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1. Community health promotion and medical provision and impact on neonates (CHAMPION2) and support to rural India’s public education system and impact on numeracy and literacy scores (STRIPES2): an update to the study protocol (v 11) for a cluster randomised trial in Madhya Pradesh, India

Author: Siddharudha Shivalli, Ila Fazzio, Chris Frost, Diana Elbourne, Nicholas Magill, Dropti Sharma, Sajjan Singh Shekhawat, Rukmini Banerji, Sridevi Karnati, Harshavardhan Reddy, Padmanabh Reddy, Rakhi Nair, Madan Gopal, and Peter Boone
Subjects: Cluster randomised controlled trial, India, Neonatal mortality, Immediate neonatal care, Postnatal care, Maternal mortality, Medicine (General), R5-920
Abstract: Abstract Background This update outlines amendments to the CHAMPION2/STRIPES2 cluster randomised trial protocol primarily made due to the COVID-19 pandemic and nationwide lockdown in India in 2020. These amendments were in line with national guidelines for health research during the COVID-19 pandemic. Methods We did not change the original trial design, eligibility, and outcomes. Amendments were introduced to minimise the risk of COVID-19 transmission and ensure safety and wellbeing of trial staff, participants, and other villagers. CHAMPION2 intervention: participatory learning and action (PLA) and fixed day service (FDS) meeting were revised to incorporate social distancing and hygiene precautions. During the COVID-19 pandemic, PLA participation was limited to pregnant women and birthing partners. STRIPES2 intervention: before/after-school classes were halted for a period and then modified temporarily (reducing class sizes, and/or changing meeting places) with hygiene and safe distancing practices introduced. Data collection: The research team gathered as much information as possible from participants by telephone. If the participant had no telephone or could not be contacted by telephone, data were collected in person. COVID-19 precautions: trial teams were trained on COVID-19 precautions and used personal protective equipment whilst in the villages for trial-related activities. After restarting the trial between June and September 2020 in a phased manner, some trial activities were suspended again in all the trial villages from April to June 2021 due to the second wave of COVID-19 cases and lockdown imposed in Satna, Madhya Pradesh. Trial timelines were also revised, with outcomes measured later than originally planned. Trial registration Clinical Trial Registry of India CTRI/2019/05/019296. Registered 23 May 2019. https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MzExOTg=&Enc=&userName=champion2 .
Published: 2024
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2. Statistical analysis plan for a cluster randomised trial in Madhya Pradesh, India: community health promotion and medical provision and impact on neonates (CHAMPION2)

Author: Nicholas Magill, Siddharudha Shivalli, Ila Fazzio, Diana Elbourne, Suzanne Keddie, Padmanabh Reddy, Rakhi Nair, Madan Gopal, Sridevi Karnati, Harshavardhan Reddy, Peter Boone, and Chris Frost
Subjects: Medicine (General), R5-920
Abstract: Abstract Background Neonatal mortality in India has fallen steadily and was estimated to be 24 per 1000 live births in the year 2017. However, neonatal mortality remains high in rural parts of the country. The Community Health Promotion and Medical Provision and Impact On Neonates (CHAMPION2) trial investigates the effect of a complex health intervention on neonatal mortality in the Satna District of Madhya Pradesh. Methods/design The CHAMPION2 trial forms one part of a cluster-randomised controlled trial with villages (clusters) randomised to receive either a health (CHAMPION2) or education (STRIPES2) intervention. Villages receiving the health intervention are controls for the education intervention and vice versa. The primary outcome is neonatal mortality. The effect of the active intervention on the primary outcome (compared to usual care) will be expressed as a risk ratio, estimated using a generalised estimating equation approach with robust standard errors that take account of clustering at village level. Secondary outcomes include maternal mortality, stillbirths, perinatal deaths, causes of death, health care and knowledge, hospital admissions of enrolled women during pregnancy or in the immediate post-natal care period or of their babies (during the neonatal period), maternal blood transfusions, and the cost effectiveness of the intervention. A total of 196 villages have been randomised and over 34,000 women have been recruited in CHAMPION2. Discussion This update to the published trial protocol gives a detailed plan for the statistical analysis of the CHAMPION2 trial. Trial registration Registry of India: CTRI/2019/05/019296. Registered on 23 May 2019. https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MzExOTg=&Enc=&userName=champion2
