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Wadhwa R, Gupta N, Dixit J, Malhotra P, Lakshmi PVM, Prinja S. Cost-Effectiveness Analysis of Denosumab in the Prevention of Skeletal-Related Events Among Patients With Breast Cancer With Bone Metastasis in India. JCO Glob Oncol 2024; 10:e2300396. [PMID: 38452304 PMCID: PMC10939583 DOI: 10.1200/go.23.00396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/25/2023] [Accepted: 01/12/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Denosumab is clinically superior to zoledronic acid (ZA) for preventing and delaying time to first and subsequent skeletal-related events (SREs) among patients with breast cancer (BC) with bone metastases. We evaluated the cost and health benefits of denosumab and ZA (once every 4 weeks and once every 12 weeks) among four different molecular subtypes of BC with bone metastases in India. MATERIALS AND METHODS A Markov model was developed in Microsoft Excel to estimate lifetime health consequences and resulting costs among cohort of 1,000 patients with BC with bone metastasis, for three intervention scenarios, namely denosumab (once every 4 weeks), ZA (once every 4 weeks), and ZA (once every 12 weeks). The health outcomes were measured in terms of SREs averted and quality-adjusted life-years (QALYs) gained. The cost of each intervention scenario was measured using both the health system and the patient's perspectives. Indirect costs because of lost productivity were not included. The future costs and outcomes were discounted at the standard rate of 3%. RESULTS Over a lifetime, the incremental number of SREs averted with use of denosumab once every 4 weeks (compared with ZA once every 4 weeks and once every 12 weeks) among patients with luminal A, luminal B, human epidermal growth factor receptor 2-enriched, and triple negative breast cancer were estimated as 0.39, 0.26, 0.25, and 0.19, respectively. The number of QALYs lived were slightly higher in the denosumab arm (1.45-2.80) compared with ZA once every 4 weeks and once every 12 weeks arms (1.44-2.78). However, denosumab once every 4 weeks was not found to be a cost-effective alternative for either of the four molecular subtypes of breast cancer. ZA once every 12 weeks was found to be a cost-effective option with an average cost-effectiveness ratio ranging between ₹68,254 and ₹73,636. CONCLUSION ZA once every 12 weeks is the cost-effective treatment option for BC with bone metastases in India. The present study findings hold significance for standard treatment guidelines under India's government-funded health insurance program.
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Affiliation(s)
- Raina Wadhwa
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Haematology and Medical Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - PVM Lakshmi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Ghosh A, Kanta P, Ramola M, Mohindra R, Goyal K, Kishore R, Suri V, Lakshmi PVM, Chauhan C, Sharma M, Rakshit P, Ponnusamy K, Dikid T, Singh MP. Rapid Decline of SARS-CoV-2 Viral Load in Single vs. Double-Dose (Short-Interval <6 Weeks) ChAdOx nCoV-19 Vaccinated Health-Care Workers. Curr Microbiol 2024; 81:95. [PMID: 38353761 DOI: 10.1007/s00284-023-03603-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/26/2023] [Indexed: 02/16/2024]
Abstract
The present work was carried out during the emergence of Delta Variant of Concern (VoC) and aimed to study the change in SARS CoV-2 viral load in Covishield vaccinated asymptomatic/mildly symptomatic health-care workers (HCWs) to find out the optimum isolation period. The SARS CoV-2 viral load was carried out in sequential samples of 55 eligible HCWs which included unvaccinated (UnV; n = 11), single-dose vaccinated (SDV, n = 20) and double-dose vaccinated [DDV, n = 24; short-interval (<6 weeks)] subjects. The mean load of envelope (E) gene on day 5 in SDV [0.42 × 105 copies/reaction] was significantly lower as compared to DDV [6.3 × 105 copies/reaction, P = 0.005] and UnV [6.6 × 105 copies/reaction, P = 0.001] groups. The rate of decline of SARS CoV-2 viral load in the initial 5 days of PCR positivity was significantly higher in SDV as compared to that in DDV (Mean log decline 0.39 vs. 0.19; P < 0.001). This was possibly due to interference of adenoviral immunity of first dose of adenovirus-vectored vaccine in double-dose vaccinated HCWs who had received vaccines within a shorter interval (<6 weeks).
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Affiliation(s)
- Arnab Ghosh
- Department of Virology, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Poonam Kanta
- Department of Virology, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Manisha Ramola
- Department of Virology, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ritin Mohindra
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Kapil Goyal
- Department of Virology, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Roop Kishore
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Vikas Suri
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Chanderkanta Chauhan
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Manisha Sharma
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Partha Rakshit
- National Centre for Disease Control (NCDC), New Delhi, India
| | | | - Tanzin Dikid
- National Centre for Disease Control (NCDC), New Delhi, India
| | - Mini P Singh
- Department of Virology, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
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Ghosh A, Goyal K, Singh R, Lakshmi PVM, Kaur R, Kumar V, Muralidharan J, Puri GD, Ram J, Singh MP. High prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibodies among unvaccinated children of Chandigarh, Northwest India, in a household-based paediatric serosurvey post-second wave of pandemic (June to July 2021). Public Health 2023; 225:160-167. [PMID: 37931485 DOI: 10.1016/j.puhe.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/05/2023] [Accepted: 10/04/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Current national severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination policy covers children aged >12 years. Unvaccinated, uninfected children remain susceptible to SARS-CoV-2 and play a role in community transmission, as paediatric infection is mostly mild or asymptomatic. To estimate the proportion of susceptible children in a community for public health measures, there is a need to assess the extent of natural infection. STUDY DESIGN We performed a cross-sectional household serosurvey of SARS-CoV-2 antibodies in unvaccinated children aged between 6 and 18 years after the second COVID-19 wave. METHODS Anti-SARS-CoV-2 immunoglobin G (IgG) testing in serum was done using chemiluminescence immunoassay. We used a logistic regression model to investigate predicted factors of seropositivity. RESULTS We observed a high prevalence (weighted average: 68.3%) of anti-SARS-CoV-2 IgG in 2700 enrolled children. Logistic regression for predictors of IgG seropositivity showed lower odds in households with completely vaccinated adults (adjusted odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.26-0.71, P = 0.0011) compared with households with unvaccinated adults. Other factors for low seropositivity included frontline workers as family members (adjusted OR: 0.69, 95% CI: 0.52-0.91, P = 0.0091) and non-crowded households (adjusted OR: 0.74, 95% CI: 0.61-0.89, P = 0.0019). CONCLUSION A high SARS-CoV-2 IgG prevalence in unvaccinated children was indicative of previous exposure to potentially infected contacts. This implies in-person academic activities for children can be continued during future community transmission. Comparatively lower seropositivity in children of completely vaccinated households or frontline workers suggests decreased transmission due to vaccination-induced immunity of family members. Vaccination will still be required in these children to maintain protective IgG levels, particularly in low seroprevalence groups.
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Affiliation(s)
- A Ghosh
- Department of Virology, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - K Goyal
- Department of Virology, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - R Singh
- Department of Community Medicine & School of Public Health, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine & School of Public Health, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - R Kaur
- Department of Virology, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - V Kumar
- Department of Virology, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - J Muralidharan
- Advanced Pediatric Centre, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - G D Puri
- Department of Anaesthesiology & Critical Care, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - J Ram
- Department of Ophthalmology, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - M P Singh
- Department of Virology, Post-graduate Institute of Medical Education & Research, Chandigarh, India.
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Goel S, Kaura T, Bisht K, Kaur J, Mewara A, Lakshmi PVM, Grover GS, Biswal M. First detection and genetic identification of Rickettsia spp. from ticks collected from rodents in north India. Indian J Med Microbiol 2023; 46:100475. [PMID: 37688843 DOI: 10.1016/j.ijmmb.2023.100475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Changing climatic conditions and invasion of ticks in urban areas have led to a greater number of cases of tick-borne diseases, thus, becoming a matter of increasing concern. Tick borne rickettsioses are one of the important emerging diseases worldwide. Knowledge of epidemiology of the vector and pathogen in the community is essential in order to understand and prevent the transmission of the disease to healthy population. METHODS In our present study, we trapped rodents in selected areas of Chandigarh and Punjab in north India. The rodents were screened for the presence of ticks which were further screened for the presence of rickettsial agents. PCRs targeting 17 kDa and gltA genes were carried out followed by Sanger sequencing of the positive amplicons followed by phylogenetic analysis of the sequences. RESULTS A total of 17 ticks were collected out of which one (Rhipicephalus sanguineus) was found to be harboring a Rickettsia sp. PCR targeting gltA and 17 kDa genes of rickettsia were put up and Sanger sequencing was performed. Phylogenetic analysis revealed the sequences to be closely related to Rickettsia rhipicephali. CONCLUSION The current study establishes the presence of rickettsial agents in the community. Although Rickettsia rhipicephali is a non-pathogenic agent, the study encourages more vigorous community surveillance should be carried out in order to determine the exact burden of rickettsial agents in our community. To our knowledge, this is the first study reporting Rickettsia rhipicephali in India.
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Affiliation(s)
- Shriya Goel
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Taruna Kaura
- Department of Medical Parasitology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Kamlesh Bisht
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Jasleen Kaur
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Abhishek Mewara
- Department of Medical Parasitology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Gagandeep Singh Grover
- Department of Health and Family Welfare, Parivar Kalyan Bhawan, Sector 34, Chandigarh, Punjab, 160022, India
| | - Manisha Biswal
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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M Lakshmi PV, Elangovan A, Bhatnagar T, Kant S, Rai SK, Saha MK, Godbole S, Mehendale S, Singh YM, Verma V, Rajan S, Kumar R. Comparison of prevention of parent-to-child HIV transmission programme & national biennial HIV sentinel surveillance data for tracking HIV epidemic in India. Indian J Med Res 2023; 156:373427. [PMID: 37006025 DOI: 10.4103/ijmr.ijmr_3311_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Background & objectives HIV sentinel surveillance (HSS) among antenatal women in India has been used to track the epidemic for many years. However, reliable tracking at the local level is not possible as ANC sentinel sites are limited in number and cover a smaller sample size at each site. Prevention of parent-to-child-transmission (PPTCT) programme data has a potential advantage due to better geographical coverage, which could provide more precise HIV case estimates; therefore, we compared HSS ANC data with PPTCT programme data for HIV tracking. Methods Out of the 499 surveillance sites, where HSS and PPTCT programme was being conducted in 2015, 210 sites (140 urban and 70 rural) were selected using a stratified random sampling method. HSS (n=72,981) and PPTCT (n=112,832) data records were linked confidentially. The socio-demographic characteristics of HSS and PPTCT attendees were compared. HIV prevalence from HSS ANC was compared with the PPTCT programme data using Chi-square test. State- and site-level correlation of HIV prevalence was also done. Concordance between HSS and PPTCT HIV positivity was estimated using kappa statistics. Results The age distribution of HSS and PPTCT attendees was similar (range: 23 to 27 yr); however, HSS ANC participants were better educated, whereas PPTCT recorded a higher proportion of homemakers. The correlation of HIV prevalence between HSS and PPTCT was high (r=0.9) at the State level and moderate at the site level (r=0.7). The HIV positivity agreement between HSS ANC and PPTCT was good (kappa=0.633). A similar prevalence was reported across 26 States, whereas PPTCT had a significantly lower prevalence than HSS in three States where PPTCT coverage was low. Overall HIV prevalence was 0.31 per cent in HSS and 0.22 per cent in PPTCT (P<0.001). Interpretation & conclusions High-quality PPTCT programme data can provide reliable HIV trends in India. An operational framework for PPTCT-based surveillance should be pilot-tested in a phased manner before replacing HSS with PPTCT.
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Affiliation(s)
- P V M Lakshmi
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Arumugan Elangovan
- Computing & Information Science Division, National Institute of Epidemiology-Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Tarun Bhatnagar
- ICMR School of Public Health, National Institute of Epidemiology-Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay K Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Malay K Saha
- Division of Virology, National HIV Reference Laboratory, ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Sheela Godbole
- ICMR-National AIDS Research Institute, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - Sanjay Mehendale
- P.D. Hinduja Hospital & Medical Research Center, Mumbai, Maharashtra, India
| | - Y Manihar Singh
- Department of Community Medicine-Epidemiology Unit, Regional Institute of Medical Sciences, Imphal West, Manipur, India
| | - Vinita Verma
- Department of Evaluation & Operational Research, Strategic Information, National AIDS Control Organization, Ministry of Health & Family Welfare, New Delhi, India
| | - Shobini Rajan
- Department of Evaluation & Operational Research, Strategic Information, National AIDS Control Organization, Ministry of Health & Family Welfare, New Delhi, India
| | - Rajesh Kumar
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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C R V, Sharma R, Jayashree M, Nallasamy K, Bansal A, Angurana SK, L Mathew J, Sankhyan N, Dutta S, Verma S, Kumar R, Devnanai M, Vaidya PC, Samujh R, Singh MP, Goyal K, Lakshmi PVM, Saxena AK. Epidemiology, Clinical Profile, Intensive Care Needs and Outcome in Children with SARS-CoV-2 Infection Admitted to a Tertiary Hospital During the First and Second Waves of the COVID-19 Pandemic in India. Indian J Pediatr 2023; 90:131-138. [PMID: 35921029 PMCID: PMC9362352 DOI: 10.1007/s12098-022-04283-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/13/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To compare the epidemiological, clinical profile, intensive care needs and outcome of children hospitalized with SARS-CoV-2 infection during the first and second waves of the pandemic. METHODS This was a retrospective study of all children between 1 mo and 14 y, admitted to a dedicated COVID-19 hospital (DCH) during the first (1st June to 31st December 2020) and second waves (1st March to 30th June 2021). RESULTS Of 217 children, 104 (48%) and 113 (52%) were admitted during the first and second waves respectively. One hundred fifty-two (70%) had incidentally detected SARS-CoV-2 infection, while 65 (30%) had symptomatic COVID-19. Comorbidities were noted in 137 (63%) children. Fifty-nine (27%) and 66 (30%) children required high-dependency unit (HDU) and ICU care respectively. Severity of infection and ICU needs were similar during both waves. High-flow oxygen (n = 5, 2%), noninvasive ventilation [CPAP (n = 34, 16%) and BiPAP (n = 8, 5%)] and invasive ventilation (n = 45, 21%) were respiratory support therapies needed. NIV use was more during the second wave (26% vs. 13%; p = 0.02). The median (IQR) length (days) of DCH stay among survivors was longer during the first wave [8 (6-10) vs. 5.5 (3-8); p = 0.0001]. CONCLUSIONS Disease severity, associated comorbidities, PICU and organ support need and mortality were similar in the first and second waves of the pandemic. Children admitted during the second wave were younger, had higher proportion of NIV use and shorter length of COVID-19 hospital stay.
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Affiliation(s)
- Vishwa C R
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Raman Sharma
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Muralidharan Jayashree
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Karthi Nallasamy
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Arun Bansal
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Suresh Kumar Angurana
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Joseph L Mathew
- Division of Pediatric Pulmonology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Sankhyan
- Division of Pediatric Neurology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sourabh Dutta
- Division of Neonatology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjay Verma
- Division of Pediatric Infectious Disease, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Kumar
- Division of Pediatric Endocrinology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mahesh Devnanai
- Division of Hospital Administration, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj C Vaidya
- Division of Pediatric Pulmonology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mini P Singh
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kapil Goyal
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Akshay K Saxena
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Boakye K, Bovbjerg M, Schuna J, Branscum A, Varma RP, Ismail R, Barbarash O, Dominguez J, Altuntas Y, Anjana RM, Yusuf R, Kelishadi R, Lopez-Jaramillo P, Iqbal R, Serón P, Rosengren A, Poirier P, Lakshmi PVM, Khatib R, Zatonska K, Hu B, Yin L, Wang C, Yeates K, Chifamba J, Alhabib KF, Avezum Á, Dans A, Lear SA, Yusuf S, Hystad P. Urbanization and physical activity in the global Prospective Urban and Rural Epidemiology study. Sci Rep 2023; 13:290. [PMID: 36609613 PMCID: PMC9822998 DOI: 10.1038/s41598-022-26406-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023] Open
Abstract
Urbanization may influence physical activity (PA) levels, although little evidence is available for low- and middle- income countries where urbanization is occurring fastest. We evaluated associations between urbanization and total PA, as well as work-, leisure-, home-, and transport-specific PA, for 138,206 adults living in 698 communities across 22 countries within the Prospective Urban and Rural Epidemiology (PURE) study. The 1-week long-form International PA Questionnaire was administered at baseline (2003-2015). We used satellite-derived population density and impervious surface area estimates to quantify baseline urbanization levels for study communities, as well as change measures for 5- and 10-years prior to PA surveys. We used generalized linear mixed effects models to examine associations between urbanization measures and PA levels, controlling for individual, household and community factors. Higher community baseline levels of population density (- 12.4% per IQR, 95% CI - 16.0, - 8.7) and impervious surface area (- 29.2% per IQR, 95% CI - 37.5, - 19.7), as well as the rate of change in 5-year population density (- 17.2% per IQR, 95% CI - 25.7, - 7.7), were associated with lower total PA levels. Important differences in the associations between urbanization and PA were observed between PA domains, country-income levels, urban/rural status, and sex. These findings provide new information on the complex associations between urbanization and PA.
