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Gupta PC, Narake S, Sinha DN, Nagler E, Pednekar MS, Sorensen G. Upscaling a behavioural intervention program for tobacco use cessation - A randomised controlled study. Prev Med Rep 2023; 36:102476. [PMID: 37908199 PMCID: PMC10613902 DOI: 10.1016/j.pmedr.2023.102476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/02/2023] Open
Abstract
A randomised control trial was conducted among school teachers in Bihar, India for upscaling a tested, evidence-based tobacco intervention using train-the-trainer model. Six blocks in three districts were selected and randomised into intervention and control blocks. Cluster coordinators in intervention blocks were given training in the details of intervention. Cluster coordinators routinely train headmasters and they were asked to include intervention training in their routine. Except for the training material, no additional resources were provided to cluster coordinators and headmasters. Headmasters implemented the intervention along with the teachers in the school. Post-intervention random sample of 70 schools out of 219 schools from intervention blocks and 70 schools out of 224 schools in control blocks were surveyed. The survey was self-administered among 429 school teachers in intervention schools and 331 among control schools. For all 140 headmasters, the survey was interviewer administered. Almost all headmasters in intervention schools had attended the training and had involved teachers in the intervention program. Odds ratios for carrying out the recommended activities in intervention schools compared to control schools were very high and significant. In addition, intervention schools also conducted activities such as including intervention messages in classroom teaching and conveying them to parents, activities that were not directly recommended in intervention program. Thus, this train-the-trainer model demonstrated that it is possible to upscale the intervention programs successfully with the resources within the system.
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Greenhall J, Sinha DN, Pantea C. Genetic algorithm-wavelet transform feature extraction for data-driven acoustic resonance spectroscopy. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; PP:1-1. [PMID: 37216242 DOI: 10.1109/tuffc.2023.3278494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Acoustic Resonance Spectroscopy enables highly accurate measurement of the properties (geometry/material) of a structure based on the structure's natural vibrational resonances. In general, measuring a specific property in multibody structures presents a significant challenge due to the complex overlapping peaks within the resonance spectrum. We present a technique for extracting useful features from a complex spectrum by isolating resonance peaks that are sensitive to the measured property and insensitive to other properties (noise peaks). We isolate specific peaks by selecting frequency regions of interest and performing wavelet transformation, where the frequency regions and wavelet scales are tuned via a Genetic Algorithm. This contrasts greatly from traditional wavelet transformation/decomposition techniques, which use a large number of wavelets at different scales to represent the signal, including the noise peaks, and results in a large feature size, thus decreasing Machine Learning generalizability. We provide a detailed description of the technique and demonstrate the feature extraction technique for example regression and classification problems. We observe reductions of 95% and 40% in regression and classification errors, respectively, when using the Genetic algorithm/Wavelet Transform feature extraction, compared to using no feature extraction, or using Wavelet Decomposition, which is common in optical spectroscopy. The feature extraction has potential to significantly increase the accuracy of spectroscopy measurements based on a wide range of Machine Learning techniques. This would have significant implications for ARS, as well as other data-driven methods for other types of spectroscopy, e.g. optical.
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Gupta R, Nethan ST, Sinha DN, Gupta S, Singh S. Systematic review of determinants and interventions of areca nut cessation: curbing a public health menace. J Public Health (Oxf) 2023; 45:145-153. [PMID: 35094090 DOI: 10.1093/pubmed/fdab411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/08/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Areca nut (AN) is a proven human carcinogen and a global public health menace. There is yet no review providing comprehensive information on the determinants and interventions available for cessation of AN. This systematic review was aimed at summarizing the available literature on drivers and interventions for cessation of AN chewing habit and to highlight the research lacunae. METHODS A systematic literature search (from 1990 till March 2021) was conducted for studies on AN cessation. Relevant data were extracted independently by two authors. RESULTS A total of 16 studies were included, which highlighted the influence of socio-cultural factors, addictive nature of AN and withdrawal symptoms as barriers to quitting. However, the knowledge of ill-effects of AN use on health, absence of concurrent alcohol use or smoking and family pressure were associated with likelihood of AN cessation. The interventions utilized for AN cessation have been behavioural in majority of the studies except for one where antidepressants were used for this purpose. CONCLUSIONS The current review emphasizes the imperative need of appropriate cessation strategies for AN chewing habit including enhancing awareness of the harmful effects and research into additional behavioural and pharmacologic cessation therapies to control this significant public health problem.