Published: 2024
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3. Statistical analysis plan for the phaco TIp position during clear corneal Phacoemulsification Surgery (TIPS) randomized controlled trial

Author: Soujanya Kaup, Dimple Kondal, Siddharudha Shivalli, and John Buchan
Subjects: Endothelial cell loss, Phacoemulsification, Phacoemulsification/complication, Pseudophakic bullous keratopathy, Phaco-tip, Bevel-up, Medicine (General), R5-920
Abstract: Abstract Background Cornea is the most important refractive media in the eye, and damage to the corneal endothelium is one of the most common causes of poor visual outcome following cataract surgery, particularly in those with predisposing factors. The role of phaco tip position during phacoemulsification on corneal endothelial damage is ambiguous, and there is no consensus regarding the most cornea-friendly phaco tip position (bevel-up or bevel-down). The objective of the trial is to compare the effect of phaco tip position (bevel-up vs. bevel-down) during phacoemulsification using direct chop technique on corneal endothelial cell count. Methods and design TIPS is a randomised, multicentre, parallel-group, triple-masked (participant, outcome assessor, and statistician) trial with 1:1 allocation ratio. A total of 480 eligible participants, aged > 18 years with immature cataract, will be randomly allocated into bevel-up and bevel-down groups at two centres. Randomisation will be stratified according to the cataract grade. The primary outcome is postoperative endothelial cell count at 1 month. Secondary outcomes are central corneal thickness on postoperative days 1, 15, and 30 and difference in intraoperative complications. Conclusion In this paper, we describe the detailed statistical analysis plan (SAP) for the TIPS trial, which was prepared prior to database lock. The SAP includes details of planned analyses and unpopulated tables, which will be reported in the publications. We plan to lock the database in July 2023 and publish the results later in the same year. SAP Version 0.1 (dated: 28 April 2023) Protocol version:2.0 Trial registration Clinical Trial Registry of India CTRI/2019/02/017464. Registered on 5 February 2019; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=29764&EncHid=&userName=2019/02/017464
Published: 2024
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4. Statistical analysis plan for a cluster randomised trial in Madhya Pradesh, India: support to rural India’s public education system and impact on numeracy and literacy scores (STRIPES2)

Author: Suzanne Keddie, Ila Fazzio, Siddharudha Shivalli, Nicholas Magill, Diana Elbourne, Dropti Sharma, Sajjan Singh Shekhawat, Rukmini Banerji, Sridevi Karnati, Harshavardhan Reddy, Alex Eble, Peter Boone, and Chris Frost
Subjects: Medicine (General), R5-920
Abstract: Abstract Background India has made steady progress in improving rates of primary school enrolment but levels of learning achievement remain low. The Support To Rural India’s Public Education System (STRIPES) trial provided evidence that an after-school para-teacher intervention improved numeracy and literacy levels in Telangana, India. The STRIPES2 trial investigates whether such an intervention will have a similar effect on the literacy and numeracy of primary school age children in the Satna District of Madhya Pradesh, India. Methods/design The STRIPES2 trial forms one part of a cluster-randomised controlled trial with villages (clusters) randomised to receive either a health (CHAMPION2) or education (STRIPES2) intervention. Building on the design of the earlier CHAMPION/STRIPES trial, villages receiving the health intervention are controls for the education intervention and vice versa. The primary outcome is a combined