarthritis outcome pain score adjusted mean difference [aMD]: −6.9 [95% confidence interval {CI} −13.7 to −0.18]; flexion ROM of less than 100° adjusted odds ratio: 5.7 [95% CI 1.6‐20.3]; and 36% lower muscle strength [95% CI 24%‐49%]) and lower objectively measured functional ability (walking speed aMD: −0.12 m/s [95% CI −0.23 to −0.02]; stair climbing time aMD: 9.5 s [95% CI 1.5‐17.5]). Participation restriction was higher in women compared with men. Of the impairment measures (pain, ROM, and muscle strength), pain contributed to participation restriction in both sexes. Conclusion This study demonstrated higher levels of disability in women than in men at the time of TKA. Effect of pain on participation restriction was higher compared with muscle strength and ROM. Evidence of delay in decision‐making to undergo TKA and reasons for delay need to be studied specifically in the context of lower middle–income countries.
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Affiliation(s)
- Niveditha Devasenapathy
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, New Delhi, India, and Deakin University, Geelong, Victoria, Australia
| | | | - Kanchan Mittal
- All India Institute of Medical Sciences, New Delhi, India
| | - Bhavuk Garg
- All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Kumar
- All India Institute of Medical Sciences, New Delhi, India
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Experiences of Perceived Gender-based Discrimination Among Women Veterans: Data From the ECUUN Study. Med Care 2020; 58:483-490. [PMID: 32000171 DOI: 10.1097/mlr.0000000000001304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Experiences of discrimination are associated with poor health behaviors and outcomes. Understanding discrimination in health care informs interventions to improve health care experiences. OBJECTIVE Describe the prevalence of, and variables associated with, perceived gender-based discrimination in the Veterans Affairs (VA) Healthcare System among women Veterans. DESIGN A cross-sectional, telephone-based survey of a random national sample of young female Veterans. PARTICIPANTS Female VA primary care patients aged 18-45 years. MAIN MEASURES The primary outcome was perceived gender-based discrimination in VA health care. Logistic and linear regression models were used to determine associations between any perceived discrimination and cumulative perceived discrimination with patient and health service characteristics. KEY RESULTS Among 2294 women Veterans, 33.7% perceived gender-based discrimination in VA. Perceiving gender-based discrimination was associated with medical illness [adjusted odds ratio (aOR)=1.67, 95% confidence interval (CI)=1.34, 2.08], mental illness (aOR=2.06, 95% CI=1.57, 2.69), and military sexual trauma (aOR=2.65, 95% CI=2.11, 3.32). Receiving most health care from the same VA provider (aOR=0.73, 95% CI=0.57, 0.94) and receiving care at a VA site with a women's health clinic (aOR=0.76, 95% CI=0.61, 0.95) were associated with reduced odds of any perceived gender-based discrimination. Among those who perceived gender-based discrimination (n=733), perceived discrimination scores were higher among women with increased age, medical illness, or history of military sexual trauma and lower among those who saw the same VA provider for most medical care. CONCLUSIONS One third of women Veterans perceived gender-based discrimination in VA. Obtaining most medical care from the same VA provider and having a women's health clinic at one's VA were associated with less perceived discrimination.
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Langawi MA, Byrnes C, Davies JC, Hamouda S, Kabra M, Rached SZ, Sands D, Shteinberg M, Taylor-Cousar J, Tullis E, Wainwright C. 'Go for it, dream big, work hard and persist': A message to the next generation of CF leaders in recognition of International Women's Day 2020. J Cyst Fibros 2020; 19:184-193. [PMID: 32156627 DOI: 10.1016/j.jcf.2020.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 11/30/2022]
Abstract
The focus for International Women's Day 2020 is gender equity:'We can actively choose to challenge stereotypes, fight bias, broaden perceptions, improve situations and celebrate women's achievements. Collectively, each one of us can help create a gender equal world.' We have come together as an international group of women holding senior positions within CF to raise awareness. There is growing recognition of gender imbalance within our sector in senior leadership, grant and publication success. Several institutions, such as National Institutes of Health, have missions to tackle this. The issues raised by our panellists were wide-ranging: decisions around starting a family, impact on career progression; experiences of bias in appointments or promotions; selfbelief. We hope that raising these issues will encourage future leaders in CF to step up, to build teams based on fairness, equity and diversity, and to catalyse steps towards this goal in their institutions and society more widely.
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Affiliation(s)
- Mona Al Langawi
- Internal Medicine, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Cass Byrnes
- Starship Children's Health and Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Jane C Davies
- NHLI, Imperial College London and Royal Brompton Hospital, Cystic Fibrosis and Chronic Lung Disease Research Group, National Heart & Lung Institute, Imperial College London, Manresa Rd SW3 6LR, London, UK.
| | - Samia Hamouda
- Pediatrics Department B, Bechir Hamza Children's Hospital of Tunis, Tunisia
| | - Madhulika Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Samia Z Rached
- Pulmonary Division, Heart Institute, Hospital das Clínicas da Universidade de São Paulo, SP, Brazil
| | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland
| | - Michal Shteinberg
- Pulmonary Division, Lady Davis-Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Elizabeth Tullis
- Internal Medicine, Respirology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Claire Wainwright
- Respiratory and Sleep Medicine, Queensland Children's Hospital and Faculty of Medicine, University of Queensland, Brisbane, Australia
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Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the leading causes of death among women globally. Cardiovascular disease-related events are more common in older women compared with men and are more likely to result in death. Although research in high-income countries suggests that women have unique sociobiological CVD risk factors, only a few study authors have examined risk factor knowledge among women from low- and middle-income countries. OBJECTIVE The aim of this study was to assess CVD risk factor knowledge among low-income urban Indian women. METHODS A cross-sectional study was conducted among a nonprobability sample of 607 slum-dwelling women, 40 to 64 years old, living in Mysore, India, between October 2017 and May 2018. Participants underwent an interviewer-administered questionnaire measuring demographics, CVD risk factor knowledge, and medical history. RESULTS Cardiovascular disease risk factor knowledge was low in this population and was associated with age, education, income, and caste. Approximately half of the participants (47%) answered less than 50% of the questions correctly, and a third had knowledge scores greater than 70%, which we defined as "good knowledge." Only 4 of 7 traditional CVD risk factors (ie, physical activity, smoking, overweight, and high cholesterol) were recognized by greater than half of the participants. The lowest knowledge levels were among older single women with no education and monthly household incomes less than Rs 3000 (approximately US $42). CONCLUSIONS Previous research among slum dwellers in India reported a high prevalence of modifiable CVD risk factors compared with more affluent urban peers. Interventions aimed at CVD risk factor knowledge may be an important first step in controlling heart disease in this vulnerable population.
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