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Affiliation(s)
- Kwadwo Boakye
- Department of Public Health and Health Services Administration, California State University, Chico, CA, USA
| | - Marit Bovbjerg
- College of Public Health and Human Sciences, Oregon State University, 2520 SW Campus Way, Corvallis, OR, 97331, USA
| | - John Schuna
- College of Public Health and Human Sciences, Oregon State University, 2520 SW Campus Way, Corvallis, OR, 97331, USA
| | - Adam Branscum
- College of Public Health and Human Sciences, Oregon State University, 2520 SW Campus Way, Corvallis, OR, 97331, USA
| | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Health Action By People, Thiruvananthapuram, India
| | - Rosnah Ismail
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Medical Center, Kuala Lumpur, Malaysia
| | - Olga Barbarash
- Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
| | - Juan Dominguez
- Estudios Clínicos Latino América, 160, Rosario, Argentina
- Instituto Cardiovascular de Rosario, Oroño 450, Rosario, Argentina
| | - Yuksel Altuntas
- Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
| | | | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Patricio Lopez-Jaramillo
- Masira Research Institute, Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Pamela Serón
- Faculty of Medicine, Universidad de La Frontera, Claro Solar 115, Temuco, Chile
| | - Annika Rosengren
- Sahlgrenska University Hospital, Göteborg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Québec, Canada
| | - P V M Lakshmi
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rasha Khatib
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL, USA
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Bo Hu
- Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, China
| | - Lu Yin
- Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, China
| | - Chuangshi Wang
- Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, China
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Jephat Chifamba
- Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Álvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, Avenida Paulista, São Paulo, Brazil
| | - Antonio Dans
- Department of Medicine, University of the Philippines, Manila, Philippines
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, 2520 SW Campus Way, Corvallis, OR, 97331, USA.
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8
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Passi R, Kaur M, Lakshmi PVM, Cheng C, Hawkins M, Osborne RH. Health literacy strengths and challenges among residents of a resource-poor village in rural India: Epidemiological and cluster analyses. PLOS Glob Public Health 2023; 3:e0001595. [PMID: 36963029 PMCID: PMC10022012 DOI: 10.1371/journal.pgph.0001595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 02/19/2023]
Abstract
Cluster analysis can complement and extend the information learned through epidemiological analysis. The aim of this study was to determine the relative merits of these two data analysis methods for describing the multidimensional health literacy strengths and challenges in a resource poor rural community in northern India. A cross-sectional survey (N = 510) using the Health Literacy Questionnaire (HLQ) was undertaken. Descriptive epidemiology included mean scores and effect sizes among sociodemographic characteristics. Cluster analysis was based on the nine HLQ scales to determine different health literacy profiles within the population. Participants reported highest mean scores for Scale 4. Social support for health (2.88) and Scale 6. Ability to actively engage with healthcare professionals (3.66). Lower scores were reported for Scale 3. Actively managing my health (1.81) and Scale 8. Ability to find good health information (2.65). Younger people (<35 years) had much higher scores than older people (ES >1.0) for social support. Eight clusters were identified. In Cluster A, educated younger men (mean age 27 years) reported higher scores on all scales except one (Scale 1. Feeling understood and supported by a healthcare professional) and were the cluster with the highest number (43%) of new hypertension diagnoses. In contrast, Cluster H also had young participants (mean age 30 years) but with low education (72% illiterate) who scored lowest across all nine scales. While epidemiological analysis provided overall health literacy scores and associations between health literacy and other characteristics, cluster analysis provided nuanced health literacy profiles with the potential to inform development of solutions tailored to the needs of specific population subgroups.
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Affiliation(s)
- Reetu Passi
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Christina Cheng
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
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9
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Soni SL, Kajal K, Yaddanapudi LN, Malhotra P, Puri GD, Bhalla A, Singh MP, Sehgal IS, Koushal V, Varma N, Biswal M, M Lakshmi PV, Sharma S, Suri V, Deepy Z, Ram S, Yadav J, Pandey N, Sharma P, Malik N, Goyal K, Mehra A, Sahoo S, Mohindra R, Francis J, Bhargava M, Singla K, Babu P, Verma A, Khaire NS, Guru RR. Authors' response. Indian J Med Res 2022; 0:363264. [PMID: 36510884 DOI: 10.4103/0971-5916.363264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Shiv Lal Soni
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Kamal Kajal
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - L N Yaddanapudi
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Goverdhan Dutt Puri
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Mini P Singh
- Department of Virology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Vipin Koushal
- Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Neelam Varma
- Department of Pathology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - P V M Lakshmi
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Sadhna Sharma
- Department of Biochemistry, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Z Deepy
- Department of Biochemistry, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Sant Ram
- Department of Biochemistry, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Jaivinder Yadav
- Department of Paediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Navin Pandey
- Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Prashant Sharma
- Department of Haematology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Nabhajit Malik
- Department of Haematology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Kapil Goyal
- Department of Virology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Aseem Mehra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Ritin Mohindra
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Jijo Francis
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Mudit Bhargava
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Karan Singla
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Preena Babu
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Amiy Verma
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Niranjan Shiwaji Khaire
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - R R Guru
- Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
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10
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Soni SL, Kajal K, Yaddanapudi LN, Malhotra P, Puri GD, Bhalla A, Singh MP, Sehgal IS, Koushal V, Varma N, Biswal M, M Lakshmi PV, Sharma S, Suri V, Deepy Z, Ram S, Yadav J, Pandey N, Sharma P, Malik N, Goyal K, Mehra A, Sahoo S, Mohindra R, Francis J, Bhargava M, Singla K, Babu P, Verma A, Khaire NS, Guru RR. Authors' response. Indian J Med Res 2022; 156:691-692. [PMID: 36926791 DOI: 10.4103/0971-5916.371296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Affiliation(s)
- Shiv Lal Soni
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Kamal Kajal
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - L N Yaddanapudi
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Goverdhan Dutt Puri
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Mini P Singh
- Department of Virology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Vipin Koushal
- Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Neelam Varma
- Department of Pathology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - P V M Lakshmi
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Sadhna Sharma
- Department of Biochemistry, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Z Deepy
- Department of Biochemistry, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Sant Ram
- Department of Biochemistry, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Jaivinder Yadav
- Department of Paediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Navin Pandey
- Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Prashant Sharma
- Department of Haematology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Nabhajit Malik
- Department of Haematology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Kapil Goyal
- Department of Virology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Aseem Mehra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Ritin Mohindra
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Jijo Francis
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Mudit Bhargava
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Karan Singla
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Preena Babu
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Amiy Verma
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Niranjan Shiwaji Khaire
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - R R Guru
- Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
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11
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Honnavar P, Chakrabarti A, Dogra S, Lakshmi PVM, Rudramurthy S. S9.5d Genotyping of Malassezia species from seborrheic dermatitis/dandruff patients. Med Mycol 2022. [PMCID: PMC9515886 DOI: 10.1093/mmy/myac072.s9.5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
S9.5 Malassezia: pathogenesis and disease, September 23, 2022, 4:45 PM - 6:15 PM
Objectives
Seborrheic dermatitis/dandruff (SD/D) are common chronic inflammatory skin disorders characterized by recurrent greasy scales with erythema and itchiness. Malassezia lobose and M. restricta are the predominant agents associated with SD/D. The aim of the study was to differentiate Malassezia strains causing SD/D from commensal using a highly discriminatory DNA fingerprinting technique, Fluorescent Amplified Fragment Length Polymorphism (FAFLP).
Methods
A total of 154 (M. globosa, n = 85; M. restricta, n = 55; M. arunalokei, n = 14; standard strains, n = 3) isolates from SD/D patients and healthy controls were analyzed using FAFLP. DNA sample was digested with restriction enzymes EcoRI and HindIII, and the fragments were linked to prepared adapters. Pre-selective followed by selective amplification reactions were performed using EcoRI-AC [6-carboxyfluorescein (6-FAM) labeled] and HindIII-T selective primers. The similarity coefficient was determined by Pearson correlation with negative similarities clip to zero. The densitometric curve cluster analysis was performed by unweighted pair group method with arithmetic means using Bionumerics software. The similarity co-efficient of 70% was taken as a cut-off.
Results
M. restricta and M. arunalokei isolates had a similarity co-efficient of 20%, whereas it was 50% among M. restricta and 60% among M. arunalokei isolates (Fig. 1). Majority of the isolates (n = 38.69%) clustered to form FAFLP type-I, followed by type-II (n = 14.25%), and type-III (n = 3.6%). All three FAFLP types formed tight clustering among themselves (>80% similarity co-efficient) showing less genetic diversity within each FAFLP type. Type-II clustered strains were isolated from the scalp of SD/D patients (P <.05). M. arunalokei isolates were clustered into two FAFLP types (P = .05). All FAFLP type-I isolates (n = 10,71%) were from the scalp of moderate and severe SD/D patients, whereas all type-II isolates (n = 4,29%) were from nasolabial folds of either SD/D patients or healthy controls. All 11 FAFLP types of M. globosa formed very loose structured cluster showing high genetic diversity in intra and inter-FAFLP types (Fig. 2). Majority of the isolates (n = 63,74%) clustered to form FAFLP type-II, followed by type X (n = 5.6%), type-I (n = 4.5%), type-III (n = 3.3.5%), type-IV (n = 3.3.5%), type-V (n = 2.2%), type-VIII (n = 2.2%), and type-VI, VII, IX, XI (n = 1.1% each). No geographic specific isolate clustering was observed in FAFLP.
Conclusion
M. restricta type-II and M. arunalokei type-I strains were isolated only from the scalp of moderate to severe forms of SD/D. However, no such severity-specific clustering was observed in M. globosa. The results strongly suggest the role of certain genotypes of M. restricta and M. arunalokei in the causation of SD/D.
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Affiliation(s)
- Prasanna Honnavar
- American University of Antigua College of Medicine (AUACOM) , St John , Antigua and Barbuda
- Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Arunaloke Chakrabarti
- Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Sunil Dogra
- Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - PVM Lakshmi
- Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
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12
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Wang Y, Shupler M, Birch A, Chu YL, Jeronimo M, Rangarajan S, Mustaha M, Heenan L, Seron P, Saavedra N, Oliveros MJ, Lopez-Jaramillo P, Camacho PA, Otero J, Perez-Mayorga M, Yeates K, West N, Ncube T, Ncube B, Chifamba J, Yusuf R, Khan A, Liu Z, Cheng X, Wei L, Tse LA, Mohan D, Kumar P, Gupta R, Mohan I, Jayachitra KG, Mony PK, Rammohan K, Nair S, Lakshmi PVM, Sagar V, Khawaja R, Iqbal R, Kazmi K, Yusuf S, Brauer M, Hystad P. Personal and household PM 2.5 and black carbon exposure measures and respiratory symptoms in 8 low- and middle-income countries. Environ Res 2022; 212:113430. [PMID: 35526584 DOI: 10.1016/j.envres.2022.113430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/22/2022] [Accepted: 05/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Household air pollution (HAP) from cooking with solid fuels has been associated with adverse respiratory effects, but most studies use surveys of fuel use to define HAP exposure, rather than on actual air pollution exposure measurements. OBJECTIVE To examine associations between household and personal fine particulate matter (PM2.5) and black carbon (BC) measures and respiratory symptoms. METHODS As part of the Prospective Urban and Rural Epidemiology Air Pollution study, we analyzed 48-h household and personal PM2.5 and BC measurements for 870 individuals using different cooking fuels from 62 communities in 8 countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Self-reported respiratory symptoms were collected after monitoring. Associations between PM2.5 and BC exposures and respiratory symptoms were examined using logistic regression models, controlling for individual, household, and community covariates. RESULTS The median (interquartile range) of household and personal PM2.5 was 73.5 (119.1) and 65.3 (91.5) μg/m3, and for household and personal BC was 3.4 (8.3) and 2.5 (4.9) x10-5 m-1, respectively. We observed associations between household PM2.5 and wheeze (OR: 1.25; 95%CI: 1.07, 1.46), cough (OR: 1.22; 95%CI: 1.06, 1.39), and sputum (OR: 1.26; 95%CI: 1.10, 1.44), as well as exposure to household BC and wheeze (OR: 1.20; 95%CI: 1.03, 1.39) and sputum (OR: 1.20; 95%CI: 1.05, 1.36), per IQR increase. We observed associations between personal PM2.5 and wheeze (OR: 1.23; 95%CI: 1.00, 1.50) and sputum (OR: 1.19; 95%CI: 1.00, 1.41). For household PM2.5 and BC, associations were generally stronger for females compared to males. Models using an indicator variable of solid versus clean fuels resulted in larger OR estimates with less precision. CONCLUSIONS We used measurements of household and personal air pollution for individuals using different cooking fuels and documented strong associations with respiratory symptoms.
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Affiliation(s)
- Ying Wang
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Matthew Shupler
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Aaron Birch
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yen Li Chu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Jeronimo
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maha Mustaha
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Laura Heenan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Paul A Camacho
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - Johnna Otero
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | | | - Karen Yeates
- Pamoja Tunaweza Research Centre, Moshi, Tanzania; Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nicola West
- Pamoja Tunaweza Research Centre, Moshi, Tanzania
| | - Tatenda Ncube
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Brian Ncube
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jephat Chifamba
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Afreen Khan
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Zhiguang Liu
- Beijing An Zhen Hospital of the Capital University of Medical Sciences, China
| | - Xiaoru Cheng
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, China
| | - Li Wei
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, China
| | - L A Tse
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | - Indu Mohan
- Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
| | - K G Jayachitra
- St. John's Medical College & Research Institute, Bangalore, India
| | - Prem K Mony
- St. John's Medical College & Research Institute, Bangalore, India
| | - Kamala Rammohan
- Health Action By People, Government Medical College, Trivandrum, India
| | - Sanjeev Nair
- Health Action By People, Government Medical College, Trivandrum, India
| | - P V M Lakshmi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Sagar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rehman Khawaja
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Romaina Iqbal
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Khawar Kazmi
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States.