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Agarwal J, Agrawal A, Kumar V, Sinha DN. Morphometric Analysis of Great Cardiac Vein and its Clinical Implication-A Cadaveric Study. J Clin Diagn Res 2023. [DOI: 10.7860/jcdr/2023/59961.17450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction: Great Cardiac Vein (GCV) is the longest venous vessel of heart. It is the main tributary of the coronary sinus and anterior wall of the left ventricle and interventricular septum are drained by GCV. Aim: To study the morphometry of GCV and its variations in north-western region of India. Materials and Methods: The present cross-sectional study was conducted in the Department of Anatomy, SRMS IMS, Bareilly, Uttar Pradesh, India, from January 2012 to December 2013. Thirty hearts of different ages and of both sexes (22 males and 8 females) procured from cadavers in the department. The length and diameter of GCV were measured with help of thread and digital vernier calipers. The mean, standard deviation and correlation were calculated using Microsoft office excel 2007. Results: In present study, 30 hearts (mean age: 41.83±12.37 years) of both sexes (22 males and 8 females) were studied. The mean length of GCV was 79.26±22.78 mm and the range of length was from 55.50±27.57 to 112.33±36.07 mm. The mean diameter of GCV was 2.85±1.32 mm. The mean length of GCV in males was 83.26±22.05 mm, while in females, the mean length of GCV was 74.72±22.08 mm. The diameter of GCV was having significant relation with weight (r=-0.663, p-value=0.0007) and age group (r-0.481; p-value=-0.023) in cadaveric males. Conclusion: The present morphometric study of GCV provides data for measurement of interventional devices required during interventional procedure in Indian setting.
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Bouvard V, Nethan ST, Singh D, Warnakulasuriya S, Mehrotra R, Chaturvedi AK, Chen THH, Ayo-Yusuf OA, Gupta PC, Kerr AR, Tilakaratne WM, Anantharaman D, Conway DI, Gillenwater A, Johnson NW, Kowalski LP, Leon ME, Mandrik O, Nagao T, Prasad VM, Ramadas K, Roitberg F, Saintigny P, Sankaranarayanan R, Santos-Silva AR, Sinha DN, Vatanasapt P, Zain RB, Lauby-Secretan B. IARC Perspective on Oral Cancer Prevention. N Engl J Med 2022; 387:1999-2005. [PMID: 36378601 DOI: 10.1056/nejmsr2210097] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Gupta AK, Kanaan M, Siddiqi K, Sinha DN, Mehrotra R. Oral Cancer Risk Assessment for Different Types of Smokeless Tobacco Products Sold Worldwide: A Review of Reviews and Meta-analyses. Cancer Prev Res (Phila) 2022; 15:733-746. [PMID: 36095092 DOI: 10.1158/1940-6207.capr-21-0567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/28/2022] [Accepted: 09/07/2022] [Indexed: 01/31/2023]
Abstract
Smokeless tobacco (SLT) use is a significant cause of lip and oral cavity cancers. Globally, oral cancer prevalence is strongly linked to the types of tobacco products used, their chemical composition, and their pattern of use. Except snus, all SLT products sold in different World Health Organization regions are strongly associated with oral cancer incidence. Shammah showed the highest association OR with 95% confidence intervals (CI; OR, 38.74; 95% CI, 19.50-76.96), followed by oral snuff (OR, 11.80; 95% CI, 8.45-16.49), gutkha (OR, 8.67; 95% CI, 3.59-20.93), tobacco with betel quid (OR, 7.74; 95% CI, 5.38-11.13), toombak (OR, 4.72; 95% CI, 2.88-7.73), and unspecified chewing tobacco (OR, 4.72; 95% CI, 3.13-7.11). Most SLT products containing high levels of carcinogenic tobacco-specific nitrosamines (TSNA) exhibit a high risk of oral cancer. There is an urgent need to frame and implement international policies for oral cancer prevention through legal control of the TSNA levels in all SLT product types. PREVENTION RELEVANCE Most smokeless tobacco products sold worldwide, mainly shammah, toombak, gutkha, betel quid with tobacco, and dry snuff, are associated with a high risk of oral cancer. A high concentration of tobacco-specific nitrosamines in smokeless tobacco products is the major causative factor for oral cancer development.
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Singh PK, Singh L, Wehrmeister FC, Singh N, Kumar C, Singh A, Sinha DN, Bhutta ZA, Singh S. Prevalence of smoking and smokeless tobacco use during breastfeeding: A cross-sectional secondary data analysis based on 0.32 million sample women in 78 low-income and middle-income countries. EClinicalMedicine 2022; 53:101660. [PMID: 36159043 PMCID: PMC9489519 DOI: 10.1016/j.eclinm.2022.101660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Smoking and smokeless tobacco use during the postpartum period is well studied in high-income countries, whereas low-income and middle-income countries (LMICs) lack evidence. METHODS In this cross-sectional study we used data from the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted in 78 LMICs between January 2010 and December 2019 to study tobacco use among 0.32 million sample lactating women. Age-standardized prevalence of smoking and smokeless tobacco use was estimated and presented with a 95% Confidence Interval (CI) for 78 LMICs. Pooled estimates overall and by WHO regions were obtained using random-effects meta-analyses. Country-level and community-level variance to understand contextual factors was also quantified using multilevel modelling. FINDINGS Pooled prevalence of any tobacco use among breastfeeding women in LMICs was 3.61% (95% CI 3.53-3.70); with the lowest prevalence in regions of the Americas (1.44%, 1.26-1.63) and the highest in the Southeast Asia region (6.13%, 6.0-6.27). The pooled prevalence of tobacco smoking was reported to be 1.16% (1.11-1.21), with the highest prevalence in the Eastern Mediterranean region (4.27%, 3.88-4.67) and the lowest in the African region (0.81%, 0.76-0.86). The pooled prevalence of smokeless tobacco use was reported to be 2.56% (2.49-2.63), with the highest prevalence in the Southeast Asia region (4.92%, 4.80-5.04). Illiterate and poor women in LMICs bore the enormous burden of tobacco use. INTERPRETATION The prevalence of smoking and smokeless tobacco use among lactating women in LMICs varied considerably across different WHO regions. Considering the cross-sectional design of the study, caution is required while interpreting the results. To improve mothers' and children's health and nutrition outcomes and reduce health inequalities in LMICs, reducing tobacco use through evidence-based interventions is critical. FUNDING None.