literacy and numeracy score. Secondary outcomes include separate scores for literacy and numeracy; caregivers’ engagement with child’s learning; expenditure on education; enrolment in school; caregiver’s report of school attendance and the cost effectiveness of the intervention. Over 7000 primary school age children have been recruited and randomised in STRIPES2. Discussion This update to the published trial protocol gives a detailed plan for the statistical analysis of the STRIPES 2 trial. Trial registration Registry of India: CTRI/2019/05/019296. Registered on 23 May 2019. http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=31198&EncHid=&modid=&compid=%27,%2731198det%27
Published: 2023
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5. The burden of injury in Central, Eastern, and Western European sub-region: a systematic analysis from the Global Burden of Disease 2019 Study

Author: Juanita A. Haagsma, Periklis Charalampous, Filippo Ariani, Anne Gallay, Kim Moesgaard Iburg, Evangelia Nena, Che Henry Ngwa, Alexander Rommel, Ausra Zelviene, Kedir Hussein Abegaz, Hanadi Al Hamad, Luciana Albano, Catalina Liliana Andrei, Tudorel Andrei, Ippazio Cosimo Antonazzo, Olatunde Aremu, Ashokan Arumugam, Alok Atreya, Avinash Aujayeb, Jose Luis Ayuso-Mateos, Luchuo Engelbert Bain, Maciej Banach, Till Winfried Bärnighausen, Francesco Barone-Adesi, Massimiliano Beghi, Derrick A. Bennett, Akshaya S. Bhagavathula, Félix Carvalho, Giulio Castelpietra, Ledda Caterina, Joht Singh Chandan, Rosa A. S. Couto, Natália Cruz-Martins, Giovanni Damiani, Anna Dastiridou, Andreas K. Demetriades, Diana Dias-da-Silva, Adeniyi Francis Fagbamigbe, Seyed-Mohammad Fereshtehnejad, Eduarda Fernandes, Pietro Ferrara, Florian Fischer, Urbano Fra.Paleo, Silvia Ghirini, James C. Glasbey, Ionela-Roxana Glavan, Nelson G. M. Gomes, Michal Grivna, Netanja I. Harlianto, Josep Maria Haro, M. Tasdik Hasan, Sorin Hostiuc, Ivo Iavicoli, Milena D. Ilic, Irena M. Ilic, Mihajlo Jakovljevic, Jost B. Jonas, Jacek Jerzy Jozwiak, Mikk Jürisson, Joonas H. Kauppila, Gbenga A. Kayode, Moien A. B. Khan, Adnan Kisa, Sezer Kisa, Ai Koyanagi, Manasi Kumar, Om P. Kurmi, Carlo La-Vecchia, Demetris Lamnisos, Savita Lasrado, Paolo Lauriola, Shai Linn, Joana A. Loureiro, Raimundas Lunevicius, Aurea Madureira-Carvalho, Enkeleint A. Mechili, Azeem Majeed, Ritesh G. Menezes, Alexios-Fotios A. Mentis, Atte Meretoja, Tomislav Mestrovic, Tomasz Miazgowski, Bartosz Miazgowski, Andreea Mirica, Mariam Molokhia, Shafiu Mohammed, Lorenzo Monasta, Francesk Mulita, Mukhammad David Naimzada, Ionut Negoi, Subas Neupane, Bogdan Oancea, Hans Orru, Adrian Otoiu, Nikita Otstavnov, Stanislav S. Otstavnov, Alicia Padron-Monedero, Songhomitra Panda-Jonas, Shahina Pardhan, Jay Patel, Paolo Pedersini, Marina Pinheiro, Ivo Rakovac, Chythra R. Rao, Salman Rawaf, David Laith Rawaf, Violet Rodrigues, Luca Ronfani, Dominic Sagoe, Francesco Sanmarchi, Milena M. Santric-Milicevic, Brijesh Sathian, Aziz Sheikh, Rahman Shiri, Siddharudha Shivalli, Inga Dora Sigfusdottir, Rannveig Sigurvinsdottir, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Catalin-Gabriel Smarandache, Bogdan Socea, Raúl A. R. C. Sousa, Paschalis Steiropoulos, Rafael Tabarés-Seisdedos, Marcos Roberto Tovani-Palone, Fimka Tozija, Sarah Van de Velde, Tommi Juhani Vasankari, Massimiliano Veroux, Francesco S. Violante, Vasiliy Vlassov, Yanzhong Wang, Ali Yadollahpour, Sanni Yaya, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Suzanne Polinder, and Marek Majdan
Subjects: Burden of disease, Injuries, Disability adjusted life years, Mortality, Europe, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Injury remains a major concern to public health in the European region. Previous iterations of the Global Burden of Disease (GBD) study showed wide variation in injury death and disability adjusted life year (DALY) rates across Europe, indicating injury inequality gaps between sub-regions and countries. The objectives of this study were to: 1) compare GBD 2019 estimates on injury mortality and DALYs across European sub-regions and countries by cause-of-injury category and sex; 2) examine changes in injury DALY rates over a 20 year-period by cause-of-injury category, sub-region and country; and 3) assess inequalities in injury mortality and DALY rates across the countries. Methods We performed a secondary database