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13
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Gupta SK, Rastogi A, Kaur M, Lakshmi PVM. Diabetes-related distress and its impact on self-care of diabetes among people with type 2 diabetes mellitus living in a resource-limited setting: A community-based cross-sectional study. Diabetes Res Clin Pract 2022; 191:110070. [PMID: 36067916 DOI: 10.1016/j.diabres.2022.110070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022]
Abstract
AIM To assess the a) prevalence, b) factors associated, and c) effect on self-care practices (SCP) of diabetes related distress (DRD) among patients with Type 2 Diabetes Mellitus (T2DM) in rural Punjab, India. METHODS Amongst the cohort of 700 patients, the Diabetes Distress Scale-17 (DDS-17) was used to assess DRD and the Summary of Diabetes Self Care Activities scale (SDSCA) for diabetes SCP. Multivariable logistic regression identified the factors associated with DRD. RESULTS DRD was universal [severe or moderate in 391 (56%) and 309 (44%) patients, respectively]. Hypertension increased the odds of severe DRD [aOR 3.47; 95% CI:2.48-4.87, p-<0.01] whereas living in a joint family reduced the odds of severe DRD [aOR 0.68; 95% CI: 0.47-0.97, p- 0.03]. Patients with severe DRD were less likely to perform DM SCPs [aOR 0.53; 95% CI:0.32-0.85, p-0.01]. CONCLUSIONS The burden of DRD was alarmingly high. There is an urgent need to screen, prevent and treat DRD to improve selfcare in T2DM.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ashu Rastogi
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
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14
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Jain S, Agarwal A, Bhardwaj A, Lakshmi PVM, Singh M, Chauhan A, Singh M. Remote Monitoring and Holistic Care of Home-Isolated COVID-19 Positive Healthcare Workers Through Digital Technology During the Omicron (B1.1.529) Wave: A Prospective Cohort Study From India. Front Public Health 2022; 10:936000. [PMID: 35910868 PMCID: PMC9326076 DOI: 10.3389/fpubh.2022.936000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023] Open
Abstract
BackgroundRemote monitoring through digital technology offers a promising solution for the diverse medical, psychological and social issues that plague patients with COVID-19 under home-isolation, but remain neglected due to a lack of streamlined medical services for these patients.MethodsThis prospective cohort study determined the feasibility of remote telemonitoring of healthcare workers with mild COVID-19 under home isolation during the Omicron (B1.1.529) wave and characterized their clinico-demographic profile. A holistic monitoring model comprising of mandatory phone calls at the beginning and end of isolation, assisted by home oximetry, predesigned google forms, and opt-in software-based (eSanjeevani OPD) teleconsultation was employed. Factors associated with development of symptomatic disease were also determined.ResultsOut of 100 COVID-19 positive healthcare workers under home-isolation, data for 94 participants was available [median age 27(20–52) years, 56(60%) females]. 93(99%) patients were previously vaccinated for COVID-19 (median time from last dose = 248 days); 34(36%) had a past history of COVID-19. Fever (67%), myalgia (69%), sore throat/dry cough (70%), and running nose (45%) were the most common symptoms. No patient progressed to moderate-severe disease or required care escalation during the remote monitoring period. Most participants reported several additional psychosocial concerns which were adequately addressed. Symptomatic patients had higher BMI (24.1 vs. 21.8kg/m2, p = 0.01) compared to asymptomatic patients. Age, past infection with COVID-19, and time since last vaccine dose were not different between symptomatic and asymptomatic patients.ConclusionCOVID-19 patients under home isolation have multi-faceted medical and psychosocial issues which can be holistically managed remotely through digital technology.
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Affiliation(s)
- Siddharth Jain
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Agarwal
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupriya Bhardwaj
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - PVM Lakshmi
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manvi Singh
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Chauhan
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Meenu Singh
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- *Correspondence: Meenu Singh
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15
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Khera S, Kaur M, Kaur R, Sharma A, Mohindra R, Suri V, Lakshmi PVM, Soni RK, Bhalla A, Singh SM. Symptoms and psychosocial effects following hospitalization for Covid-19: A sequential, mixed-methods study from northern India. Natl Med J India 2022; 35:210-214. [PMID: 36715045 DOI: 10.25259/nmji_800_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background It is reported that patients who have recovered from Covid-19 continue to experience various symptoms and adverse outcomes. However, this aspect has not been studied well. We aimed to evaluate these variables and the perceived impact of Covid-19 among patients discharged from a Covid hospital in northern India. Methods We conducted this study among patients discharged from a Covid-19 hospital in northern India in June 2020. As per the official policy at that time, patients detected to have Covid-19 (symptomatically or via contact tracing) were mandatorily admitted. A sequential, mixed-methods design was followed. Patients discharged from the hospital were contacted telephonically, and the cross-sectional prevalence of symptoms, the prevalence of depression and anxiety and the social consequences of admission were assessed. A subgroup of patients was interviewed for qualitative assessment of their experience. Results A total of 274 patients provided consent and were assessed, of which 8 patients underwent detailed interviews. The prevalence of somatic symptoms was 3.4%; 36.2% of the patients had depressive and 12% of the patients had anxiety symptoms. A majority of patients experienced adverse social and economic consequences of hospitalization for Covid-19. These themes were reinforced by a qualitative analysis of in-depth interviews. Conclusions Our study population experienced a high prevalence of adverse psychosocial consequences of Covid-19. These included depression and anxiety symptoms, stigma and economic and occupational consequences. These deserve more recognition and study.
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Affiliation(s)
- Sagar Khera
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Manmeet Kaur
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rupinder Kaur
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Abhishek Sharma
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ritin Mohindra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - P V M Lakshmi
- Department of Epidemiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Roop Kishor Soni
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shubh Mohan Singh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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16
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Kumar Gupta S, Rastogi A, Kaur M, Malhotra S, Lakshmi PVM. Foot Self-Care Behaviour among People with Type 2 Diabetes mellitus Living in Rural Underserved Area of North India: A Community-Based Cross-Sectional Study. INT J LOW EXTR WOUND 2022:15347346221110074. [PMID: 35758288 DOI: 10.1177/15347346221110074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to ascertain the foot self-care behaviour and its associated factors among people with type 2 diabetes mellitus (T2DM) living in the rural resource-constrained health setting of Punjab, North India. A community based cross sectional study was undertaken in the randomly selected underserved rural area of District Fatehgarh Sahib, Punjab, North India. A pre-validated Nottingham Assessment of Functional Footcare (NAFF) scale was administered to assess foot self-care behaviour, and participants were classified based on the percentage of a maximum possible score of 84 on the scale, as poor, if the score was <50%, satisfactory if score 50%-70% and >70% good foot self-care behaviour. A total of 700 participants' responses were recorded. The study results revealed that 84% (588) of the respondents had poor, 16% (112) had satisfactory, and none were following good foot self-care behaviour. An outcome of multivariable logistics regression suggested satisfactory foot self-care behaviour was significantly associated with foot self-care education, with an adjusted odds ratio (aOR) of 2.83 (95%, CI:1.62 - 4.93; p <0.01) among respondents who had received foot self-care education, literate than illiterate (aOR 2.50 95%, CI:1.31- 4.74; p <0.01) and women compared to men (aOR 1.69 95%, CI: 1.06 -2.70; p -0.26). This study revealed that foot self-care behaviours were alarmingly low among people with T2DM living in rural resource-constrained health settings of Punjab, North India, suggesting an urgent need to disseminate foot self-care education to prevent diabetes foot related complications.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Community Medicine and School of Public Health, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, 160012
| | - Ashu Rastogi
- Department of Endocrinology, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, 160012
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, 160012
| | - Sunita Malhotra
- Department of Dietetics, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, 160012
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, 160012
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17
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Li S, Lear SA, Rangarajan S, Hu B, Yin L, Bangdiwala SI, Alhabib KF, Rosengren A, Gupta R, Mony PK, Wielgosz A, Rahman O, Mazapuspavina MY, Avezum A, Oguz A, Yeates K, Lanas F, Dans A, Abat MEM, Yusufali A, Diaz R, Lopez-Jaramillo P, Leach L, Lakshmi PVM, Basiak-Rasala A, Iqbal R, Kelishadi R, Chifamba J, Khatib R, Li W, Yusuf S. Association of Sitting Time With Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries. JAMA Cardiol 2022; 7:796-807. [PMID: 35704349 DOI: 10.1001/jamacardio.2022.1581] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance High amounts of sitting time are associated with increased risks of cardiovascular disease (CVD) and mortality in high-income countries, but it is unknown whether risks also increase in low- and middle-income countries. Objective To investigate the association of sitting time with mortality and major CVD in countries at different economic levels using data from the Prospective Urban Rural Epidemiology study. Design, Setting, and Participants This population-based cohort study included participants aged 35 to 70 years recruited from January 1, 2003, and followed up until August 31, 2021, in 21 high-income, middle-income, and low-income countries with a median follow-up of 11.1 years. Exposures Daily sitting time measured using the International Physical Activity Questionnaire. Main Outcomes and Measures The composite of all-cause mortality and major CVD (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Results Of 105 677 participants, 61 925 (58.6%) were women, and the mean (SD) age was 50.4 (9.6) years. During a median follow-up of 11.1 (IQR, 8.6-12.2) years, 6233 deaths and 5696 major cardiovascular events (2349 myocardial infarctions, 2966 strokes, 671 heart failure, and 1792 cardiovascular deaths) were documented. Compared with the reference group (<4 hours per day of sitting), higher sitting time (≥8 hours per day) was associated with an increased risk of the composite outcome (hazard ratio [HR], 1.19; 95% CI, 1.11-1.28; Pfor trend < .001), all-cause mortality (HR, 1.20; 95% CI, 1.10-1.31; Pfor trend < .001), and major CVD (HR, 1.21; 95% CI, 1.10-1.34; Pfor trend < .001). When stratified by country income levels, the association of sitting time with the composite outcome was stronger in low-income and lower-middle-income countries (≥8 hours per day: HR, 1.29; 95% CI, 1.16-1.44) compared with high-income and upper-middle-income countries (HR, 1.08; 95% CI, 0.98-1.19; P for interaction = .02). Compared with those who reported sitting time less than 4 hours per day and high physical activity level, participants who sat for 8 or more hours per day experienced a 17% to 50% higher associated risk of the composite outcome across physical activity levels; and the risk was attenuated along with increased physical activity levels. Conclusions and Relevance High amounts of sitting time were associated with increased risk of all-cause mortality and CVD in economically diverse settings, especially in low-income and lower-middle-income countries. Reducing sedentary time along with increasing physical activity might be an important strategy for easing the global burden of premature deaths and CVD.
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Affiliation(s)
- Sidong Li
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, Ontario, Canada
| | - Bo Hu
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Yin
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shrikant I Bangdiwala
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, Ontario, Canada
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jawahar Circle, Jaipur, India
| | - Prem K Mony
- St John's Medical College & Research Institute, Bangalore, India
| | - Andreas Wielgosz
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Omar Rahman
- University of Liberal Arts, Dhaka, Bangladesh
| | - M Y Mazapuspavina
- Department of Primary Care Medicine, Faculty of Medicine UiTM Sg Buloh Campus, University Teknologi MARA UiTM, Malaysia
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz and UNISA, São Paulo, Brazil
| | - Aytekin Oguz
- Faculty of Medicine, Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Antonio Dans
- Department of Medicine, University of the Philippines, Manila, Philippines
| | - Marc Evans M Abat
- Division of Adult Medicine, Department of Medicine, Philippine General Hospital, Ermita, Manila, Philippines
| | - Afzalhussein Yusufali
- Hatta Hospital, Dubai Health Authority/Dubai Medical College, Dubai, United Arab Emirates
| | - Rafael Diaz
- Estudios Clínicos Latino América, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | | | - Lloyd Leach
- University of the Western Cape, Bellville, Cape Town, South Africa
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jephat Chifamba
- Department of Biomedical Sciences Physiology Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Rasha Khatib
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, Illinois.,Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Wei Li
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, Ontario, Canada
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18
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Wang Y, Shupler M, Birch A, Chu YL, Jeronimo M, Rangarajan S, Mustaha M, Heenan L, Seron P, Lanas F, Salazar L, Saavedra N, Oliveros MJ, Lopez-Jaramillo P, Camacho PA, Otero J, Perez-Mayorga M, Yeates K, West N, Ncube T, Ncube B, Chifamba J, Yusuf R, Khan A, Liu Z, Bo H, Wei L, Tse LA, Mohan D, Kumar P, Gupta R, Mohan I, Jayachitra KG, Mony PK, Rammohan K, Nair S, Lakshmi PVM, Sagar V, Khawaja R, Iqbal R, Kazmi K, Yusuf S, Brauer M, Hystad P. Measuring and predicting personal and household Black Carbon levels from 88 communities in eight countries. Sci Total Environ 2022; 818:151849. [PMID: 34822894 DOI: 10.1016/j.scitotenv.2021.151849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 06/13/2023]
Abstract
Black Carbon (BC) is an important component of household air pollution (HAP) in low- and middle- income countries (LMICs), but levels and drivers of exposure are poorly understood. As part of the Prospective Urban and Rural Epidemiological (PURE) study, we analyzed 48-hour BC measurements for 1187 individual and 2242 household samples from 88 communities in 8 LMICs (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Light absorbance (10-5 m-1) of collected PM2.5 filters, a proxy for BC concentrations, was calculated via an image-based reflectance method. Surveys of household/personal characteristics and behaviors were collected after monitoring. The geometric mean (GM) of personal and household BC measures was 2.4 (3.3) and 3.5 (3.9)·10-5 m-1, respectively. The correlation between BC and PM2.5 was r = 0.76 for personal and r = 0.82 for household measures. A gradient of increasing BC concentrations was observed for cooking fuels: BC increased 53% (95%CI: 30, 79) for coal, 142% (95%CI: 117, 169) for wood, and 190% (95%CI: 149, 238) for other biomass, compared to gas. Each hour of cooking was associated with an increase in household (5%, 95%CI: 3, 7) and personal (5%, 95%CI: 2, 8) BC; having a window in the kitchen was associated with a decrease in household (-38%, 95%CI: -45, -30) and personal (-31%, 95%CI: -44, -15) BC; and cooking on a mud stove, compared to a clean stove, was associated with an increase in household (125%, 95%CI: 96, 160) and personal (117%, 95%CI: 71, 117) BC. Male participants only had slightly lower personal BC (-0.6%, 95%CI: -1, 0.0) compared to females. In multivariate models, we were able to explain 46-60% of household BC variation and 33-54% of personal BC variation. These data and models provide new information on exposure to BC in LMICs, which can be incorporated into future exposure assessments, health research, and policy surrounding HAP and BC.
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Affiliation(s)
- Ying Wang
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Matthew Shupler
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Aaron Birch
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yen Li Chu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Jeronimo
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maha Mustaha
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Laura Heenan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | | | | - Paul A Camacho
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - Johnna Otero
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - Maritza Perez-Mayorga
- Facultad de Medicina Universidad Militar Nueva Granada and Clinica de Marly, Bogota, Colombia
| | - Karen Yeates
- Pamoja Tunaweza Research Centre, Moshi, Tanzania; Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nicola West
- Pamoja Tunaweza Research Centre, Moshi, Tanzania
| | - Tatenda Ncube
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Brian Ncube
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jephat Chifamba
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Afreen Khan
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Zhiguang Liu
- Beijing An Zhen Hospital of the Capital University of Medical Sciences, China
| | - Hu Bo
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, China
| | - Li Wei
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, China
| | - L A Tse
- Jockey Club School of Public health and Primary Care, the Chinese University of Hong Kong, HKSAR, China
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | - Indu Mohan
- Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
| | - K G Jayachitra
- St. John's Medical College & Research Institute, Bangalore, India
| | - Prem K Mony
- St. John's Medical College & Research Institute, Bangalore, India
| | - Kamala Rammohan
- Health Action By People, Government Medical College, Trivandrum, India
| | - Sanjeev Nair
- Health Action By People, Government Medical College, Trivandrum, India
| | - P V M Lakshmi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Sagar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rehman Khawaja
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Romaina Iqbal
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Khawar Kazmi
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States.