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Gupta R, Mariano LC, Nethan ST, Kedar A, Sinha DN, Warnakulasuriya S, Monteiro L, Sharma S, Gupta S, Singh S, Straif K. Risk Reversal of Oral, Pharyngeal and Oesophageal Cancers after Cessation of Betel Quid Users: A Systematic Review and Meta-Analysis. Ann Glob Health 2022; 88:5. [PMID: 35087705 PMCID: PMC8757388 DOI: 10.5334/aogh.3643] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Areca nut (AN), the principal ingredient of betel quid (BQ) has been categorized as a human carcinogen associated with various cancers of upper aerodigestive tract. However, there has been no attempt at summarizing the risk reversal of oral and other cancers after cessation of BQ with or without tobacco (BQ+T/BQ-T). OBJECTIVE To analyze the effect of cessation of betel quid without tobacco (BQ-T) and with tobacco (BQ+T) on reversal of the risk of oral, pharyngeal and oesophageal cancers. METHODS A systematic literature search was conducted for publications evaluating risk of these three cancers among current and former users of BQ-T or BQ+T. The overall as well as subgroup meta-relative risks (meta-RR) were estimated using random-effect models. RESULTS A total of 14 studies, seven each providing estimates for BQ-T and BQ+T, were identified. For BQ-T and oral cancer, a 28.9% risk reversal was observed among former users (meta-RR 5.61, 95% CI 2.24-14.04) compared to current users (meta-RR 7.89, 95% CI 3.90-15.98). A risk reversal of 48% was noted for pharyngeal cancer - former users (meta-RR 2.50, 95% CI 1.43-4.38), current users (meta-RR 4.81, 95% CI 2.05-11.30). For oesophageal cancer, no appreciable difference in risk was observed between current and former users.For BQ+T and oral cancer the overall meta-RR indicated a higher risk in former than in current users. However, sensitivity analysis including only better-quality studies showed a modestly lower cancer risk in former than in current users. Compared to current users, the risk in former users who quit less than 10 years ago (meta-RR 1.21, 95% CI 0.90-1.63) was increased, but decreased in former users who quit more than 10 years ago (meta-RR 0.72, 95% CI 0.48-1.07). CONCLUSION Our analysis highlights for the first time the potential of risk reversal for oral and pharyngeal cancers following cessation of BQ-T and for oral cancer in long-term quitters (greater than 10 years) of BQ+T. The suggestive evidence from this systematic review further supports the imperative need of a strong policy to reduce the initiation of BQ use and inclusion of interventions for BQ cessation in cancer control efforts especially in geographic regions where BQ chewing is prevalent.
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Gupta R, Gupta S, Sharma S, Sinha DN, Mehrotra R. Association of smokeless tobacco and cerebrovascular accident: a systematic review and meta-analysis of global data. J Public Health (Oxf) 2021; 42:e150-e157. [PMID: 31067304 DOI: 10.1093/pubmed/fdz054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/14/2019] [Accepted: 04/24/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The association of smokeless tobacco (SLT) with stroke has been dealt with in only a few reviews. The present meta-analysis aims to present the updated comprehensive summary risk of stroke in adult SLT users along with sub group analysis. METHODS A systematic literature search for articles evaluating risk of stroke in SLT users was conducted. The study characteristics and risk estimates were extracted independently by two authors (RG and SG). Random-effect model was used to estimate the summary relative risks. RESULTS The overall risk of stroke in SLT users was found to be significantly higher (1.17, 95% CI 1.04–1.30) compared to non-users, especially for users in Southeast Asian region. The results remained unchanged even after strict adjustment for smoking (1.18, 95% CI 1.04–1.32). SLT users had 1.34 times or 13.4% higher risk of fatal stroke, though risk of nonfatal stroke was not enhanced. Significantly higher risk of stroke was seen in users of chewing tobacco (1.35, 95% CI 1.20–1.50) in comparison to non-chewers. Gender-based analysis showed enhanced risk of fatal stroke in both male and female users. SLT-attributable fraction of fatal stroke was highest for India at 14.8%. CONCLUSION The significant higher risk of stroke with SLT use, even after adjustment for smoking, emphasizes the imperative need to include SLT cessation advice for control and prevention of stroke.