descriptive study using the GBD 2019 results on injuries in 44 European countries from 2000 to 2019. Inequality in DALY rates between these countries was assessed by calculating the DALY rate ratio between the highest-ranking country and lowest-ranking country in each year. Results In 2019, in Eastern Europe 80 [95% uncertainty interval (UI): 71 to 89] people per 100,000 died from injuries; twice as high compared to Central Europe (38 injury deaths per 100,000; 95% UI 34 to 42) and three times as high compared to Western Europe (27 injury deaths per 100,000; 95%UI 25 to 28). The injury DALY rates showed less pronounced differences between Eastern (5129 DALYs per 100,000; 95% UI: 4547 to 5864), Central (2940 DALYs per 100,000; 95% UI: 2452 to 3546) and Western Europe (1782 DALYs per 100,000; 95% UI: 1523 to 2115). Injury DALY rate was lowest in Italy (1489 DALYs per 100,000) and highest in Ukraine (5553 DALYs per 100,000). The difference in injury DALY rates by country was larger for males compared to females. The DALY rate ratio was highest in 2005, with DALY rate in the lowest-ranking country (Russian Federation) 6.0 times higher compared to the highest-ranking country (Malta). After 2005, the DALY rate ratio between the lowest- and the highest-ranking country gradually decreased to 3.7 in 2019. Conclusions Injury mortality and DALY rates were highest in Eastern Europe and lowest in Western Europe, although differences in injury DALY rates declined rapidly, particularly in the past decade. The injury DALY rate ratio of highest- and lowest-ranking country declined from 2005 onwards, indicating declining inequalities in injuries between European countries.
Published: 2022
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6. Does the phaco TIp position during clear corneal Phacoemulsification Surgery adversely affect corneal endothelium? TIPS study protocol for a randomised, triple-masked, parallel-group trial of bevel-up versus bevel-down phacoemulsification [version 2; peer review: 2 approved, 1 approved with reservations]

Author: Krishna Prasad Kudlu, Suresh Kumar Pandey, Siddharudha Shivalli, Soujanya Kaup, Cynthia Arunachalam, Chinnappa Ajjinicanda Ganapathi, and John Buchan
Subjects: Endothelial cell loss, phacoemulsification, phacoemulsification/complication, pseudophakic bullous keratopathy, Phaco-tip, bevel-up, eng, Medicine, Science
Abstract: Introduction: Globally, at least 30 million cataract surgeries are required annually to prevent cataract-related blindness. Corneal endothelial decompensation is one of the most common causes of poor visual outcome following cataract surgery, particularly in those with predisposing factors. The increasing ageing population and reduced visual impairment threshold for cataract surgery have resulted in rising cataract surgical rates and hence, an increase in corneal endothelial decompensation is expected. The role of phaco tip position on corneal endothelial damage is ambiguous. Previous studies have reported contradictory results and were also underpowered to detect a significant difference due to small sample sizes. With no consensus regarding the most cornea-friendly phaco tip position (bevel-up versus bevel-down) during phacoemulsification, we propose a randomised clinical trial with a robust design using direct chop phaco-technique. Objective: To compare the effect of phaco tip position (bevel-up vs. bevel-down) on corneal endothelial cell count during phacoemulsification. Methods: A randomised, multicentre, parallel-group, triple-masked (participant, outcome assessor, and statistician) trial with 1:1 allocation ratio is proposed. By adopting stratified randomisation (according to cataract grade), we will randomly allocate 480 patients aged >18 years with immature cataract into bevel-up and bevel-down groups at two centres. History of significant ocular trauma, previous intraocular surgery, shallow anterior chamber, low endothelial cell count, pseudoexfoliation syndrome, intraocular inflammation, and corneal endothelial dystrophy are the key exclusion criteria. The primary outcome is postoperative endothelial cell count at one month. Secondary outcomes are central corneal thickness on postoperative days 1, 15, and 30, and intraoperative complications. Trial registration: Clinical Trial Registry of India CTRI/2019/02/017464 (05/02/2019).