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19
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Shupler M, Hystad P, Birch A, Chu YL, Jeronimo M, Miller-Lionberg D, Gustafson P, Rangarajan S, Mustaha M, Heenan L, Seron P, Lanas F, Cazor F, Jose Oliveros M, Lopez-Jaramillo P, Camacho PA, Otero J, Perez M, Yeates K, West N, Ncube T, Ncube B, Chifamba J, Yusuf R, Khan A, Liu Z, Wu S, Wei L, Tse LA, Mohan D, Kumar P, Gupta R, Mohan I, Jayachitra KG, Mony PK, Rammohan K, Nair S, Lakshmi PVM, Sagar V, Khawaja R, Iqbal R, Kazmi K, Yusuf S, Brauer M. Multinational prediction of household and personal exposure to fine particulate matter (PM 2.5) in the PURE cohort study. Environ Int 2022; 159:107021. [PMID: 34915352 DOI: 10.1016/j.envint.2021.107021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Use of polluting cooking fuels generates household air pollution (HAP) containing health-damaging levels of fine particulate matter (PM2.5). Many global epidemiological studies rely on categorical HAP exposure indicators, which are poor surrogates of measured PM2.5 levels. To quantitatively characterize HAP levels on a large scale, a multinational measurement campaign was leveraged to develop household and personal PM2.5 exposure models. METHODS The Prospective Urban and Rural Epidemiology (PURE)-AIR study included 48-hour monitoring of PM2.5 kitchen concentrations (n = 2,365) and male and/or female PM2.5 exposure monitoring (n = 910) in a subset of households in Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania and Zimbabwe. PURE-AIR measurements were combined with survey data on cooking environment characteristics in hierarchical Bayesian log-linear regression models. Model performance was evaluated using leave-one-out cross validation. Predictive models were applied to survey data from the larger PURE cohort (22,480 households; 33,554 individuals) to quantitatively estimate PM2.5 exposures. RESULTS The final models explained half (R2 = 54%) of the variation in kitchen PM2.5 measurements (root mean square error (RMSE) (log scale):2.22) and personal measurements (R2 = 48%; RMSE (log scale):2.08). Primary cooking fuel type, heating fuel type, country and season were highly predictive of PM2.5 kitchen concentrations. Average national PM2.5 kitchen concentrations varied nearly 3-fold among households primarily cooking with gas (20 μg/m3 (Chile); 55 μg/m3 (China)) and 12-fold among households primarily cooking with wood (36 μg/m3 (Chile)); 427 μg/m3 (Pakistan)). Average PM2.5 kitchen concentration, heating fuel type, season and secondhand smoke exposure were significant predictors of personal exposures. Modeled average PM2.5 female exposures were lower than male exposures in upper-middle/high-income countries (India, China, Colombia, Chile). CONCLUSION Using survey data to estimate PM2.5 exposures on a multinational scale can cost-effectively scale up quantitative HAP measurements for disease burden assessments. The modeled PM2.5 exposures can be used in future epidemiological studies and inform policies targeting HAP reduction.
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Affiliation(s)
- Matthew Shupler
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom.
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Aaron Birch
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yen Li Chu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Jeronimo
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maha Mustaha
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Laura Heenan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Pamela Seron
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Paul A Camacho
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - Johnna Otero
- Universidad Militar Nueva Granada, Bogota, Colombia
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Nicola West
- Pamoja Tunaweza Research Centre, Moshi, Tanzania
| | - Tatenda Ncube
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Brian Ncube
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jephat Chifamba
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Afreen Khan
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Zhiguang Liu
- Beijing An Zhen Hospital of the Capital University of Medical Sciences, China
| | - Shutong Wu
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, China
| | - Li Wei
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, China
| | - Lap Ah Tse
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, HKSAR, China
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | - Indu Mohan
- Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
| | - K G Jayachitra
- St. John's Medical College & Research Institute, Bangalore, India
| | - Prem K Mony
- St. John's Medical College & Research Institute, Bangalore, India
| | - Kamala Rammohan
- Health Action By People, Government Medical College, Trivandrum, India
| | - Sanjeev Nair
- Health Action By People, Government Medical College, Trivandrum, India
| | - P V M Lakshmi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Sagar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rehman Khawaja
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Romaina Iqbal
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Khawar Kazmi
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Chakrapani V, Lakshmi PVM, Newman PA, Kaur J, Tsai AC, Vijin PP, Singh B, Kumar P, Rajan S, Kumar R. Syndemic violence victimization, alcohol and drug use, and HIV transmission risk behavior among HIV-negative transgender women in India: A cross-sectional, population-based study. PLOS Glob Public Health 2022; 2:e0000437. [PMID: 36962491 PMCID: PMC10021466 DOI: 10.1371/journal.pgph.0000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/29/2022] [Indexed: 03/26/2023]
Abstract
Transgender women globally are disproportionately burdened by HIV. Co-occurring epidemics of adverse psychosocial exposures accelerate HIV sexual risk, including among transgender women; however, studies using additive models fail to examine synergies among psychosocial conditions that define a syndemic. We examined the impact of synergistic interactions among 4 psychosocial exposures on condomless anal sex (CAS) among transgender women in India. A national probability-based sample of 4,607 HIV-negative transgender women completed the Indian Integrated Biological and Behavioural Surveillance survey, 2014-2015. We used linear probability regression and logistic regression to assess 2-, 3-, and 4-way interactions among 4 psychosocial exposures (physical violence, sexual violence, drug use, and alcohol use) on CAS. Overall, 27.3% reported physical and 22.3% sexual violence victimization (39.2% either physical or sexual violence), one-third (33.9%) reported frequent alcohol use and 11.5% illicit drug use. Physical violence was associated with twofold higher odds of CAS in the main effects model. Statistically significant two- and three-way interactions were identified, on both the multiplicative and the additive scales, between physical violence and drug use; physical and sexual violence; physical violence, sexual violence, and alcohol use; and physical violence, alcohol use and drug use. Physical and sexual violence victimization, and alcohol and drug use are highly prevalent and synergistically interact to increase CAS among HIV-negative transgender women in India. Targeted and integrated multilevel initiatives to improve the assessment of psychosocial comorbidities, to combat systemic transphobic violence, and to provide tailored, trauma-informed alcohol and substance use treatment services may reduce HIV risk among transgender women.
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Affiliation(s)
- Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
| | - P V M Lakshmi
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
| | - Peter A Newman
- University of Toronto, Factor-Inwentash Faculty of Social Work, Toronto, Canada
| | - Jasvir Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
| | - Alexander C Tsai
- Massachusetts General Hospital and Harvard Medical School, Boston, United States of America
| | - P P Vijin
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
| | - Bhawani Singh
- National AIDS Control Organisation, New Delhi, India
| | - Pradeep Kumar
- National AIDS Control Organisation, New Delhi, India
| | - Shobini Rajan
- National AIDS Control Organisation, New Delhi, India
| | - Rajesh Kumar
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
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Valecha D, Lakshmi PVM, Sachdeva N, Kumar R. Association of birth weight with risk factors of cardiovascular diseases: A birth cohort analysis from a rural area of Northern India. Indian J Public Health 2022; 66:9-14. [PMID: 35381707 DOI: 10.4103/ijph.ijph_944_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Fetal origin of cardiovascular diseases (CVD) hypothesis has been explored mostly in retrospective studies. OBJECTIVES A prospective study was conducted to find the association of birth weight with CVD risk factors. METHODS A cohort of 243 babies born in 1992-1993 in ten villages of Raipur Rani Block in India, were followed-up in 2016-2017. WHO STEPS methods were used to assess the risk factors of CVDs. A total of 213 (87.8%) participants were examined; blood samples were collected from 207. Multivariable regression analysis was done to adjust for the confounding variables. RESULTS Study participants were 22-24 year old, 27.7% were exposed to tobacco and 24.8% consumed alcohol, 3.3% were taking >5 servings of fruits and vegetables per day, 35.7% were physically inactive, 28.6% were overweight (body mass index [BMI] ≥23 kg/m2), 12.2% had hypertension, 16% had high cholesterol (≥200 mg/dl), 16.4% had insulin resistance (IR) (Homeostatic Model Assessment-IR >3), and 20.7% were born with low birth weight (<2.5 kg). Multivariable regression analysis revealed inverse relationship between birth weight and systolic blood pressure (regression coefficient ‒3.72 mmHg, 95% confidence interval ‒7.249; ‒0.183, P < 0.05). CONCLUSION Birth weight has inverse relationship with blood pressure. Effect of birth weight on CVDs should also be studied in future follow-ups.
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Affiliation(s)
- Divya Valecha
- Former Junior Resident, Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P V M Lakshmi
- Professor, Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Sachdeva
- Additional Professor, Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Kumar
- Former Professor, Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kumar J, Kumar P, Saini SS, Sundaram V, Mukhopadhyay K, Dutta S, Paulpandian RR, Mittal P, Das S, Rameshbabu M, Mandula PP, Ranjan A, Tiwari D, Taneja M, Garg A, Jayashree M, Goyal K, Singh M, Puri GD, M Lakshmi PV, Guru RR. Clinical characteristics & outcome of SARS-CoV-2 infected neonates presenting to paediatric emergency. Indian J Med Res 2022; 155:189-196. [PMID: 35859443 PMCID: PMC9552379 DOI: 10.4103/ijmr.ijmr_461_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background & objectives Data on neonatal COVID-19 are limited to the immediate postnatal period, with a primary focus on vertical transmission in inborn infants. This study was aimed to assess the characteristics and outcome of COVID-19 in outborn neonates. Methods All neonates admitted to the paediatric emergency from August 1 to December 31, 2020, were included in the study. SARS-CoV-2 reverse transcription- (RT)-PCR test was done on oro/nasopharyngeal specimens obtained at admission. The clinical characteristics and outcomes of SARS-CoV-2 positive and negative neonates were compared and the diagnostic accuracy of a selective testing policy was assessed. Results A total of 1225 neonates were admitted during the study period, of whom SARS-CoV-2 RT-PCR was performed in 969. The RT-PCR test was positive in 17 (1.8%). Mean (standard deviation) gestation and birth weight of SARS-CoV-2-infected neonates were 35.5 (3.2) wk and 2274 (695) g, respectively. Most neonates (11/17) with confirmed COVID-19 reported in the first two weeks of life. Respiratory distress (14/17) was the predominant manifestation. Five (5/17, 29.4%) SARS-CoV-2 infected neonates died. Neonates with COVID-19 were at a higher risk for all-cause mortality [odds ratio (OR): 3.1; 95% confidence interval (CI): 1.1-8.9, P=0.03]; however, mortality did not differ after adjusting for lethal malformation (OR: 2.4; 95% CI: 0.7-8.7). Sensitivity, specificity, accuracy, positive and negative likelihood ratios (95% CI) of selective testing policy for SARS-CoV-2 infection at admission was 52.9 (28.5-76.1), 83.3 (80.7-85.6), 82.8 (80.3-85.1), 3.17 (1.98-5.07), and 0.56 (0.34-0.93) per cent, respectively. Interpretation & conclusions SARS-CoV-2 positivity rate among the outborn neonates reporting to the paediatric emergency and tested for COVID-19 was observed to be low. The selective testing policy had poor diagnostic accuracy in distinguishing COVID-19 from non-COVID illness.
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Affiliation(s)
- Jogender Kumar
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Praveen Kumar
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shiv Sajan Saini
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Venkataseshan Sundaram
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kanya Mukhopadhyay
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sourabh Dutta
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Raja Rajan Paulpandian
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Piyush Mittal
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Swati Das
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Monisha Rameshbabu
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Phani Priya Mandula
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ankit Ranjan
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Deepika Tiwari
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Manish Taneja
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashok Garg
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Murlidharan Jayashree
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kapil Goyal
- Department of Virology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Mini Singh
- Department of Virology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Rashmi Ranjan Guru
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Chauhan A, Singh M, Agarwal A, Jaiswal N, M Lakshmi PV, Singh M. Exploring the role of bacillus calmette-guerin vaccination in protection against COVID-19. Int J Mycobacteriol 2021; 10:433-436. [PMID: 34916464 DOI: 10.4103/ijmy.ijmy_179_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background In recent studies, it has been established that countries having Bacillus Calmette-Guerin (BCG) vaccination programs reported less COVID-19 cases and deaths per population Preliminary studies suggest that BCG vaccination could upregulate the vaccine-induced immunity against SARS-CoV-2. Hence, the recent study was aimed to determine the association of BCG vaccine with the development of COVID-19 in health care workers. Methods The participants included in the study were healthcare workers (doctors, paramedics, and other supporting staff) working in the high and low-risk zones of COVID-19 in the hospital. The Graph Pad statistical analysis tool was used to determine the association of preliminary BCG vaccination with their COVID-19 status. Results A total of 200 health care workers working in different departments of the hospital were enrolled in the study. The relative risk of COVID-19 positivity in BCG vaccinated versus unvaccinated was 0.79 (0.50-1.25). There was also a significant negative correlation between two groups. The relative risk of COVID-19 positivity in those with a BCG scar was 0.63 (0.44-0.92). The relative risk of COVID-19 infection in those with a history of tuberculosis was 1.08 (0.56-2.09). Conclusion The present study did not support the beneficial effect of BCG vaccine in protection against the development of COVID-19 disease.
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Affiliation(s)
- Anil Chauhan
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manvi Singh
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Agarwal
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nishant Jaiswal
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Meenu Singh
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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25
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Honnavar P, Chakrabarti A, Dhaliwal M, Dogra S, Handa S, Lakshmi PVM, Rudramurthy SM. Sociodemographic characteristics and spectrum of Malassezia species in individuals with and without seborrhoeic dermatitis/dandruff: A comparison of residents of the urban and rural populations. Med Mycol 2021; 59:259-265. [PMID: 32556200 DOI: 10.1093/mmy/myaa050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 12/22/2022] Open
Abstract
Seborrhoeic dermatitis/dandruff (SD/D) is a common, persistent, relapsing inflammatory condition affecting the areas rich in sebaceous glands. SD/D is widely prevalent in India but Malassezia species implicated are not well studied. To estimate the prevalence and spectrum of Malassezia species causing SD/D and understand the sociodemographic characteristics of SD/D in rural and urban populations, a total of 200 SD/D patients and 100 healthy controls (HC) from both rural and urban backgrounds were enrolled in this study. SD/D severity was clinically graded as mild, moderate, severe, and very severe. The isolates were identified by phenotypic characters and confirmed by ITS2 PCR-RFLP and sequencing of the ITS region of rDNA. Severe (59%) and very severe (71%) form of SD/D was higher in the rural population compared to the urban population (P = .004). The isolation rate of Malassezia was significantly higher in overall SD/D patients scalp (82%) compared to HC (67%) (P = .005). From the scalp of SD/D patients, M. globosa (36.2%) was predominantly isolated followed by M. restricta (31.3%), M. furfur (15.7%), a mixture of M. globosa and M. restricta (12%) or M. arunalokei (4.8%). Similarly, M. globosa (49.3%) was predominately isolated from the scalp of HC followed by M. restricta (22.4%). M. restricta was significantly higher in the scalp of SD/D patients compared to HC and/or nasolabial fold of both SD/D patients and HC (P = .0001). Our findings indicate that M. restricta has a high association with SD/D. More severe disease frequency was observed in the rural population. PRECIS Dandruff is associated with Malassezia restricta and very severe cases are higher in rural population, probably due the poor hygiene. Moderate to severe hair loss and itching were strongly associated with dandruff. Use of soaps to cleanse scalp appears to be better than shampoo in preventing dandruff.
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Affiliation(s)
| | | | | | - Sunil Dogra
- Dept. of Dermatology, Leprosy and Venereology
| | | | - P V M Lakshmi
- Dept. of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Singh D, Prinja S, Bahuguna P, Chauhan AS, Guinness L, Sharma S, Lakshmi PVM. Cost of scaling-up comprehensive primary health care in India: Implications for universal health coverage. Health Policy Plan 2021; 36:407-417. [PMID: 33693828 DOI: 10.1093/heapol/czaa157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 11/14/2022] Open
Abstract
India has announced the ambitious program to transform the current primary healthcare facilities to health and wellness centres (HWCs) for provision of comprehensive primary health care (CPHC). We undertook this study to assess the cost of this scale-up to inform decisions on budgetary allocation, as well as to set the norms for capitation-based payments. The scale-up cost was assessed from both a financial and an economic perspective. Primary data on resources used to provide services in 93 sub-health centres (SHCs) and 38 primary health care centres (PHCs) were obtained from the National Health System Cost Database. The cost of additional infrastructure and human resources was assessed against the normative guidelines of Indian Public Health Standards and the HWC. The cost of other inputs (drugs, consumables, etc.) was determined by undertaking the need estimation based on disease burden or programme guidelines, standard treatment guidelines and extent and pattern of care utilization from nationally representative sample surveys. The financial cost is reported in terms of the annual incremental cost at health facility level, as well as its implications at national level, given the planned scale-up path. Secondly, economic cost is assessed as the total annual as well as annual per capita cost of services at HWC level. Bootstrapping technique was undertaken to estimate 95% confidence intervals for cost estimations. Scaling to CPHC through HWC would require an additional ₹ 721 509 (US$10 178) million allocation of funds for primary healthcare >5 years from 2019 to 2023. The scale-up would imply an addition to Government of India's health budget of 2.5% in 2019 to 12.1% in 2023. Our findings suggest a scale-up cost of 0.15% of gross domestic product (GDP) for full provision of CPHC which compares with current public health spending of 1.28% of GDP and a commitment of 2.5% of GDP by 2025 in the National Health Policy. If a capitation-based payment system was used to pay providers, provision of CPHC would need to be paid at between ₹ 333 (US$4.70) and ₹ 253 (US$3.57) per person covered for SHC and PHC, respectively.