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Yadav A, Singh PK, Yadav N, Kaushik R, Chandan K, Chandra A, Singh S, Garg S, Gupta PC, Sinha DN, Mehrotra R. Smokeless tobacco control in India: policy review and lessons for high-burden countries. BMJ Glob Health 2021; 5:bmjgh-2020-002367. [PMID: 32665375 PMCID: PMC7365431 DOI: 10.1136/bmjgh-2020-002367] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 11/15/2022] Open
Abstract
We examined the magnitude of smokeless tobacco (SLT) use in India and identified policy gaps to ascertain the priorities for SLT control in India and other high SLT burden countries in the Southeast Asia region. We reviewed and analysed the legal and policy framework to identify policy gaps, options and priority areas to address the SLT burden in India and lessons thereof. In India, 21.4% adults, including 29.6% of men, 12.8% of women, use SLT while more than 0.35 million Indians die every year due to SLT use. SLT use remains a huge public health concern for other countries in the region as well. Priority areas for SLT control should include: constant monitoring, increasing taxes and price of SLT products, strengthening and strict enforcement of existing laws, integration of SLT cessation with all health and development programmes, banning of advertisement and promotion of SLT, increasing age of access to tobacco up to 21 years, introducing licensing for the sale of SLT, standardising of SLT packaging and preventing SLT industry interference in the implementation of SLT control policies besides a committed multistakeholder approach for effective policy formulation and enforcement. SLT control in India and the other high SLT burden countries, especially in the Southeast Asia region, should focus on strengthening and implementing the above policy priorities.
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Singh PK, Yadav A, Singh L, Mazumdar S, Sinha DN, Straif K, Singh S. Areca nut consumption with and without tobacco among the adult population: a nationally representative study from India. BMJ Open 2021; 11:e043987. [PMID: 34130957 PMCID: PMC8208015 DOI: 10.1136/bmjopen-2020-043987] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/19/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Areca nut is one of the most widely consumed substances globally, after nicotine, ethanol and caffeine and classified as carcinogenic to humans. This study examines the disparity and determinants of areca nut consumption with and without tobacco in India. DESIGN Nationally representative cross-sectional study. PARTICIPANTS We used the nationally representative Global Adult Tobacco Survey 2016-2017. The analytical sample size was 74 037 individual's aged 15 years and above with a response rate of 92.9%. MEASURES Current consumption of areca nut without tobacco and with tobacco. METHOD We examined determinants of areca nut consumption (without tobacco and with tobacco) using multinomial logistic regression, accounting for the survey design. RESULTS About 23.9% (95% CI 23.1 to 24.8) of the adult population consume areca nut, that is, approximately 223.79 million people in India; majority of users (14.2%-95% CI 13.5 to 14.9) consumed areca nut with tobacco. When compared with women, men were more likely to consume areca nut (with tobacco relative risk (RR)=2.02; 95% CI 1.85 to 2.21 and without tobacco RR=1.13; 95% CI 1.07 to 1.20). Age, marital status, education, occupation, caste, religion and region were significantly associated with areca nut consumption. However, the direction and magnitude of association differ with respect to the areca nut consumption with and without tobacco. CONCLUSION The ongoing tobacco control efforts would not address the majority of areca nut users until greater attention to areca nut consumption with and without tobacco is reflected in health policies in India.
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Nethan ST, Sinha DN, Kedar A, Kumar V, Sharma S, Hariprasad R, Mehrotra R. Tobacco use among urban slum dwellers attending a cancer screening clinic in the National Capital Region of India: a cross-sectional study. Ecancermedicalscience 2021; 15:1230. [PMID: 34158834 PMCID: PMC8183651 DOI: 10.3332/ecancer.2021.1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 12/02/2022] Open
Abstract
Background Tobacco consumption in India varies based on the place of residence (urban/rural). Minimal, exclusive information exists regarding the same for ‘urban slum’ dwellers. The current study determines the tobacco use pattern among such individuals in Noida, Uttar Pradesh (India). Methods A cross-sectional study was conducted among the urban slum residents visiting the institutional clinic between December 2016 and June 2019. Apart from tobacco history, routine recording of the basic demographic details and oral visual examination was carried out for the participants. For categorical data, the percentage of different parameters was calculated and for quantitative data, descriptive statistics were calculated. Chi-square or Fisher’s exact tests were employed to determine the association between the two categorical variables. To find the strength of association between tobacco use and the socio-demographic factors, univariate and multivariable binary logistic regression was used. Results Among 2,043 urban slum respondents (602 male, 1441 female), 15.0% (n = 308) currently consumed tobacco. The majority were smokeless tobacco (SLT) users (among both males and females). Among males, khaini (42.1%) and gutkha (32.5%) and among females gul (36.1%) were the most widely used tobacco products. Conclusion The majority of the Noida urban slum population attending the screening clinic consumed SLT. Gender variation in the tobacco form and product-specific consumption patterns indicates that the undertaking of urban slums-specific surveys is essential. Tobacco control programmes must incorporate appropriate strategies addressing such subgroups of tobacco users.