Published: 2023
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7. Protocol for a cluster randomised trial in Madhya Pradesh, India: community health promotion and medical provision and impact on neonates (CHAMPION2); and support to rural India’s public education system and impact on numeracy and literacy scores (STRIPES2)

Author: Arjun Agarwal, Rukmini Banerji, Peter Boone, Diana Elbourne, Ila Fazzio, Chris Frost, Madan Gopal, Sridevi Karnati, Rakhi Nair, Harshavardhan Reddy, Padmanabh Reddy, Dropti Sharma, Sajjan Singh Shekhawat, and Siddharudha Shivalli
Subjects: Cluster randomised controlled trial, India, Neonatal mortality, Immediate neonatal care, Postnatal care, Maternal mortality, Medicine (General), R5-920
Abstract: Abstract Background Rural areas of India exhibit high neonatal mortality, and low literacy and numeracy. We assess the effect of a complex package of health interventions on neonatal survival and the effect of out-of-school-hours teaching on children’s literacy and numeracy in rural Madhya Pradesh. Methods/design This is a cluster-randomised controlled trial with villages (clusters) receiving either a health (CHAMPION2) or education (STRIPES2) intervention. Building on the design of the earlier CHAMPION/STRIPES trial, villages receiving the health intervention are controls for the education intervention and vice versa. The clusters are 196 villages in Satna district, Madhya Pradesh, India: each is at least 5 km from a Community Health Centre, has a population below 2500, and has at least 15 children eligible for the education intervention. The participants in CHAMPION2 are resident married women younger than 50 years of age who had not undergone a family planning operation, provided they are enumerated pre-randomisation or marry a man enumerated pre-randomisation. The participants in STRIPES2 are resident children born 16 June 2010 to 15 June 2013, not in school before the 2018–2019 school year and intending to enrol in first grade in 2018–2019 or 2019–2020. Discussion In CHAMPION2, the NICE Foundation will deliver a 3.5-year programme comprising Accredited Social Health Activists or village health workers and midwives promoting health knowledge and providing antenatal, postnatal, and neonatal healthcare; community mobilisation; referrals to appropriate government health facilities; and a health education campaign. In STRIPES2, the Pratham Education Foundation will deliver a programme of village-based, before/after school support focusing on literacy and numeracy. As controls, the CHAMPION2 control villages will receive the usual health services (plus the STRIPES2 intervention). STRIPES2 control villages will receive the usual education services (plus the CHAMPION2 intervention). The primary outcome in CHAMPION2 is neonatal mortality. Secondary outcomes include antenatal, delivery, immediate neonatal and postnatal care practices, maternal mortality, stillbirths, early neonatal deaths, perinatal deaths, health knowledge, hospital admissions, maternal blood transfusions, and cost effectiveness. The primary outcome in STRIPES2 is a composite literacy and numeracy test score. Secondary outcomes include separate literacy and numeracy scores, reported school enrolment and attendance, parents’ engagement with children’s learning, and cost effectiveness. Independent research and implementation teams will conduct the trial. Trial Steering and Data Monitoring Committees, with independent members, will supervise the trial. Trial registration Clinical Trial Registry of India: CTRI/2019/05/019296. Registered on 23 May 2019. http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=31198&EncHid=&modid=&compid=%27,%2731198det%27
Published: 2020
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8. Determinants of healthcare facility utilization for childbirth in Kuantan Singingi regency, Riau province, Indonesia 2017

Author: Rajunitrigo Sukirman, Tri Yunis Miko Wahyono, and Siddharudha Shivalli