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Affiliation(s)
- Diksha Singh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lorna Guinness
- Centre for Global Development (Europe), Great College St, Westminster, London SW1P 3SE, UK
| | - Sameer Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Narula N, Wong ECL, Dehghan M, Mente A, Rangarajan S, Lanas F, Lopez-Jaramillo P, Rohatgi P, Lakshmi PVM, Varma RP, Orlandini A, Avezum A, Wielgosz A, Poirier P, Almadi MA, Altuntas Y, Ng KK, Chifamba J, Yeates K, Puoane T, Khatib R, Yusuf R, Boström KB, Zatonska K, Iqbal R, Weida L, Yibing Z, Sidong L, Dans A, Yusufali A, Mohammadifard N, Marshall JK, Moayyedi P, Reinisch W, Yusuf S. Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study. BMJ 2021; 374:n1554. [PMID: 34261638 PMCID: PMC8279036 DOI: 10.1136/bmj.n1554] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the relation between intake of ultra-processed food and risk of inflammatory bowel disease (IBD). DESIGN Prospective cohort study. SETTING 21 low, middle, and high income countries across seven geographical regions (Europe and North America, South America, Africa, Middle East, south Asia, South East Asia, and China). PARTICIPANTS 116 087 adults aged 35-70 years with at least one cycle of follow-up and complete baseline food frequency questionnaire (FFQ) data (country specific validated FFQs were used to document baseline dietary intake). Participants were followed prospectively at least every three years. MAIN OUTCOME MEASURES The main outcome was development of IBD, including Crohn's disease or ulcerative colitis. Associations between ultra-processed food intake and risk of IBD were assessed using Cox proportional hazard multivariable models. Results are presented as hazard ratios with 95% confidence intervals. RESULTS Participants were enrolled in the study between 2003 and 2016. During the median follow-up of 9.7 years (interquartile range 8.9-11.2 years), 467 participants developed incident IBD (90 with Crohn's disease and 377 with ulcerative colitis). After adjustment for potential confounding factors, higher intake of ultra-processed food was associated with a higher risk of incident IBD (hazard ratio 1.82, 95% confidence interval 1.22 to 2.72 for ≥5 servings/day and 1.67, 1.18 to 2.37 for 1-4 servings/day compared with <1 serving/day, P=0.006 for trend). Different subgroups of ultra-processed food, including soft drinks, refined sweetened foods, salty snacks, and processed meat, each were associated with higher hazard ratios for IBD. Results were consistent for Crohn's disease and ulcerative colitis with low heterogeneity. Intakes of white meat, red meat, dairy, starch, and fruit, vegetables, and legumes were not associated with incident IBD. CONCLUSIONS Higher intake of ultra-processed food was positively associated with risk of IBD. Further studies are needed to identify the contributory factors within ultra-processed foods. STUDY REGISTRATION ClinicalTrials.gov NCT03225586.
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Affiliation(s)
- Neeraj Narula
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Emily C L Wong
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Mahshid Dehghan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Andrew Mente
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Fernando Lanas
- Department of Internal Medicine, Universidad de La Frontera, Temuco, Chile
| | - Patricio Lopez-Jaramillo
- Masira Research Institute, Universidad de Santander (UDES) Fundación Oftalmológica de Santander-FOSCAL-Bucaramanga, Colombia
| | - Priyanka Rohatgi
- Department of Nutrition and Dietetics, Apollo Hospitals, Bangalore, India
| | - P V M Lakshmi
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, SCTIMST and Health Action by People, Thiruvananthapuram, India
| | - Andres Orlandini
- Department of Cardiology, Estudios Clinicos Latinoamerica ECLA Rosario, Santa Fe, Argentina
| | - Alvaro Avezum
- International Research Centre, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil, Universidade Santo Amaro (UNISA), Sao Paulo, Brazil
| | - Andreas Wielgosz
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Paul Poirier
- Faculté de pharmacie, Université Laval Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Majid A Almadi
- Department of Medicine, Division of Gastroenterology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yuksel Altuntas
- University of Health Sciences, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Health Training and Research Hospital, Clinic of Endocrinology and Metabolism Sisli/Istanbul, Turkey
| | - Kien Keat Ng
- Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia
| | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Bellville. South Africa
| | - Rasha Khatib
- Institute for Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Rita Yusuf
- Advocate Research Institute, Advocate Health Care, IL, USA
- School of Life Sciences, Independent University, Bangladesh Bashundhara, Dhaka, Bangladesh
| | - Kristina Bengtsson Boström
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Romaina Iqbal
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Liu Weida
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences Mentougou District, Beijing, China
| | - Zhu Yibing
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences Mentougou District, Beijing, China
| | - Li Sidong
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences Mentougou District, Beijing, China
| | - Antonio Dans
- Section of Adult Medicine and Medical Research Unit, University of Philippines, Manila, Philippines
| | - Afzalhussein Yusufali
- Hatta Hospital, Dubai Medical University, Dubai Health Authority, Dubai, United Arab Emirates
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - John K Marshall
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Paul Moayyedi
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Walter Reinisch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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Gupta SK, Lakshmi PVM, Rastogi A, Kaur M. Development and evaluation of self-care intervention to improve self-care practices among people living with type 2 diabetes mellitus: a mixed-methods study protocol. BMJ Open 2021; 11:e046825. [PMID: 34210727 PMCID: PMC8252870 DOI: 10.1136/bmjopen-2020-046825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/02/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The management of diabetes mellitus (DM) depends on medication adherence, self-care and regular follow-up to prevent complications and premature mortality. This study aims to develop and implement the behavioural change theory and model based diabetes self-care intervention package to improve self-care practices among people living with type 2 DM. METHODS AND ANALYSIS An exploratory sequential mixed-method study design wherein, quantitative follows qualitative will be used to develop, implement and evaluate the effect of diabetes self-care intervention package among people living with type 2 diabetes. The qualitative research method will be used to identify barriers and facilitators for self-care practices among people living with type 2 DM and will also provide the basis for the development of the diabetes self-care intervention package. The quasi-experimental with control study design will be used to evaluate the developed intervention package among 220 randomly selected people living with type 2 diabetes in both intervention and control arms. Baseline, follow-ups and endline data will be collected using same prevalidated and structured questionnaire for each self-care activity. Difference-in-difference analysis will be used to measure for changes in the proportion of people living with type 2 DM doing different component of self-care practices, preintervention and postintervention in both arms. ETHICS AND DISSEMINATION Permission for conducting the study has been taken from Institutional Ethical Committee of PGIMER, Chandigarh (Ref no. NK/4538/PhD/226, Dated 18.08.18). The findings of the trial will be disseminated through publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER CTRI/2018/10/016108; Pre-results.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, Chandigarh, India
| | - Ashu Rastogi
- Department of Endocrinology, PGIMER, Chandigarh, Chandigarh, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, Chandigarh, India
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Bansal R, Markan A, Gautam N, Guru RR, Lakshmi PVM, Katoch D, Agarwal A, Singh MP, Suri V, Mohindra R, Sahni N, Bhalla A, Malhotra P, Gupta V, Puri GD. Retinal Involvement in COVID-19: Results From a Prospective Retina Screening Program in the Acute and Convalescent Phase. Front Med (Lausanne) 2021; 8:681942. [PMID: 34249972 PMCID: PMC8264127 DOI: 10.3389/fmed.2021.681942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: To detect retinal involvement in coronavirus disease 2019 (COVID-19) patients in acute and convalescent phase by their fundus screening. Methods: In a prospective, cross-sectional, observational study (July–November 2020), 235 patients (142 acute and 93 convalescent phase) underwent fundus screening in a tertiary care center in North India. For convalescent phase, “hospitalized” patients (73) were screened at least 2 weeks after hospital discharge, and “home-isolated” patients (20) were screened 17 days after symptom onset/COVID-19 testing. Results: None in acute phase showed any retinal lesion that could be attributed exclusively to COVID-19. Five patients (5.38%) in convalescent phase had cotton wool spots (CWSs) with/without retinal hemorrhage, with no other retinal finding, and no visual symptoms, seen at a median of 30 days from COVID-19 diagnosis. Conclusions: CWSs (and retinal hemorrhages) were an incidental finding in COVID-19, detected only in the convalescent phase. These patients were much older (median age = 69 years) than the average age of our sample and had systemic comorbidities (diabetes mellitus, hypertension, etc.). We propose the term “COVID-19 retinopathy” to denote the presence of CWSs at the posterior pole, occasionally associated with intraretinal hemorrhages, in the absence of ocular inflammation in patients with a history of COVID-19 disease.
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Affiliation(s)
- Reema Bansal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Markan
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nitin Gautam
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rashmi Ranjan Guru
- Department of Hospital Administration, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aniruddha Agarwal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini P Singh
- Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritin Mohindra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeru Sahni
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G D Puri
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Background & objectives Being more efficient and widely used, limiting antigen (LAg)-avidity enzyme immunoassay (EIA) based on the recent infection testing algorithm (RITA) has been developed for differentiating recent and established HIV-1 infection. So far, LAg-avidity EIA has not been validated among the Indian population. Hence, the present study was planned to identify recent HIV infections in high risk patients in the North-West region of India using modified LAg-avidity RITA. Methods Four hundred HIV-positive high risk patients registered on pre-antiretroviral therapy (ART) programme in the last one year, from five ART centres in North-Western States of India, were included for identifying the recent HIV infections. One hundred HIV-positive cases registered for pre-ART for greater than two years in ART centres were included for estimating false recent rate (FRR). Single-well LAg-avidity EIA-based modified RITA was used to identify recent HIV infection cases. Results Of the 400 HIV-1-positive samples, 64 (16%) were found to have been infected within the past 130 days. The proportion of recent HIV infections was 16.8 per cent (18/107) among female sex workers, 10.7 per cent (9/84) among men who have sex with men and 17.7 per cent (37/209) among injecting drug users. The FRR was one per cent (1/100). Interpretation & conclusions LAg-avidity EIA-based modified RITA provided good discrimination between recent and non-recent HIV infection, hence, it could be considered suitable for estimating HIV incidence in sentinel surveillance system in India.
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Affiliation(s)
- Chandar Kanta Chauhan
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Vivek Sagar
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sunil K Arora
- Department of Immunopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Rajesh Kumar
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Soni SL, Kajal K, Yaddanapudi LN, Malhotra P, Puri GD, Bhalla A, Singh MP, Sehgal IS, Koushal V, Varma N, Biswal M, Lakshmi PVM, Sharma S, Suri V, Deepy Z, Ram S, Yadav J, Pandey N, Sharma P, Malik N, Goyal K, Mehra A, Sahoo S, Mohindra R, Francis J, Bhargava M, Singla K, Babu P, Verma A, Khaire NS, Guru RR. Demographic & clinical profile of patients with COVID-19 at a tertiary care hospital in north India. Indian J Med Res 2021; 153:115-125. [PMID: 33818468 PMCID: PMC8184067 DOI: 10.4103/ijmr.ijmr_2311_20] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background & objectives: The COVID-19 pandemic emerged as a major public health emergency affecting the healthcare services all over the world. It is essential to analyze the epidemiological and clinical characteristics of patients with COVID-19 in different parts of our country. This study highlights clinical experience in managing patients with COVID-19 at a tertiary care centre in northern India. Methods: Clinical characteristics and outcomes of consecutive adults patients admitted to a tertiary care hospital at Chandigarh, India, from April 1 to May 25, 2020 were studied. The diagnosis of SARS-CoV-2 infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) on throat and/or nasopharyngeal swabs. All patients were managed according to the institute's consensus protocol and in accordance with Indian Council of Medical Research guidelines. Results: During the study period, 114 patients with SARS-CoV-2 infection were admitted. The history of contact with COVID-19-affected individuals was available in 75 (65.8%) patients. The median age of the patients was 33.5 yr (13-79 yr), and there were 66 (58%) males. Of the total enrolled patients, 48 (42%) were symptomatic. The common presenting complaints were fever (37, 77%), cough (26, 54%) and shortness of breath (10, 20.8%). Nineteen (17%) patients had hypoxia (SpO2<94%) at presentation and 36 (31%) had tachypnoea (RR >24). Thirty four (29.8%) patients had an accompanying comorbid illness. Age more than 60 yr and presence of diabetes and hypertension were significantly associated with severe COVID-19 disease. Admission to the intensive care unit (ICU) was needed in 18 patients (52%), with three (2.6%) patients requiring assisted ventilation. Mortality of 2.6 per cent (3 patients) was observed. Interpretation & conclusions: Majority of the patients with COVID-19 infection presenting to our hospital were young and asymptomatic. Fever was noted only in three-fourth of the patients and respiratory symptoms in half of them. Patients with comorbidities were more vulnerable to complications. Triaged classification of patients and protocol-based treatment resulted in good outcomes and low case fatality.
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Affiliation(s)
- Shiv Lal Soni
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kamal Kajal
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - L N Yaddanapudi
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Mini P Singh
- Department of Virology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Vipin Koushal
- Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Neelam Varma
- Department of Pathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sadhna Sharma
- Department of Biochemistry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Z Deepy
- Department of Biochemistry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sant Ram
- Department of Biochemistry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Jaivinder Yadav
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Navin Pandey
- Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Prashant Sharma
- Department of Hematology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Nabhajit Malik
- Department of Hematology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kapil Goyal
- Department of Virology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Aseem Mehra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ritin Mohindra
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Jijo Francis
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Mudit Bhargava
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Karan Singla
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Preena Babu
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Amiy Verma
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Niranjan Shiwaji Khaire
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - R R Guru
- Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Sahu D, Kumar P, Chandra N, Rajan S, Shukla DK, Venkatesh S, Nair S, Kumar A, Singh J, Reddy S, Godbole S, Elangovan A, Saha MK, Rai S, Lakshmi PVM, Gambhir T, Ammassari S, Joshi D, Das A, Bakshi P, Chakraborty S, Palkar A, Singh SK, Reddy DCS, Kant S, Pandey A, Vardhana Rao MV. Findings from the 2017 HIV estimation round & trend analysis of key indicators 2010-2017: Evidence for prioritising HIV/AIDS programme in India. Indian J Med Res 2021; 151:562-570. [PMID: 32719229 PMCID: PMC7602920 DOI: 10.4103/ijmr.ijmr_1619_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background & objectives: The National AIDS Control Organisation (NACO) and the ICMR-National Institute of Medical Statistics, the nodal agency for conducting HIV estimations in India, have been generating HIV estimates regularly since 2003. The objective of this study was to describe India's biennial HIV estimation 2017 process, data inputs, tool, methodology and epidemiological assumptions used to generate the HIV estimates and trends of key indicators for 2010-2017 at national and State/Union Territory levels. Methods: Demographic Projection (DemProj) and AIDS Impact Modules (AIM) of Spectrum 5.63 software recommended by the United Nations Programme on HIV and AIDS Global Reference Group on HIV Estimates, Modelling and Projections, were used for generating HIV estimations on key indicators. HIV sentinel surveillance, epidemiological and programme data were entered into Estimation Projection Package (EPP), and curve fitting was done using EPP classic model. Finally, calibration was done using the State HIV prevalence of two rounds of National Family Health Survey (NFHS) -3 and -4 and Integrated Biological and Behavioural Surveillance (IBBS), 2014-2015. Results: The national adult prevalence of HIV was estimated to be 0.22 per cent in 2017. Mizoram, Manipur and Nagaland had the highest prevalence over one per cent. An estimated 2.1 million people were living with HIV in 2017, with Maharashtra estimated to have the highest number. Of the 88 thousand annual new HIV infections estimated nationally in 2017, Telangana accounted for the largest share. HIV incidence was found to be higher among key population groups, especially people who inject drugs. The annual AIDS-related deaths were estimated to be 69 thousand nationally. For all indicators, geographic variation in levels and trends between States existed. Interpretation & conclusions: With a slow decline in annual new HIV infections by only 27 per cent from 2010 to 2017 against the national target of 75 per cent by 2020, the national target to end AIDS by 2030 may be missed; although at the sub-national level some States have made better progress to reduce new HIV infection. It calls for reinforcement of HIV prevention, diagnosis and treatment efforts by geographical regions and population groups.