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Gupta R, Gupta S, Sharma S, Sinha DN, Mehrotra R. Corrigendum to: Association of smokeless tobacco and cerebrovascular accident: a systematic review and meta-analysis of global data. J Public Health (Oxf) 2021; 43:e115. [PMID: 32725202 DOI: 10.1093/pubmed/fdaa134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/14/2019] [Accepted: 04/24/2019] [Indexed: 11/13/2022] Open
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Singh PK, Yadav A, Lal P, Sinha DN, Gupta PC, Swasticharan L, Singh S, Mehrotra R. Dual Burden of Smoked and Smokeless Tobacco Use in India, 2009-2017: A Repeated Cross-Sectional Analysis Based on Global Adult Tobacco Survey. Nicotine Tob Res 2021; 22:2196-2202. [PMID: 32034915 DOI: 10.1093/ntr/ntaa033] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 02/06/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The dual use of smoked and smokeless tobacco (SLT) poses a serious challenge to tobacco control efforts. This article examines the trends and patterns of this usage in India during the period 2009-2010 and 2016-2017. METHODS Data from two rounds of nationally representative cross-sectional Global Adult Tobacco Survey (GATS) conducted in 2009-2010 and 2016-2017 have been used. Dual use was assessed based on current smokers and SLT users in both rounds. RESULTS Findings reveal that dual use in India has dropped from 5.3% during 2009-2010 to 3.4% during 2016-2017, a decline of nearly 10 million dual users. However, some states have added nearly 4.6 million new dual users during this period. While dual use continues to remain high in rural areas, there has been a manifold increase in urban areas. Findings revealed that intention to quit tobacco was lower among dual tobacco users as compared to single users with considerable difference between urban and rural areas. CONCLUSION Easy availability and affordability of SLT products compared to smoking products and restrictions on smoking in public places may have pushed current smokers and dual users to take to or intensify their SLT consumption. Measures relating to awareness, pricing, taxation, and enforcement of tobacco control laws should focus on all forms of tobacco, especially targeting high dual burden in rural and urban settings. IMPLICATIONS Dual form of tobacco users represent 12% of all tobacco users in the country. The study reveals that intention to quit tobacco among dual users is significantly lower than that among single tobacco product users. This requires improving public awareness about the morbidity and mortality that arises from the use of all forms of tobacco products. Efforts to restrict the availability of tobacco products should focus on licensing the sale of all tobacco products. Reduction in dual tobacco use will not only result in multiplied health benefits but also help in achieving the Non-Communicable Diseases targets under the United Nations Sustainable Development Goals.
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Sinha DN. Anatomy teaching in medical education. NATIONAL JOURNAL OF CLINICAL ANATOMY 2021. [DOI: 10.4103/njca.njca_10_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Grover S, Anand T, Kishore J, Tripathy JP, Sinha DN. Tobacco Use Among the Youth in India: Evidence From Global Adult Tobacco Survey-2 (2016-2017). Tob Use Insights 2020; 13:1179173X20927397. [PMID: 33013161 PMCID: PMC7513003 DOI: 10.1177/1179173x20927397] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Worldwide, tobacco use is a serious public health concern affecting the
youth. A vast majority of tobacco users start using tobacco well before the
age of 18 years which has enormous psychosocial and health effects. Objectives: To estimate the prevalence of individual forms of tobacco usage among youth
aged 15 to 24 years and to assess the association of sociodemographic
factors with tobacco use. Methods: The source of data was a cross-sectional GATS-2 survey in India (analysed
using SPSSv17.0) which used a multistage, geographically stratified cluster
sampling method. Bivariate analysis was done for evaluation of the possible
association of tobacco use with sociodemographic factors. Multivariable
logistic regression analysis was conducted to determine the relative
strength of association between those factors and tobacco use. Results: There were 13 329 respondents (44.9% males and 55.1% females) aged 15 to
24 years. Overall, 11.9% of respondents were using tobacco. The prevalence
of smoke and smokeless tobacco usage was 5% and 10.9%, respectively, whereas
2% of respondents reported dual usage. The odds of using any form of tobacco
were significantly higher among respondents aged 20 to 24 years (odds ratio
[OR]: 2 [1.76-2.77]) who were primarily residing in rural areas (adjusted
odds ratio [aOR]: 1.36 [1.2-1.54]) and were unmarried (aOR: 1.56
[1.37-1.88]). The odds of using any form of tobacco were significantly lower
among females (aOR: 0.21 [0.19-0.24]), literate individuals (aOR: 0.33
[0.29-0.37]), and those who were unemployed/students/homemakers (aOR: 0.44
[0.39-0.50]). Conclusions: The overall tobacco usage of 11.9% among young people in the age group of 15
to 24 years is a matter of concern. The study identified several
sociodemographic factors significantly associated with tobacco use, implying
the need for designing interventions considering social vulnerabilities of
youth.
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Grover S, Sinha DN, Gupta S, Gupta PC, Mehrotra R. The changing face of risk factors for non-communicable disease in Myanmar: findings from the 2009 and 2014 WHO STEP Surveys. J Public Health (Oxf) 2020; 41:750-756. [PMID: 30321380 DOI: 10.1093/pubmed/fdy176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Myanmar is burdened with the dual problem of communicable and non-communicable diseases (NCD), and is constantly endeavoring to attain its health objectives with limited resources. This study compares the results for the 2009 and 2014 WHO STEPs surveys (the 'stepwise' approach to adult risk factor surveillance) in Myanmar to determine the change in NCD risk factors over time. METHODOLOGY The proportion of individuals with major NCD risk factors such as current tobacco and alcohol consumption, <5 fruit/vegetable servings, physical activity, raised blood pressure (BP) and overweight and obesity from the year 2009 (n = 6414) and year 2014 (n = 8757) WHO STEP surveys were compared for the age group 25-64 and relative changes (RC) calculated. RESULTS Tobacco and alcohol consumption has increased significantly (25 and 49% RC, respectively) over the years. Individuals with low fruit/vegetable consumption (<5 servings) have declined (4.3% RC) and physical activity has increased significantly (46.5% RC). The prevalence of overweight, obese and hypertensive individuals has reduced significantly during this period with a RC reduction of 18, 28 and 20%, respectively. CONCLUSION Reductions in some NCD risk factors are encouraging but control of tobacco use and alcohol consumption requires more stringent policies in order to prevent NCDs in the future.