Subjects: Epidemiologic, Determinants, Delivery place, Healthcare facility, Indonesia, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Reducing maternal mortality ratio (MMR) is a high priority public health issue in developing countries such as Indonesia. The current MMR in Indonesia is 126/100,000 live births. Optimum use of available healthcare facilities for delivery can avert maternal deaths. This study aimed to determine the factors associated with healthcare facility utilization for childbirth in Kuantan Singingi regency, Riau province, Indonesia 2017. Methods We conducted a community-based cross-sectional study in 15 sub-districts of Kuantan Singingi regency from May–June 2017. We selected 320 mothers from 15 sub-districts who delivered in the last 3 months (February–April 2017). Trained data enumerators collected the relevant data by using a pre-tested semi-structured questionnaire. We used Cox regression analysis to determine the factors associated with delivery at healthcare facilities. Prevalence Ratio (PR) with a 95% confidence interval (CI) for childbirth at healthcare facilities was the key outcome measure. Results Only 54.4% (174) of the 320 mothers delivered at healthcare facilities. Knowledge about pregnancy danger signs (PR = 1.59, 95%CI:1.15–2.2), attitude towards healthcare services (PR = 0.79, 95%CI:0.33–1.89), and access to health care services (PR = 0.39, 95%CI:0.18–0.84) were the dominant factors of childbirth at healthcare facilities. There was an interaction between attitude and access to healthcare influencing delivery at healthcare facilities. Conclusions Utilization of healthcare facilities for childbirth was low in Kuantan Singingi regency. Knowledge of pregnancy danger signs was an independent correlate of childbirth at healthcare facilities. Also, the interaction between attitude and access to healthcare showed a significant influence on childbirth at healthcare facilities. We recommend strengthening of existing maternal and child health program with a particular emphasis on complete and quality antenatal care, health education on danger signs of pregnancy and childbirth, and promoting positive attitudes towards healthcare facilities.
Published: 2020
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9. Factors associated with pasung (physical restraint and confinement) of schizophrenia patients in Bogor regency, West Java Province, Indonesia 2017

Author: Nenden Hikmah Laila, Renti Mahkota, Siddharudha Shivalli, Krisnawati Bantas, and Tri Krianto
Subjects: Schizophrenia, Pasung, Aggressive, Violent, Discourse, Psychiatry, RC435-571
Abstract: Abstract Background Schizophrenia is a chronic mental disorder affecting more than 21 million worldwide. In Indonesia, 14.3% of households have a patient with a mental disorder, and the majority of these are in rural areas. Family members in Indonesia use repressive social measures like pasung (physical restraint and confinement) for these patients. A study was conducted with the objective to determine the factors associated with pasung among patients with schizophrenia in Bogor Regency, West Java Province, Indonesia 2017. Methods A case-control study was conducted in Bogor Regency from May–June 2017. A case subject was defined as a patient with schizophrenia who was ever subjected to pasung and a control subject was defined as a patient with schizophrenia residing in the same geographical area and never subjected to pasung. Multi-stage sampling was used to select case and control subjects from the registered reports of the Health Service of Bogor Regency (2012–16) in 34 sub districts and 59 health centers. Multivariate logistic regression was used to identify the factors associated with pasung. Attributable and population attributable risks (AR, PAR) for pasung were calculated. Results A total of 114 case and 136 control subjects were studied. Patient’s aggressive or violent behavior (AdjOR: 4.49, 95%CI: 2.52–8.0), unemployment (AdjOR: 2.74, 95%CI: 1.09–6.9) and informal employment (AdjOR: 2.5, 95%CI: 1.1–5.84) in the family and negative attitude of the family towards the patient (AdjOR: 2.52, 95%CI: 1.43–4.43) were associated with pasung. Patient’s aggressive or violent behavior (PAR = 44.3%) and unemployment in the family (PAR = 49.3%) were the predominant factors of pasung. Conclusions Patient’s aggressive or violent behavior, negative attitude of the family towards the patient and unemployment in the family were associated with pasung. We recommend health education and encouraging family members to shift patients with schizophrenia exhibiting aggressive or violent behavior to a mental health facility. Strengthening of basic mental health services and involving family members while treating patients with schizophrenia to develop positive attitudes could be considered. Creating employment opportunities and a social support system for treated patients with schizophrenia and family members could further avert pasung.