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Affiliation(s)
- Damodar Sahu
- ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India
| | - Pradeep Kumar
- Division of Strategic lnformation - Surveillance and Epidemiology, National AIDS Control Organisation, Ministry of Health & Family Welfare, Government of India, Chennai, Tamil Nadu, India
| | - Nalini Chandra
- Joint United Nations Programme on HIV/AIDS, New Delhi, India
| | - Shobini Rajan
- Division of Strategic lnformation - Surveillance and Epidemiology, National AIDS Control Organisation, Ministry of Health & Family Welfare, Government of India, Chennai, Tamil Nadu, India
| | - D K Shukla
- ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India
| | - S Venkatesh
- Principal Advisor to Board of Governors, Medical Council of India, New Delhi, India
| | - Saritha Nair
- ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India
| | - Anil Kumar
- ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India
| | - Jitenkumar Singh
- ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India
| | - Srikanth Reddy
- ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India
| | - Sheela Godbole
- ICMR-National AIDS Research Institute, Pune, Maharashtra, India
| | - A Elangovan
- Computing and Information Sciences, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - M K Saha
- Department of Virology, ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Sanjay Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, Chennai, Tamil Nadu, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - T Gambhir
- Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | | | | | - Amitabh Das
- Odisha State AIDS Control Society, Bhubaneswar, Odisha, India
| | - Poonam Bakshi
- Chandigarh State AIDS Control Society, Chandigarh, India
| | | | - Amol Palkar
- Mumbai District AIDS Control Society, Maharashtra, India
| | - S K Singh
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
| | - D C S Reddy
- Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, Chennai, Tamil Nadu, India
| | - Arvind Pandey
- ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India
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Dutta U, Sachan A, Premkumar M, Gupta T, Sahoo S, Grover S, Sharma S, Lakshmi PVM, Talati S, Biswal M, Suri V, Singh MP, Ghai B, Chhabra R, Bharti B, Samanta J, Arora P, Mohindra R, Malhotra S, Singh G, Guru RR, Pandey N, Koushal V, Kumar A, Bhogal RS, Aggarwal AK, Goel K, Malhotra P, Yaddanapudi N, Mahajan P, Thakur JS, Sehgal R, Ghosh A, Sehgal IS, Agarwal R, Jayashree M, Bhalla A, Jain S, Kochhar R, Chakrabarti A, Puri GD, Ram J. Multidimensional dynamic healthcare personnel (HCP)-centric model from a low-income and middle-income country to support and protect COVID-19 warriors: a large prospective cohort study. BMJ Open 2021; 11:e043837. [PMID: 33619195 PMCID: PMC7902325 DOI: 10.1136/bmjopen-2020-043837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Healthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty. SETTING Our tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless. PARTICIPANTS We recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone. RESULTS Between 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment. CONCLUSION A multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.
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Affiliation(s)
- Usha Dutta
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Anurag Sachan
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Madhumita Premkumar
- Department of Gastroenterology, PGIMER, Chandigarh, India
- Department of Hepatology, PGIMER, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, PGIMER, Chandigarh, India
| | | | | | - Sugandhi Sharma
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Shweta Talati
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | | | - Vikas Suri
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Mini P Singh
- Department of Virology, PGIMER, Chandigarh, India
| | - Babita Ghai
- Department of Anesthesia, PGIMER, Chandigarh, India
| | | | | | | | - Pankaj Arora
- Department of Hospital Administration, PGIMER, Chandigarh, India
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Ritin Mohindra
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | | | - Gurmeet Singh
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - Navin Pandey
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - Vipin Koushal
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - Ashok Kumar
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | | | - Arun K Aggarwal
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | | | - Pranay Mahajan
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - J S Thakur
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Rakesh Sehgal
- Department of Parasitology, PGIMER, Chandigarh, India
| | - Arnab Ghosh
- Department of Virology, PGIMER, Chandigarh, India
| | | | | | | | - Ashish Bhalla
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | | | | | - Jagat Ram
- Department of Ophthalmology, PGIMER, Chandigarh, India
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Mohindra R, Ghai A, Brar R, Khandelwal N, Biswal M, Suri V, Goyal K, Singh MP, Bhalla A, Rana K, Lakshmi PVM. Superspreaders: A Lurking Danger in the Community. J Prim Care Community Health 2021; 12:2150132720987432. [PMID: 33448254 PMCID: PMC7812391 DOI: 10.1177/2150132720987432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A "superspreader" refers to an unusually contagious organism infected with a disease. With respect to a human borne illnesses, a superspreader is someone who is more likely to infect other humans when compared to a typically infected person. The existence of human superspreaders is deeply entrenched in history; the most famous case being that of Typhoid Mary. Through contact tracing, epidemiologists have identified human superspreaders in measles, tuberculosis, rubella, monkeypox, smallpox, Ebola hemorrhagic fever, and SARS. The recent outbreak of Coronavirus disease (COVID-19) has shifted the focus back on the superspreaders. We herein present a case report of a COVID-19 superspreader with a hitherto unusually high number of infected contacts. The index case was a 33 year old male who resided in a low income settlement comprising of rehabilitated slum dwellers and worked as a healthcare worker (HCW) in a tertiary care hospital and had tested positive for COVID-19.On contact tracing, he had a total of 125 contacts, of which 49 COVID-19 infections had direct or indirect contact with the index case, qualifying him as a "superspreader." This propagated infection led to an outbreak in the community. Contact tracing, testing and isolation of such superspreaders from the other members of the community is essential to stop the spread of this disease and contain the COVID-19 pandemic.
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Affiliation(s)
- Ritin Mohindra
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi Ghai
- Lady Hardinge Medical College New Delhi, Delhi, India
| | - Rinnie Brar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neha Khandelwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Biswal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kapil Goyal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini P Singh
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirtan Rana
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P V M Lakshmi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Murhekar MV, Kamaraj P, Kumar MS, Khan SA, Allam RR, Barde PV, Dwibedi B, Kanungo S, Mohan U, Mohanty SS, Roy S, Sagar V, Savargaonkar D, Tandale BV, Topno RK, Kumar CPG, Sabarinathan R, Bitragunta S, Grover GS, Lakshmi PVM, Mishra CM, Sadhukhan P, Sahoo PK, Singh SK, Yadav CP, Kumar R, Dutta S, Toteja GS, Gupta N, Mehendale SM. Immunity against diphtheria among children aged 5-17 years in India, 2017-18: a cross-sectional, population-based serosurvey. Lancet Infect Dis 2021; 21:868-875. [PMID: 33485469 DOI: 10.1016/s1473-3099(20)30595-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/27/2020] [Accepted: 06/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diphtheria is re-emerging as a public health problem in several Indian states. Most diphtheria cases are among children older than 5 years. In this study, we aimed to estimate age-specific immunity against diphtheria in children aged 5-17 years in India. METHODS We used residual serum samples from a cross-sectional, population-based serosurvey for dengue infection done between June 19, 2017, and April 12, 2018, to estimate the age-group-specific seroprevalence of antibodies to diphtheria in children aged 5-17 years in India. 8309 serum samples collected from 240 clusters (122 urban and 118 rural) in 60 selected districts of 15 Indian states spread across all five geographical regions (north, northeast, east, west, and south) of India were tested for the presence of IgG antibodies against diphtheria toxoid using an ELISA. We considered children with antibody concentrations of 0·1 IU/mL or greater as immune, those with levels less than 0·01 IU/mL as non-immune (and hence susceptible to diphtheria), and those with levels in the range of 0·01 to less than 0·1 IU/mL as partially immune. We calculated the weighted proportion of children who were immune, partially immune, and non-immune, with 95% CIs, for each geographical region by age group, sex, and area of residence (urban vs rural). FINDINGS 29·7% (95% CI 26·3-33·4) of 8309 children aged 5-17 years were immune to diphtheria, 10·5% (8·6-12·8) were non-immune, and 59·8% (56·3-63·1) were partially immune. The proportion of children aged 5-17 years who were non-immune to diphtheria ranged from 6·0% (4·2-8·3) in the south to 16·8% (11·2-24·4) in the northeast. Overall, 9·9% (7·7-12·5) of children residing in rural areas and 13·1% (10·2-16·6) residing in urban areas were non-immune to diphtheria. A higher proportion of girls than boys were non-immune to diphtheria in the northern (17·7% [12·6-24·2] vs 7·1% [4·1-11·9]; p=0·0007) and northeastern regions (20·0% [12·9-29·8] vs 12·9% [8·6-19·0]; p=0·0035). INTERPRETATION The findings of our serosurvey indicate that a substantial proportion of children aged 5-17 years were non-immune or partially immune to diphtheria. Transmission of diphtheria is likely to continue in India until the immunity gap is bridged through adequate coverage of primary and booster doses of diphtheria vaccine. FUNDING Indian Council of Medical Research.
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Affiliation(s)
- Manoj V Murhekar
- Indian Council of Medical Research (ICMR) National Institute of Epidemiology, Chennai, India.
| | - Pattabi Kamaraj
- Indian Council of Medical Research (ICMR) National Institute of Epidemiology, Chennai, India
| | | | - Siraj Ahmed Khan
- ICMR Regional Medical Research Centre, Northeast Region, Dibrugarh, India
| | | | - Pradip V Barde
- ICMR National Institute of Research in Tribal Health, Jabalpur, India
| | | | - Suman Kanungo
- ICMR National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Uday Mohan
- King George's Medical University, Lucknow, India
| | | | - Subarna Roy
- ICMR National Institute of Traditional Medicine, Belagavi, India
| | - Vivek Sagar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Roshan Kamal Topno
- ICMR Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - C P Girish Kumar
- Indian Council of Medical Research (ICMR) National Institute of Epidemiology, Chennai, India
| | - Ramasamy Sabarinathan
- Indian Council of Medical Research (ICMR) National Institute of Epidemiology, Chennai, India
| | | | | | - P V M Lakshmi
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Provash Sadhukhan
- ICMR National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | | | | | - Rajesh Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shanta Dutta
- ICMR National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - G S Toteja
- ICMR Desert Medicine Research Centre, Jodhpur, India
| | - Nivedita Gupta
- Epidemiology and Communicable Diseases Division, ICMR, New Delhi, India
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36
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Anjana RM, Mohan V, Rangarajan S, Gerstein HC, Venkatesan U, Sheridan P, Dagenais GR, Lear SA, Teo K, Karsidag K, Alhabib KF, Yusoff K, Ismail N, Mony PK, Lopez-Jaramillo P, Chifamba J, Palileo-Villanueva LM, Iqbal R, Yusufali A, Kruger IM, Rosengren A, Bahonar A, Zatonska K, Yeates K, Gupta R, Li W, Hu L, Rahman MO, Lakshmi PVM, Iype T, Avezum A, Diaz R, Lanas F, Yusuf S. Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the PURE Study. Diabetes Care 2020; 43:3094-3101. [PMID: 33060076 PMCID: PMC7770267 DOI: 10.2337/dc20-0886] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/18/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV mortality rates among adults with and without diabetes in countries with differing levels of income. RESEARCH DESIGN AND METHODS The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults aged 35-70 years from 4 high-income countries (HIC), 12 middle-income countries (MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 ± 3.0 years. RESULTS Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 person-years, P < 0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1,000 person-years, P < 0.001), and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1,000 person-years, P < 0.001) were considerably higher in LIC compared with MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, and high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioral risk factors and treatments (hazard ratio [95% CI] 1.89 [1.58-2.27] to 1.78 [1.36-2.34]). CONCLUSIONS CVD rates, all-cause mortality, and CV mortality were markedly higher among those with diabetes in LIC compared with MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society.
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Affiliation(s)
- Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ulagamadesan Venkatesan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Patrick Sheridan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Gilles R Dagenais
- Institut universitaire de Cardiologie et Pneumologie de Québec-Université Laval, Québec, Québec, Canada
| | - Scott A Lear
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada
| | - Koon Teo
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kubilay Karsidag
- Department of Internal Medicine, Division of Endocrinology, Istanbul, Turkey
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Yusoff
- Department of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia.,Department of Medicine, UCSI University, Cheras, Selangor, Malaysia
| | - Noorhassim Ismail
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Prem K Mony
- Division of Epidemiology and Population Health, St. John's Medical College and Research Institute, Bangalore, India
| | | | - Jephat Chifamba
- College of Health Sciences, Physiology Department, University of Zimbabwe, Harare, Zimbabwe
| | | | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Afzalhussein Yusufali
- Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Iolanthe M Kruger
- Africa Unit for Transdisciplinary Health Research, Department of Medicine, Faculty of Health Sciences, North-West University, Mmabatho, South Africa
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ahmad Bahonar
- Hypertension Research Center, Cardiovascular Research Institute, Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Wei Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Lihua Hu
- Nanchang County Center for Disease Prevention and Control, Nanchang, Jiangxi Province, China
| | | | - P V M Lakshmi
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Thomas Iype
- Health Action by People and Government Medical College, Thiruvanthapuram, Kerala, India
| | - Alvaro Avezum
- Hospital Alemão Oswaldo Cruz and UNISA, São Paulo, Brazil
| | - Rafael Diaz
- Estudios Clínicos Latino America, Instituto Cardiovascular de Rosario, Rosario, Santa Fe, Argentina
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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37
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Bhavadharini B, Mohan V, Dehghan M, Rangarajan S, Swaminathan S, Rosengren A, Wielgosz A, Avezum A, Lopez-Jaramillo P, Lanas F, Dans AL, Yeates K, Poirier P, Chifamba J, Alhabib KF, Mohammadifard N, Zatońska K, Khatib R, Vural Keskinler M, Wei L, Wang C, Liu X, Iqbal R, Yusuf R, Wentzel-Viljoen E, Yusufali A, Diaz R, Keat NK, Lakshmi PVM, Ismail N, Gupta R, Palileo-Villanueva LM, Sheridan P, Mente A, Yusuf S. White Rice Intake and Incident Diabetes: A Study of 132,373 Participants in 21 Countries. Diabetes Care 2020; 43:2643-2650. [PMID: 32873587 PMCID: PMC7576435 DOI: 10.2337/dc19-2335] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/08/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Previous prospective studies on the association of white rice intake with incident diabetes have shown contradictory results but were conducted in single countries and predominantly in Asia. We report on the association of white rice with risk of diabetes in the multinational Prospective Urban Rural Epidemiology (PURE) study. RESEARCH DESIGN AND METHODS Data on 132,373 individuals aged 35-70 years from 21 countries were analyzed. White rice consumption (cooked) was categorized as <150, ≥150 to <300, ≥300 to <450, and ≥450 g/day, based on one cup of cooked rice = 150 g. The primary outcome was incident diabetes. Hazard ratios (HRs) were calculated using a multivariable Cox frailty model. RESULTS During a mean follow-up period of 9.5 years, 6,129 individuals without baseline diabetes developed incident diabetes. In the overall cohort, higher intake of white rice (≥450 g/day compared with <150 g/day) was associated with increased risk of diabetes (HR 1.20; 95% CI 1.02-1.40; P for trend = 0.003). However, the highest risk was seen in South Asia (HR 1.61; 95% CI 1.13-2.30; P for trend = 0.02), followed by other regions of the world (which included South East Asia, Middle East, South America, North America, Europe, and Africa) (HR 1.41; 95% CI 1.08-1.86; P for trend = 0.01), while in China there was no significant association (HR 1.04; 95% CI 0.77-1.40; P for trend = 0.38). CONCLUSIONS Higher consumption of white rice is associated with an increased risk of incident diabetes with the strongest association being observed in South Asia, while in other regions, a modest, nonsignificant association was seen.