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Mbulo L, Palipudi KM, Smith T, Yin S, Munish VG, Sinha DN, Gupta PC, Swasticharan L. Patterns and related factors of bidi smoking in India. Tob Prev Cessat 2020; 6:28. [PMID: 32760863 PMCID: PMC7398128 DOI: 10.18332/tpc/119053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/29/2020] [Accepted: 03/16/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Bidis are the most commonly smoked tobacco product in India. Understanding bidi smoking is important to reducing overall tobacco smoking and health-related consequences in India. We analyzed 2009–2010 and 2016–2017 Global Adult Tobacco Survey (GATS) India data to examine bidi smoking and its associated sociodemographic correlates and perceptions of dangers of smoking. METHODS GATS is a nationally representative household survey of adults aged ≥15 years, designed to measure tobacco use and tobacco control indicators. Current bidi smoking was defined as current smoking of one or more bidis during a usual week. We computed bidi smoking prevalence estimates and relative change during 2009–2010 and 2016–2017. Used pooled multilevel logistic regression to identify individual-level determinants of bidi smoking and neighborhood-level and state-level variations. RESULTS Overall, 9.2% and 7.7% of adults smoked bidis in India during 2009–2010 and 2016–2017, respectively, reflecting 16.4% significant relative decline. In pooled analysis, male, older age, rural residence, lower education level, lower wealth index, less knowledge about harms of smoking, and survey year were associated with increased odds of bidi smoking. Results also showed variance in odds of smoking bidis is associated with neighborhood (15.9%) and state (31.8%) level. CONCLUSIONS Higher odds of bidi smoking were found among males, older age groups, and among those with lower socioeconomic status. Accordingly, health education interventions designed for these groups across India and other population-level interventions, such as WHO recommendation on increasing price on tobacco products, could help reduce bidi smoking. In addition, state/neighborhood-specific interventions could also help address differential bidi smoking across India.
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Asthana S, Labani S, Kailash U, Sinha DN, Mehrotra R. Association of Smokeless Tobacco Use and Oral Cancer: A Systematic Global Review and Meta-Analysis. Nicotine Tob Res 2020; 21:1162-1171. [PMID: 29790998 DOI: 10.1093/ntr/nty074] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 04/12/2018] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Smokeless tobacco products have been linked to precancerous and cancers of oral cavity for long. Evidence was available on the association between smokeless tobacco (SLT) products and oral cancers at regional but not at global level. Present meta-analysis is aimed to evaluate the risk of oral cancer with the use of SLT products among "ever" versus "never" users. METHOD Studies published for the period (1960-2016) are retrieved using Pubmed, Indmed, EMBASE, and Google Scholar search engines for the subject "ever" versus "never" users of SLT products and estimated the risk association with oral cancer. Summary odds ratios (relative risk) are estimated and meta-analysis was performed using random-effects model. RESULTS Thirty-seven studies from four of six WHO regions, Southeast Asia region (SEAR), the Eastern Mediterranean Region (EMR), Europe, and region of Americas (North and South) are included in the analysis. Significant risk with SLT products with oral cancer was found for SEAR (4.44, 95% CI = 3.51 to 5.61) and for EMR (1.28, 95% CI = 1.04 to 1.56). Significantly higher risk (p < .001) was found for females (5.83, 95% CI = 2.93 to 11.58). Product wise analysis for different SLT products revealed various levels of risk viz. gutkha (8.67, 95% CI = 3.59 to 20.93), pan tobacco / betel liquid (7.18, 95% CI = 5.48 to 9.41), oral snuff (4.18, 50% CI = 2.37 to 7.38), Mainpuri tobacco (3.32, 95% CI = 1.32 to 8.36), and snus (0.86, 95% CI = 0.58 to 1.29). CONCLUSION A significant positive association was observed between SLT use and the risk of oral cancer, in SEAR, EMRs, and among women users. IMPLICATIONS The present meta-analysis demonstrates SLT product use and the risk of oral cancer at global level. Moreover, the present analysis provided data on the risk associated with individual SLT product. The results fulfil the gap in the data on independent effect of individual SLT product use on the outcome of oral cancer at global level, conclusively. Chewing SLT products was associated with higher risk of oral cancer than other types of SLT. This can serve as a useful tool for policy makers in forming strict policies in controlling SLT menace. Hence, we propose that in addition to smoking, efforts should be directed towards SLT product cessation as well in reducing oral cancer incidence.