Published: 2019
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10. Combating the COVID-19 pandemic in a resource-constrained setting: insights from initial response in India

Author: Rabbanie Tariq Wani, Paragkumar Dhirajlal Chavda, Siddharudha Shivalli, Mohan Bairwa, Madhur Verma, Pranab Chatterjee, Nitika Sharma, Sabyasachi Behera, Praveen Kulkarni, Archisman Mohapatra, Balaji Ramraj, Arvind Kumar Singh, Manish Kumar Singh, Ravi Rohilla, Bharti Chawla, Sumit Chawla, Rashmi Agarwalla, Shubhashri Sudhiendra Jahagirdar, Madan Mohan Majhi, Harshal Ramesh Salve, Pallavi Shukla, Kapil Yadav, Ramadass Sathiyamoorthy, Kaushik Sarkar, Soumya Swaroop Sahoo, Shamshad Ahmad, Dewesh Kumar, Anirban Chatterjee, Gaihemlung Pamei, Hariom Kumar Solanki, Shashanka Shekhar Chakraborty, Gitismita Naik, M Mohan Kumar, Chinnadurai Aravinda, Shilpa Karir, Jasmin Nilima Panda, Jaya Singh Kshatri, Smrutiranjan Nayak, Sithun Kumar Patro, Shib Sekhar Datta, Nilanjana Ghosh, Pritam Roy, Shankar Reddy Dudala, Rachana R Annadani, Malatesh Undi, Sudhir Prabhu, Santosh K Yatnatti, Rakesh N Pillai, Antony Stanley, Satyanarayana G Konda, Kajal Davara, Mihir Prafulbhai Rupani, Anuj Mundra, Akhil Dhanesh Goel, and Manoj Kumar Gupta
Subjects: Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Abstract: The low-and-middle-income country (LMIC) context is volatile, uncertain and resource-constrained. India, an LMIC, has put up a complex response to the COVID-19 pandemic. Using an analytic approach, we have described India’s response to combat the pandemic during the initial months (from 17 January to 20 April 2020). India issued travel advisories and implemented graded international border controls between January and March 2020. By early March, cases started to surge. States scaled up movement restrictions. On 25 March, India went into a nationwide lockdown to ramp up preparedness. The lockdown uncovered contextual vulnerabilities and stimulated countermeasures. India leveraged existing legal frameworks, institutional mechanisms and administrative provisions to respond to the pandemic. Nevertheless, the cross-sectoral impact of the initial combat was intense and is potentially long-lasting. The country could have further benefited from evidence-based policy and planning attuned to local needs and vulnerabilities. Experience from India offers insights to nations, especially LMICs, on the need to have contextualised pandemic response plans.
Published: 2020
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11. Does mobile phone instructional video demonstrating sputum expectoration improve the sputum sample quality and quantity in presumptive pulmonary TB cases? Protocol for a prospective pragmatic non-randomised controlled trial in Karnataka state, India

Author: Siddharudha Shivalli, Amrut Hondappagol, Kibballi Madhukeshwar Akshaya, Abhay Nirgude, Narendra Varun, Raveendra Harohally Ramaiah Reddy, and Burugina Nagaraja Sharath
Subjects: Medicine
Abstract: IntroductionSputum smear microscopy is the cornerstone of tuberculosis (TB) diagnosis under the Revised National Tuberculosis Control Programme (RNTCP) in India. Instructions on how to produce a good sputum sample are a part of RNTCP training manuals, but its assessment is not emphasised. Healthcare provider’s instruction to expectorate a good sputum sample has limitations. Presumptive TB patients often submit inadequate (in quantity and/or quality) sputum samples, which may result in false-negative results. Objectives of the study are, among the selected RNTCP designated microscopy centres in Dakshina Kannada district, Karnataka, India, (a) to assess the effectiveness of mobile phone instructional video demonstrating sputum expectoration on sputum quality and quantity and (b) to explore the mobile phone video implementation challenges as perceived by the healthcare providers.Methods and analysisThis is a pragmatic, prospective, non-randomised controlled trial in two pairs of RNTCP Designated Microscopy Centres (located at secondary and primary healthcare facilities) of Dakshina Kannada district, India. Presumptive pulmonary TB patients aged ≥18 years will be included. We will exclude who are severely ill, blind, hearing impaired, patients who have already brought their sputum for examination, and transported sputum. In the intervention group, participants will watch a mobile phone instructional video demonstrating submission of an adequate sputum sample. The control group will follow the usual ongoing procedure for sputum submission. This study would require 406 participants for each group to achieve a power of 90% for detecting a difference of 15% between the two groups. The participant enrolment started in December 2019.Ethics and disseminationYenepoya University Ethics Committee, Mangaluru, India, has approved the study protocol (YEC-1/158/2019). It complies with the Declaration of Helsinki, local laws, and the International Council for Harmonization-good clinical practices. Investigators will present the results in scientific forums, publish in a scientific journal, and share with RNTCP officers.Trial registration numberClinical Trial Registry of India (CTRI/2019/06/019887).