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Affiliation(s)
- Balaji Bhavadharini
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Mahshid Dehghan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
| | | | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Patricio Lopez-Jaramillo
- Instituto Masira, Medical School, Universidad de Santander, and Fundación Oftalmológica de Santander-Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | | | - Antonio L Dans
- University of the Philippines College of Medicine, Manila, Philippines
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Katarzyna Zatońska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Rasha Khatib
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mirac Vural Keskinler
- Department of Internal Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Li Wei
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chuangshi Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyun Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Rita Yusuf
- Independent University, Dhaka, Bangladesh
| | | | - Afzalhussein Yusufali
- Hatta Hospital, Dubai Medical University, Dubai Health Authority, Dubai, United Arab Emirates
| | - Rafael Diaz
- Estudios Clínicos Latinoamerica, Rosario, Santa Fe, Argentina
| | - Ng Kien Keat
- Universiti Teknologi MARA, Sungai Buloh, Malaysia.,University College Sedaya International University, Cheras, Malaysia
| | - P V M Lakshmi
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Noorhassim Ismail
- Department of Community Health, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Lia M Palileo-Villanueva
- University of the Philippines College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Patrick Sheridan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
| | - Andrew Mente
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
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38
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Shupler M, Hystad P, Birch A, Miller-Lionberg D, Jeronimo M, Arku RE, Chu YL, Mushtaha M, Heenan L, Rangarajan S, Seron P, Lanas F, Cazor F, Lopez-Jaramillo P, Camacho PA, Perez M, Yeates K, West N, Ncube T, Ncube B, Chifamba J, Yusuf R, Khan A, Hu B, Liu X, Wei L, Tse LA, Mohan D, Kumar P, Gupta R, Mohan I, Jayachitra KG, Mony PK, Rammohan K, Nair S, Lakshmi PVM, Sagar V, Khawaja R, Iqbal R, Kazmi K, Yusuf S, Brauer M. Household and personal air pollution exposure measurements from 120 communities in eight countries: results from the PURE-AIR study. Lancet Planet Health 2020; 4:e451-e462. [PMID: 33038319 PMCID: PMC7591267 DOI: 10.1016/s2542-5196(20)30197-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 05/03/2023]
Abstract
BACKGROUND Approximately 2·8 billion people are exposed to household air pollution from cooking with polluting fuels. Few monitoring studies have systematically measured health-damaging air pollutant (ie, fine particulate matter [PM2·5] and black carbon) concentrations from a wide range of cooking fuels across diverse populations. This multinational study aimed to assess the magnitude of kitchen concentrations and personal exposures to PM2·5 and black carbon in rural communities with a wide range of cooking environments. METHODS As part of the Prospective Urban and Rural Epidemiological (PURE) cohort, the PURE-AIR study was done in 120 rural communities in eight countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Data were collected from 2541 households and from 998 individuals (442 men and 556 women). Gravimetric (or filter-based) 48 h kitchen and personal PM2·5 measurements were collected. Light absorbance (10-5m-1) of the PM2·5 filters, a proxy for black carbon concentrations, was calculated via an image-based reflectance method. Surveys of household characteristics and cooking patterns were collected before and after the 48 h monitoring period. FINDINGS Monitoring of household air pollution for the PURE-AIR study was done from June, 2017, to September, 2019. A mean PM2·5 kitchen concentration gradient emerged across primary cooking fuels: gas (45 μg/m3 [95% CI 43-48]), electricity (53 μg/m3 [47-60]), coal (68 μg/m3 [61-77]), charcoal (92 μg/m3 [58-146]), agricultural or crop waste (106 μg/m3 [91-125]), wood (109 μg/m3 [102-118]), animal dung (224 μg/m3 [197-254]), and shrubs or grass (276 μg/m3 [223-342]). Among households cooking primarily with wood, average PM2·5 concentrations varied ten-fold (range: 40-380 μg/m3). Fuel stacking was prevalent (981 [39%] of 2541 households); using wood as a primary cooking fuel with clean secondary cooking fuels (eg, gas) was associated with 50% lower PM2·5 and black carbon concentrations than using only wood as a primary cooking fuel. Similar average PM2·5 personal exposures between women (67 μg/m3 [95% CI 62-72]) and men (62 [58-67]) were observed. Nearly equivalent average personal exposure to kitchen exposure ratios were observed for PM2·5 (0·79 [95% 0·71-0·88] for men and 0·82 [0·74-0·91] for women) and black carbon (0·64 [0·45-0·92] for men and 0·68 [0·46-1·02] for women). INTERPRETATION Using clean primary fuels substantially lowers kitchen PM2·5 concentrations. Importantly, average kitchen and personal PM2·5 measurements for all primary fuel types exceeded WHO's Interim Target-1 (35 μg/m3 annual average), highlighting the need for comprehensive pollution mitigation strategies. FUNDING Canadian Institutes for Health Research, National Institutes of Health.
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Affiliation(s)
- Matthew Shupler
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Aaron Birch
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Matthew Jeronimo
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Raphael E Arku
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Yen Li Chu
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Maha Mushtaha
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Laura Heenan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | | | - Karen Yeates
- Pamoja Tunaweza Research Centre, Moshi, Tanzania; Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Nicola West
- Pamoja Tunaweza Research Centre, Moshi, Tanzania
| | - Tatenda Ncube
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | - Brian Ncube
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Afreen Khan
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Bo Hu
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyun Liu
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Li Wei
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lap Ah Tse
- Jockey Club School of Public health and Primary Care, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | - Indu Mohan
- Mahatma Gandhi Medical College, Jaipur, India
| | - K G Jayachitra
- St John's Medical College & Research Institute, Bangalore, India
| | - Prem K Mony
- St John's Medical College & Research Institute, Bangalore, India
| | - Kamala Rammohan
- Health Action By People, Thiruvananthapuram and Medical College, Trivandrum, India
| | - Sanjeev Nair
- Health Action By People, Thiruvananthapuram and Medical College, Trivandrum, India
| | - P V M Lakshmi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Sagar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rehman Khawaja
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Romaina Iqbal
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Khawar Kazmi
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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39
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Murhekar MV, Santhosh Kumar M, Kamaraj P, Khan SA, Allam RR, Barde P, Dwibedi B, Kanungo S, Mohan U, Mohanty SS, Roy S, Sagar V, Savargaonkar D, Tandale BV, Topno RK, Girish Kumar CP, Sabarinathan R, Bitragunta S, Grover GS, Lakshmi PVM, Mishra CM, Sadhukhan P, Sahoo PK, Singh SK, Yadav CP, Kumar R, Dutta S, Toteja GS, Gupta N, Mehendale SM. Hepatitis-B virus infection in India: Findings from a nationally representative serosurvey, 2017-18. Int J Infect Dis 2020; 100:455-460. [PMID: 32896662 DOI: 10.1016/j.ijid.2020.08.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION India introduced a hepatitis-B (HB) vaccine in the Universal Immunization Program in 2002-2003 on a pilot basis, expanded to ten states in 2007-2008 (phase-1), and the entire country in 2011-2012 (phase-2). We tested sera from a nationally representative serosurvey conducted duing 2017, to estimate the seroprevalence of different markers of HB infection among children aged 5-17 years in India and to assess the impact of vaccination. METHODS We tested sera from 8273 children for different markers of HB infection and estimated weighted age-group specific seroprevalence of children who were chronically infected (HBsAg and anti-HBc positive), and immune due to past infection (anti-HBc positive and HBsAg negative), and having serological evidence of HB vaccination (only anti-HBs positive). We compared the prevalence of serological markers among children born before (aged 11-17 years) and after (aged 5-10 years) introduction of HB-vaccine from phase-1 states. RESULTS Among children aged 5-8 years, 1.1% were chronic carriers, 5.3% immune due to past infection, and 23.2% vaccinated. The corresponding proportions among children aged 9-17 years were 1.1%, 8.0%, and 12.0%, respectively. In phase-1 states, children aged 5-10 years had a significantly lower prevalence of anti-HBc (4.9% vs. 7.6%, p<0.001) and higher prevalence of anti-HBs (37.7% vs. 14.7%, p<0.001) compared to children aged 11-17 years. HBsAg positivity, however, was not different in the two age groups. CONCLUSIONS Children born after the introduction of HB vaccination had a lower prevalence of past HBV infection and a higher prevalence of anti-HBs. The findings of our study could be considered as an interim assessment of the impact of the hepatitis B vaccine introduction in India.
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Affiliation(s)
- Manoj V Murhekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India.
| | | | - P Kamaraj
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Siraj Ahmed Khan
- ICMR-Regional Medical Research Centre, Northeast Region, Dibrugarh, India
| | | | - Pradip Barde
- ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | | | - Suman Kanungo
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Uday Mohan
- King George's Medical University, Lucknow, India
| | | | - Subarna Roy
- ICMR-National Institute of Traditional Medicine, Belagavi, India
| | - Vivek Sagar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Roshan Kamal Topno
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - C P Girish Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - R Sabarinathan
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Sailaja Bitragunta
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | | | - P V M Lakshmi
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Provash Sadhukhan
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - S K Singh
- King George's Medical University, Lucknow, India
| | | | - Rajesh Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shanta Dutta
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - G S Toteja
- ICMR-Desert Medicine Research Centre, Jodhpur, India
| | - Nivedita Gupta
- Epidemiology and Communicable Diseases Division, ICMR, New Delhi, India
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Yuvapriya T, Lakshmi P. Simulation study on ride comfort enhancement for a heavy duty vehicle with fractional order sliding mode controller. SN Appl Sci 2020. [DOI: 10.1007/s42452-020-03263-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Arku RE, Brauer M, Duong M, Wei L, Hu B, Ah Tse L, Mony PK, Lakshmi PVM, Pillai RK, Mohan V, Yeates K, Kruger L, Rangarajan S, Koon T, Yusuf S, Hystad P. Adverse health impacts of cooking with kerosene: A multi-country analysis within the Prospective Urban and Rural Epidemiology Study. Environ Res 2020; 188:109851. [PMID: 32798956 PMCID: PMC7748391 DOI: 10.1016/j.envres.2020.109851] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND Kerosene, which was until recently considered a relatively clean household fuel, is still widely used in low- and middle-income countries for cooking and lighting. However, there is little data on its health effects. We examined cardiorespiratory effects and mortality in households using kerosene as their primary cooking fuel within the Prospective Urban Rural Epidemiology (PURE) study. METHODS We analyzed baseline and follow-up data on 31,490 individuals from 154 communities in China, India, South Africa, and Tanzania where there was at least 10% kerosene use for cooking at baseline. Baseline comorbidities and health outcomes during follow-up (median 9.4 years) were compared between households with kerosene versus clean (gas or electricity) or solid fuel (biomass and coal) use for cooking. Multi-level marginal regression models adjusted for individual, household, and community level covariates. RESULTS Higher rates of prevalent respiratory symptoms (e.g. 34% [95% CI:15-57%] more dyspnea with usual activity, 44% [95% CI: 21-72%] more chronic cough or sputum) and lower lung function (differences in FEV1: -46.3 ml (95% CI: -80.5; -12.1) and FVC: -54.7 ml (95% CI: -93.6; -15.8)) were observed at baseline for kerosene compared to clean fuel users. The odds of hypertension was slightly elevated but no associations were observed for blood pressure. Prospectively, kerosene was associated with elevated risks of all-cause (HR: 1.32 (95% CI: 1.14-1.53)) and cardiovascular (HR: 1.34 (95% CI: 1.00-1.80)) mortality, as well as major fatal and incident non-fatal cardiovascular (HR: 1.34 (95% CI: 1.08-1.66)) and respiratory (HR: 1.55 (95% CI: 0.98-2.43)) diseases, compared to clean fuel use. Further, compared to solid fuel users, those using kerosene had 20-47% higher risks for the above outcomes. CONCLUSIONS Kerosene use for cooking was associated with higher rates of baseline respiratory morbidity and increased risk of mortality and cardiorespiratory outcomes during follow-up when compared to either clean or solid fuels. Replacing kerosene with cleaner-burning fuels for cooking is recommended.
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Affiliation(s)
- Raphael E Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA; School of Population and Public Health, The University of British Columbia, Vancouver, Canada.
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - MyLinh Duong
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Li Wei
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Bo Hu
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Lap Ah Tse
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Prem K Mony
- Division of Epidemiology & Population Health, St John's Medical College & Research Institute, Bangalore, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Rajamohanan K Pillai
- School of Health Policy, Kerala University of Health Sciences, Trivandrum, India
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lanthe Kruger
- North-West University, Africa Unit for Transdisciplinary Health Research (AUTHeR), South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Teo Koon
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
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Mohindra R, Sainath KG, Kanta P, Singh MP, Goyal K, Lakshmi PVM, Bhalla A, Suri V. Anosmia and ageusia as presenting complaints of coronavirus disease (COVID-19) infection. J Family Med Prim Care 2020; 9:4406-4408. [PMID: 33110869 PMCID: PMC7586601 DOI: 10.4103/jfmpc.jfmpc_685_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/25/2020] [Accepted: 05/08/2020] [Indexed: 01/05/2023] Open
Abstract
The recently discovered SARS-CoV2 virus produces a influenza like illness named Coronavirus disease 2019 (COVID-19). The usual presentation is with upper/lower respiratory tract symptoms and rarely gastrointestinal symptoms. Although some of the clinical features of this novel disease like fever, dry cough, and shortness of breath have been well documented in literature, we report hitherto infrequently reported clinical features of this disease, namely Anosmia and Ageusia.
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Affiliation(s)
- Ritin Mohindra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
| | - K Gowri Sainath
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
| | - Poonam Kanta
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
| | - Mini P Singh
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
| | - Kapil Goyal
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
| | - Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
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Menon P, Perayil J, Fenol A, Rajan Peter M, Lakshmi P, Suresh R. Effectiveness of ginger on pain following periodontal surgery - A randomized cross-over clinical trial. J Ayurveda Integr Med 2020; 12:65-69. [PMID: 32624375 PMCID: PMC8039361 DOI: 10.1016/j.jaim.2020.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/19/2020] [Accepted: 05/07/2020] [Indexed: 11/05/2022] Open
Abstract
Background Ibuprofen is one of the generally prescribed Non-steroidal anti-inflammatory drugs (NSAIDs) for postoperative pain after periodontal surgery, but are contraindicated in certain patients. Ginger, which is the rhizome of Zingiber officinale, being a common herbal drug having anti-inflammatory as well as analgesic activities can be an efficient substitute for synthetic agents like Ibuprofen. Objectives To compare the effectiveness of ibuprofen and dried ginger powder on pain and gingival inflammation following open flap debridement. Materials and methods Ten systemically healthy individuals with chronic generalized periodontitis were selected for this single-blinded randomized cross-over clinical trial and underwent open flap debridement in at least two quadrants. Each quadrant was randomly allocated to receive either Ibuprofen (400 mg) or Ginger powder capsules (400 mg) thrice daily for three days. Subjects were requested to note down the pain score on the Visual Analogue Scale (VAS) provided in a printed format, for the first eight hours after surgery and on the following two days, and gingival inflammation was assessed after one week, using Modified Gingival Index (MGI). Result The difference in the VAS score and MGI between the two groups was not of statistical significance. Conclusion Effectiveness of ginger powder for the management of pain and gingival inflammation following open flap debridement is comparable to that of ibuprofen.
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Affiliation(s)
- Pallavi Menon
- Department of Periodontics, Amrita School of Dentistry, Kochi, Amrita Vishwa Vidyapeetham, India.
| | - Jayachandran Perayil
- Department of Periodontics, Amrita School of Dentistry, Kochi, Amrita Vishwa Vidyapeetham, India
| | - Angel Fenol
- Department of Periodontics, Amrita School of Dentistry, Kochi, Amrita Vishwa Vidyapeetham, India
| | - Maya Rajan Peter
- Department of Periodontics, Amrita School of Dentistry, Kochi, Amrita Vishwa Vidyapeetham, India
| | - P Lakshmi
- Department of Periodontics, Manipal Academy of Higher Education, Manipal, India
| | - Reshma Suresh
- Department of Periodontics, Amrita School of Dentistry, Kochi, Amrita Vishwa Vidyapeetham, India
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Brabhukumr A, Malhi P, Ravindra K, Lakshmi PVM. Exposure to household air pollution during first 3 years of life and IQ level among 6-8-year-old children in India - A cross-sectional study. Sci Total Environ 2020; 709:135110. [PMID: 31874342 DOI: 10.1016/j.scitotenv.2019.135110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/02/2019] [Accepted: 10/20/2019] [Indexed: 06/10/2023]
Abstract
Many illnesses have been attributed to the exposure of solid biomass smoke but the effect on intelligence has largely been unexplored. The study aims to examine the effect of exposure to solid biomass smoke during the first 3 years of life on intelligence among 6-8-year-old children. Children aged 6-8 years were enrolled from a primary school and their houses were visited to collect data on socio-economic status and household exposure assessment. Households using LPG as cooking fuel were considered as the unexposed group. All the children were tested for their Intelligence Quotient (IQ) using Malin's Intelligence Scale for Indian Children (MISIC). The mean IQ was calculated as the average of Verbal and Performance score. Potential confounders were adjusted using multivariate general linear model. About 45% of children had average or above-average IQ while the rest had below-average IQ. The mean scores for the arithmetic component of IQ were found to be significantly lower among solid biomass fuel users as compared to LPG users after adjusting for confounders. The mean IQ of LPG users were 5.58 points higher (95% CI: 0.46-10.1) for the arithmetic component as compared to solid biomass users. Children living in the houses using solid biomass fuel for cooking have lower IQ as compared to the children living in the houses using LPG for cooking for arithmetic component even after adjusting for potential confounders.