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Nagler EM, Aghi M, Rathore A, Lando H, Pednekar MS, Gupta PC, Stoddard AM, Kenwood C, Penningroth B, Sinha DN, Sorensen G. Factors associated with successful tobacco use cessation among teachers in Bihar state, India: a mixed-method study. HEALTH EDUCATION RESEARCH 2020; 35:60-73. [PMID: 31999824 PMCID: PMC6991618 DOI: 10.1093/her/cyz035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
Although tobacco use is declining in several countries including India (dropping from 35% in 2009-10 to 29% 2016-17 among adults)-it still poses a huge burden on India, as the world's second largest consumer of tobacco products. In Bihar state, with a prevalence of 25%, the Bihar School Teachers Study (BSTS) successfully enlisted teachers as role models for encouraging quitting and changing social norms pertaining to tobacco. The study used a mixed-methods approach to identify factors associated with teachers' quitting. Qualitative data were collected through focus groups with teachers and school principals. Quantitative data were collected through a written survey administered to school personnel post-intervention. Key findings from focus groups were that teachers and principals quit using tobacco and promoted cessation because they wanted to model positive behaviors; specific information about tobacco's harms aided cessation; and the BSTS intervention facilitated a school environment that supported quitting. Survey results indicated teachers who reported knowing people who quit using tobacco in the prior year were far more likely to quit as were teachers who reported that their school's tobacco policy was completely enforced. The combination of qualitative and quantitative data yielded important insights with strong implications for future interventions.
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Gupta R, Gupta S, Sharma S, Sinha DN, Mehrotra R. Risk of Coronary Heart Disease Among Smokeless Tobacco Users: Results of Systematic Review and Meta-Analysis of Global Data. Nicotine Tob Res 2020; 21:25-31. [PMID: 29325111 DOI: 10.1093/ntr/nty002] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 01/06/2018] [Indexed: 01/31/2023]
Abstract
Background Use of smokeless tobacco (SLT) products has been linked to multiple adverse effects, especially precancer and cancer of oral cavity. However, the association of SLT use with risk of coronary heart disease (CHD) is shrouded with controversy due to conflicting results in the literature. The present meta-analysis aimed to evaluate the risk of CHD among adult ever-users of SLT products along with sub-group analysis. Methods The analysis included studies retrieved from a systematic literature search for published articles assessing risk of CHD with SLT use. Two authors independently extracted risk estimates and study characteristics of the included studies. Summary relative risks were estimated using the random-effect model. Results Twenty studies from four WHO regions were included in the analysis. The summary risk of CHD in SLT users was not significantly positive (1.05, 95% CI = 0.96 to 1.15) although a higher risk of fatal CHD was seen (1.10, 95% CI = 1.00 to 1.20). The risk was significant for users in European Region (1.30, 95% CI = 1.14 to 1.47). The results remained unchanged even after strict adjustment for smoking. Product-wise analysis revealed a significant positive association of fatal CHD with snus/snuff use (1.37, 95% CI = 1.14 to 1.61). The SLT-attributable fraction of fatal CHD was calculated to be 0.3%, highest being for European region (5%). Conclusion A significant positive association was detected between SLT use and risk of fatal CHD, especially for European users and those consuming snus/snuff. In view of the positive association even after strict adjustment for smoking, these results underscore the need for inclusion of cessation efforts for smokeless tobacco in addition to smoking for control of fatal cardiovascular diseases. Implications The present meta-analysis demonstrates a global perspective of association between coronary heart disease (CHD) and use of smokeless tobacco (SLT), especially for fatal cardiac events, even with strict adjustment for smoking. There appears to be some difference in this effect based on the type of SLT product used. These results highlight the independent deleterious effect of SLT products on the outcome of CHD and might help to resolve the long-standing controversy regarding the association of SLT with the risk of CHD. Hence, we propose that in addition to smoking, cessation efforts should be directed towards SLT products as well, for control of cardiovascular diseases.
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Suliankatchi RA, Sinha DN, Rath R, Aryal KK, Zaman MM, Gupta PC, Karki KB, Venugopal D. Smokeless Tobacco Use is "Replacing" the Smoking Epidemic in the South-East Asia Region. Nicotine Tob Res 2020; 21:95-100. [PMID: 29281083 DOI: 10.1093/ntr/ntx272] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/20/2017] [Indexed: 01/10/2023]
Abstract
Background The sustained anti-tobacco campaign initiated in response to the mounting evidence against tobacco smoking has driven tobacco companies and smokers to look for alternative choices, such as smokeless tobacco (SLT) products. If this strategy advances, it could undermine several gains made by the campaign over the years. Our objective was to examine the trends in the prevalence of different tobacco types in three countries (Bangladesh, India, and Nepal) of South-East Asia. Methods Data from national surveys were used to estimate the trends of weighted and age-standardized prevalence (along with 95% CI) of different tobacco products. The share of each tobacco type was then calculated as a percentage of total tobacco use for each time point and country. Results In all the three countries, smoking prevalence declined (by 6% in Bangladesh, 3% in India, and 7% in Nepal) but SLT use increased (by 3% in Bangladesh, 6% in India, and 4% in Nepal) over the study period. SLT use increased irrespective of whether the total tobacco use increased or decreased. The share of SLT as a percentage of total tobacco use increased from 15% to 19% among Bangladeshi men, from 46% to 61% in India, and from 29% to 41% in Nepal. Conclusions In South-East Asia, a clear shift in the product preference from smoking to SLT was noted. Misleading advertising by tobacco companies may be responsible for the increase in the SLT prevalence, which is as harmful as smoking. Countries should strengthen policies to restrict SLT usage and prevent the rise of its use. Implications It has been documented that the smoking prevalence has been declining in most countries of the South-East Asia region where effective anti-tobacco laws have been implemented. But, due to a number of factors, the prevalence of smokeless tobacco has been increasing steadily, making the entire anti-tobacco movement less effective in terms of reducing the tobacco-attributable disease burden. In this context, this study has provided a detailed comparative analysis of the prevalence of smokeless tobacco use and smoking in three countries of the SEAR where such data were available. It can be clearly seen that the preference for smoking has shifted towards the smokeless tobacco in all the three study countries. This study recommends that tobacco control interventions should be aligned with the changing dynamics of the tobacco epidemic, and the need of the hour is placing restrictions of smokeless tobacco use so as to drive forward the gains of the anti-tobacco movement.