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Affiliation(s)
- Ajith Brabhukumr
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - Khaiwal Ravindra
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India.
| | - P V M Lakshmi
- Department of Paediatrics, PGIMER, Chandigarh, India.
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Shupler M, Hystad P, Gustafson P, Rangarajan S, Mushtaha M, Jayachtria KG, Mony PK, Mohan D, Kumar P, Lakshmi PVM, Sagar V, Gupta R, Mohan I, Nair S, Varma RP, Li W, Hu B, You K, Ncube T, Ncube B, Chifamba J, West N, Yeates K, Iqbal R, Khawaja R, Yusuf R, Khan A, Seron P, Lanas F, Lopez-Jaramillo P, Camacho PA, Puoane T, Yusuf S, Brauer M. Household, Community, Sub-National and Country-level Predictors of Primary Cooking Fuel Switching in Nine Countries from the PURE Study. Environ Res Lett 2019; 14:085006. [PMID: 33777170 PMCID: PMC7995525 DOI: 10.1088/1748-9326/ab2d46] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Switching from polluting (e.g. wood, crop waste, coal) to clean cooking fuels (e.g. gas, electricity) can reduce household air pollution (HAP) exposures and climate-forcing emissions. While studies have evaluated specific interventions and assessed fuel-switching in repeated cross-sectional surveys, the role of different multilevel factors in household fuel switching, outside of interventions and across diverse community settings, is not well understood. METHODS We examined longitudinal survey data from 24,172 households in 177 rural communities across nine countries within the Prospective Urban and Rural Epidemiology (PURE) study. We assessed household-level primary cooking fuel switching during a median of 10 years of follow up (~2005-2015). We used hierarchical logistic regression models to examine the relative importance of household, community, sub-national and national-level factors contributing to primary fuel switching. RESULTS One-half of study households (12,369) reported changing their primary cooking fuels between baseline and follow up surveys. Of these, 61% (7,582) switched from polluting (wood, dung, agricultural waste, charcoal, coal, kerosene) to clean (gas, electricity) fuels, 26% (3,109) switched between different polluting fuels, 10% (1,164) switched from clean to polluting fuels and 3% (522) switched between different clean fuels. Among the 17,830 households using polluting cooking fuels at baseline, household-level factors (e.g. larger household size, higher wealth, higher education level) were most strongly associated with switching from polluting to clean fuels in India; in all other countries, community-level factors (e.g. larger population density in 2010, larger increase in population density between 2005-2015) were the strongest predictors of polluting-to-clean fuel switching. CONCLUSIONS The importance of community and sub-national factors relative to household characteristics in determining polluting-to-clean fuel switching varied dramatically across the nine countries examined. This highlights the potential importance of national and other contextual factors in shaping large-scale clean cooking transitions among rural communities in low- and middle-income countries.
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Affiliation(s)
- Matthew Shupler
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, United States
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maha Mushtaha
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - KG Jayachtria
- St. John’s Medical College & Research Institute, Bangalore, India
| | - Prem K. Mony
- St. John’s Medical College & Research Institute, Bangalore, India
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - PVM Lakshmi
- School of Public Health, PGIMER, Chandigarh, India
| | - Vivek Sagar
- School of Public Health, PGIMER, Chandigarh, India
- Department of Community Medicine, PGIMER, Chandigarh, India
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Indu Mohan
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Sanjeev Nair
- Health Action By People, Thiruvananthapuram and Medical College, Trivandrum, India
| | - Ravi Prasad Varma
- Health Action By People, Thiruvananthapuram and Medical College, Trivandrum, India
- Achutha Menon Centre for Health Science Studies, Trivandrum India
| | - Wei Li
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Bo Hu
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Kai You
- Shunyi District Center for Disease Prevention and Control, Beijing, China
| | - Tatenda Ncube
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | - Brian Ncube
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | - Nicola West
- Pamoja Tunaweza Research Centre, Moshi, Tanzania
| | - Karen Yeates
- Pamoja Tunaweza Research Centre, Moshi, Tanzania
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Romaina Iqbal
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Rehman Khawaja
- Department of Community Health Science, Aga Khan University Hospital, Karachi, Pakistan
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Afreen Khan
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | | | | | - Patricio Lopez-Jaramillo
- Research Department, FOSCAL and Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Paul A. Camacho
- Research Department, FOSCAL and Medical School, Universidad Autonoma de Bucaramanga (UNAB), Colombia
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Murhekar MV, Kamaraj P, Kumar MS, Khan SA, Allam RR, Barde P, Dwibedi B, Kanungo S, Mohan U, Mohanty SS, Roy S, Sagar V, Savargaonkar D, Tandale BV, Topno RK, Sapkal G, Kumar CPG, Sabarinathan R, Kumar VS, Bitragunta S, Grover GS, Lakshmi PVM, Mishra CM, Sadhukhan P, Sahoo PK, Singh SK, Yadav CP, Bhagat A, Srivastava R, Dinesh ER, Karunakaran T, Govindhasamy C, Rajasekar TD, Jeyakumar A, Suresh A, Augustine D, Kumar PA, Kumar R, Dutta S, Toteja GS, Gupta N, Mehendale SM. Burden of dengue infection in India, 2017: a cross-sectional population based serosurvey. Lancet Glob Health 2019; 7:e1065-e1073. [PMID: 31201130 DOI: 10.1016/s2214-109x(19)30250-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/03/2019] [Accepted: 05/01/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The burden of dengue virus (DENV) infection across geographical regions of India is poorly quantified. We estimated the age-specific seroprevalence, force of infection, and number of infections in India. METHODS We did a community-based survey in 240 clusters (118 rural, 122 urban), selected from 60 districts of 15 Indian states from five geographical regions. We enumerated each cluster, randomly selected (with an Andriod application developed specifically for the survey) 25 individuals from age groups of 5-8 years, 9-17 years, and 18-45 years, and sampled a minimum of 11 individuals from each age group (all the 25 randomly selected individuals in each age group were visited in their houses and individuals who consented for the survey were included in the study). Age was the only inclusion criterion; for the purpose of enumeration, individuals residing in the household for more than 6 months were included. Sera were tested centrally by a laboratory team of scientific and technical staff for IgG antibodies against the DENV with the use of indirect ELISA. We calculated age group specific seroprevalence and constructed catalytic models to estimate force of infection. FINDINGS From June 19, 2017, to April 12, 2018, we randomly selected 17 930 individuals from three age groups. Of these, blood samples were collected and tested for 12 300 individuals (5-8 years, n=4059; 9-17 years, n=4265; 18-45 years, n=3976). The overall seroprevalence of DENV infection in India was 48·7% (95% CI 43·5-54·0), increasing from 28·3% (21·5-36·2) among children aged 5-8 years to 41·0% (32·4-50·1) among children aged 9-17 years and 56·2% (49·0-63·1) among individuals aged between 18-45 years. The seroprevalence was high in the southern (76·9% [69·1-83·2]), western (62·3% [55·3-68·8]), and northern (60·3% [49·3-70·5]) regions. The estimated number of primary DENV infections with the constant force of infection model was 12 991 357 (12 825 128-13 130 258) and for the age-dependent force of infection model was 8 655 425 (7 243 630-9 545 052) among individuals aged 5-45 years from 30 Indian states in 2017. INTERPRETATION The burden of dengue infection in India was heterogeneous, with evidence of high transmission in northern, western, and southern regions. The survey findings will be useful in making informed decisions about introduction of upcoming dengue vaccines in India. FUNDING Indian Council of Medical Research.
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Affiliation(s)
- Manoj V Murhekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India.
| | - P Kamaraj
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | | | - Siraj Ahmed Khan
- ICMR-Regional Medical Research Centre, Northeast Region, Dibrugarh, India
| | | | - Pradip Barde
- ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | | | - Suman Kanungo
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Uday Mohan
- King George's Medical University, Lucknow, India
| | | | - Subarna Roy
- ICMR-National Institute of Traditional Medicine, Belagavi, India
| | - Vivek Sagar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Roshan Kamal Topno
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | | | - C P Girish Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - R Sabarinathan
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Velusamy Saravana Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | | | | | - P V M Lakshmi
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Provash Sadhukhan
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - S K Singh
- King George's Medical University, Lucknow, India
| | | | - Asha Bhagat
- ICMR-National Institute of Virology, Pune, India
| | | | - E Ramya Dinesh
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - T Karunakaran
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - C Govindhasamy
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - T Daniel Rajasekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A Jeyakumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A Suresh
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - D Augustine
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - P Ashok Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Rajesh Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shanta Dutta
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - G S Toteja
- ICMR-Desert Medicine Research Centre, Jodhpur, India
| | - Nivedita Gupta
- Epidemiology and Communicable Diseases Division, ICMR, New Delhi, India
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47
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Chakrapani V, Lakshmi PVM, Tsai AC, Vijin PP, Kumar P, Srinivas V. The syndemic of violence victimisation, drug use, frequent alcohol use, and HIV transmission risk behaviour among men who have sex with men: Cross-sectional, population-based study in India. SSM Popul Health 2019; 7:100348. [PMID: 30656208 PMCID: PMC6329829 DOI: 10.1016/j.ssmph.2018.100348] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 12/29/2018] [Accepted: 12/31/2018] [Indexed: 02/08/2023] Open
Abstract
The theory of syndemics has been used to explain elevated HIV risk facing men who have sex with men (MSM). However, few studies have employed suitable analytical methods to test this theory. Using data from a probability-based sample of MSM in India, we tested three proposed models linking the co-occurring epidemics of violence victimisation, drug use, and frequent alcohol use to HIV risk: 1) the syndemic model of synergistically interacting epidemics; 2) the "chains of risk" model; and 3) the model of mutually causal epidemics. The primary outcome was inconsistent condom use with male or hijra (transgender women) partners in the past month. For the syndemic model, we included product terms between the exposures and assessed for interaction on the additive (linear probability regression) and multiplicative (logistic regression) scales. Path analysis was used to test the models of serially causal epidemics and mutually causal epidemics. Among 22,297 HIV-negative MSM, violence victimisation (24.7%), frequent alcohol use (27.5%), and drug use (10.9%) frequently co-occurred. We found evidence for a three-way interaction between violence victimisation, drug use and frequent alcohol use on both the multiplicative (semi-elasticity = 0.28; 95% CI 0.10, 0.47) and additive (b = 0.14; 95% CI 0.01, .27) scales. We also estimated statistically significant two-way interactions between violence victimisation and frequent alcohol use on the multiplicative (semi-elasticity = .10; 95% CI 0.008, 0.20) and additive (b = 0.05, 95% CI 0.002, 0.107) scales, and between drug use and frequent alcohol use on the multiplicative (semi-elasticity = 0.13, 95% CI 0.02, 0.24) and additive (b = 0.06, 95% CI 0.007, 0.129) scales. Thus, we found strong evidence for the syndemic model. The models of serially causal and mutually causal epidemics were partially supported. These findings highlight the need to sharpen how syndemic models are specified so that their empirical predictions can be adequately tested and distinguished from other theories of disease distribution.
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Affiliation(s)
- Venkatesan Chakrapani
- Postgraduate Institute of Medical Education and Research (PGIMER), India.,Centre for Sexuality and Health Research and Policy (C-SHaRP), India
| | - P V M Lakshmi
- Postgraduate Institute of Medical Education and Research (PGIMER), India
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48
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Soni T, Lakshmi PVM, Kaur M. A cross sectional study on internet usage for health information among 18- 49 years in urban Chandigarh. Indian J Community Health 2017. [DOI: 10.47203/ijch.2017.v29i04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Internet use for health information has increased over the years. However, how people use internet for health needs to be explored. Aims & Objectives: Our study aim was to determine the proportion of people who use internet for health information in the age group of 18-49 years in urban Chandigarh, to document the type of health information sought from Internet, and its association with socio-demographic variables. Material & Methods: Community based cross sectional study was carried out with multistage sampling using simple random and systematic random sampling. Data was collected using pretested semi-structured interview schedule. Results: Out of 262, 60.6 % of participants used the internet for health information. Availability of broadband connection at home and gender were significantly associated (p<0.05) with use of the internet for health information. Conclusion: Internet use for health information could have significant potential, particularly in terms of the general public decision-making and autonomy as has been reflected in the results of the present study. The Internet has become an important tool with the potential to improve information dissemination and health care delivery to consumers.
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49
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Rawal I, Kaur M, Chakrapani V, Khanna P, Lakshmi PVM, Kaur N. Association between Social Capital and Self-rated Health of Older People in Chandigarh, India. Indian J Community Health 2017. [DOI: 10.47203/ijch.2017.v29i02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Social capital reflect the degree of social cohesion in communities. Although studies have shown that social capital influences health, there is limited understanding about the role of social capital on physical and mental health of older people in India. Aims & Objectives: To assess the association between social capital and self-rated health among older people. Material &Methods: A cross-sectional study was conducted among 211 older people selected from 1563 households in urban and rural Chandigarh District. Standardized tools were used to measure social capital (Global Social Capital Survey) and self-rated health (SF-36). The association between social capital and physical and mental health dimensions of self-rated health was analyzed using multiple linear regression. Results: Participants’ mean age was 68.1 years (SD 7.6); about half were women. The mean total social capital score was 45.5 (SD 11.9). The mean physical and mental health dimensions of self-rated health scores were 1027.7 (SD 252.5) and 1416.9 (SD 487.7), respectively. Social capital was found to be a significant predictor of mental health dimension of self-rated health. Age and gender were found to be significant predictors of physical health dimension of self-rated health. Conclusion: Social capital influences mental health of older people. Interventions to improve social capital, in terms of strengthening relationships with family members and other social networks, can contribute to improving mental health of older people.
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50
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Lakshmi PVM, Tripathy JP, Tripathy N, Singh S, Bhatia D, Jagnoor J, Kumar R. A pilot study of a hospital-based injury surveillance system in a secondary level district hospital in India: lessons learnt and way ahead. Inj Epidemiol 2016; 3:24. [PMID: 27807806 PMCID: PMC5093103 DOI: 10.1186/s40621-016-0090-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 09/07/2016] [Indexed: 11/19/2022] Open
Abstract
Background Reliable epidemiological information on injury burden and pattern is essential to formulate effective injury control and prevention strategies. Injury surveillance systems are globally gaining ground as a tool for collecting such systematic data on injuries, but less so in low and middle income countries. This study describes the experience of setting up a District Level Hospital-Based Injury Surveillance System in India and the pattern of injuries encountered therein. Methods A prospective study was conducted during Jan-Dec 2012 at the emergency department of a District Hospital in Fatehgarh Sahib in a North Indian state of Punjab. A comprehensive injury proforma was devised to record information on all injury cases reporting to the hospital. Emergency Medical Officers were trained to record data. Results A total of 649 injuries were reported in 2012. The surveilance system used the existing resources at the hospital to collect data without the need for additional manpower, equipments etc. About 78 % of injuries reported were unintentional in nature. More than half (52.9 %) of the patients had injuries due to Road Traffic Crashes. Head (29.7 %) was the most common site of injury. Incised injury (50.2 %) was the most common type of injury and most of the injuries occurred while travelling (61.8 %). Conclusion Developing better and sustainable systems of routine injury surveillance or trauma registries is essential to generate reliable information for formulating effective intervention policies.
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Affiliation(s)
- P V M Lakshmi
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | - Jaya Prasad Tripathy
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India.,International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India
| | - Nalinikanta Tripathy
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India.,Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sunita Singh
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Deepak Bhatia
- Integrated Disease Surveillance Project, Punjab, India
| | - Jagnoor Jagnoor
- Injury Division, The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Rajesh Kumar
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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