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Sinha DN, Gupta PC, Kumar A, Bhartiya D, Agarwal N, Sharma S, Singh H, Parascandola M, Mehrotra R. The Poorest of Poor Suffer the Greatest Burden From Smokeless Tobacco Use: A Study From 140 Countries. Nicotine Tob Res 2019; 20:1529-1532. [PMID: 29309692 DOI: 10.1093/ntr/ntx276] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 12/21/2017] [Indexed: 11/12/2022]
Abstract
Background The full extent of global smokeless tobacco (SLT) use and its association with key demographic factors such as gender, place of residence, and household or country income status is not yet known. Methods The global burden of SLT use among adults was estimated using nationally representative data of 140 countries by gender and country income group. Countries were grouped in Group 1 (low and low-middle income countries combined) and Group 2 (upper middle and high income countries combined). The number of male and female SLT users was calculated using prevalence and population estimates of corresponding age groups. Results Nearly one in 10 males and one in 20 females used SLT in some form. SLT use prevalence was significantly higher among males (p < .001) and females (p < .001) in Group 1 countries compared with their counterparts in Group 2 countries. However, for both Group 1 (p < .01) and Group 2 (p < .01), males were more likely to use SLT than females. Nearly 91% of a total 356 million adult SLT users resided in Group 1 countries, with 81.6% in countries of WHO South-East Asia region (SEAR). In SEAR and African region, SLT use was higher in rural areas and poorest communities. Conclusion The majority of the burden of SLT use is on lower and lower middle income countries with the greatest burden on the poorest segments of the population in these countries. Implications This study brings the comprehensive information on epidemiology of SLT use among adults at global level. Ninety percent of SLT burden is in low and low-middle income group of countries and more specifically among the poorest group in such countries. These countries need to have strategies to implement different provisions of the WHO Framework Convention on Tobacco Control. The program in such countries should be targeted towards the poorest communities for effective SLT control.
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Huque R, Zaman MM, Huq SM, Sinha DN. Smokeless tobacco and public health in Bangladesh. Indian J Public Health 2019; 61:S18-S24. [PMID: 28928314 PMCID: PMC6349136 DOI: 10.4103/ijph.ijph_233_17] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Despite the high prevalence of smokeless tobacco (SLT) use among adults in Bangladesh, SLT was not included in the Tobacco Control Law till 2013. Information on SLT use among Bangladeshi people is inadequate for policymaking and implementing effective control measures. With the aim to identify the prevalence and trends of different SLT products, health and economic impacts, manufacture, and sale of and policies related to SLT in Bangladesh, we carried out a literature review, which involved literature search, data extraction, and synthesis. Evidence suggests that in Bangladesh, SLTs range from unprocessed to processed or manufactured products including Sada Pata, Zarda, Gul, and Khoinee. Over 27% of Bangladeshi adults aged 15 years and older use SLT in one form or other. SLT use is associated with age, sex, education, and socioeconomic status. SLT consumption has reportedly been associated with increased prevalence of heart diseases, stroke, and oral cancer and led to around 320,000 disability adjusted life years lost in Bangladesh in 2010. No cessation service is available for SLT users in public facilities. Compared to cigarettes, taxation on SLT remains low in Bangladesh. The amendment made in Tobacco Control Law in 2013 requires graphic health warnings to cover 50% of SLT packaging, ban on advertisement of SLT products, and restriction to sale to minors. However, implementation of the law is weak. As the use of SLT is culturally accepted in Bangladesh, culturally appropriate public awareness program is required to curb SLT use along with increased tax and cessation services.
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Suliankatchi Abdulkader R, Sinha DN, Jeyashree K, Rath R, Gupta PC, Kannan S, Agarwal N, Venugopal D. Trends in tobacco consumption in India 1987–2016: impact of the World Health Organization Framework Convention on Tobacco Control. Int J Public Health 2019; 64:841-851. [DOI: 10.1007/s00038-019-01252-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022] Open
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