Published: 2020
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12. Perceptions about pasung (physical restraint and confinement) of schizophrenia patients: a qualitative study among family members and other key stakeholders in Bogor Regency, West Java Province, Indonesia 2017

Author: Nenden Hikmah Laila, Renti Mahkota, Tri Krianto, and Siddharudha Shivalli
Subjects: Schizophrenia, Pasung, Qualitative, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract: Abstract Background The UN resolution recommends treating all mentally ill patients with humanity and respect. However, social stigma continues to prevail for patients with schizophrenia. Physical restraint and confinement of the mentally ill is a well-known phenomenon in Indonesia and is termed as pasung. Objective To explore the perceptions of family members of patients of schizophrenia and other key stakeholders concerning pasung in Bogor Regency, West Java Province 2017. Methods This qualitative exploratory study was conducted in Bogor Regency, West Java Province from May to June 2017. This study involved 12 key stakeholders including family members, neighbors, community leaders, and mental health officers. In-depth interviews were conducted with family members (n = 3) who practiced pasung for patients with schizophrenia and key informant interviews of neighbors, community leaders (two household heads and one from a health cadre) (n = 3) and mental health officers of puskesmas (three midwives). Data triangulation was performed by interviewing residents and mental health workers. Content analysis was conducted and themes were identified based on valid inference and interpretation. Results Family members and society in general perceived that pasung is necessary for security reasons due to the patient’s aggressive behavior such as physical violence to neighbors, stealing food etc. According to community leaders, families often do not respond to patient’s request to be released from pasung. Family members had financial constraints to seek mental healthcare and were also dissatisfied with available services. Healthcare providers highlighted the poor knowledge and prevailing misconceptions about schizophrenia in the community. Conclusion Concurrent efforts to strengthen basic mental health services and health education regarding schizophrenia, prevalent misconceptions, and importance of timely and appropriate treatment are needed, especially in rural settings.
Published: 2018
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13. Sustaining academics during COVID-19 pandemic: The role of online teaching-learning

Author: Soujanya Kaup, Rashmi Jain, Siddharudha Shivalli, Suresh Pandey, and Soumya Kaup
Subjects: Ophthalmology, RE1-994
Published: 2020
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14. Age at diagnosis predicted survival outcome of female patients with breast cancer at a tertiary hospital in Yogyakarta, Indonesia

Author: Evi Susanti Sinaga, Riris Andono Ahmad, Siddharudha Shivalli, and Susanna Hilda Hutajulu
Subjects: breast cancer, five-year overall survival, age, indonesia, Medicine
Abstract: INTRODUCTION: Breast cancer is the most common cancer in women in Indonesia. Patients survival depends on various factors, namely patient-, tumor-, and treatment-related factors. Survival analysis on Indonesian patients has only been reported in a few studies. This study aimed to identify the factors that are associated with five-year overall survival (OS) among patients with breast cancer at a local tertiary hospital in Indonesia. METHODS: A retrospective cohort study was conducted at Dr Sardjito Hospital, Yogyakarta. Female patients diagnosed with breast cancer between January and December 2009 were studied. Socio-demographic and clinicopathological data were collected from the medical and pathological records. The five-year OS rate was assessed using Kaplan Meier method and prognostic factors were analyzed using Cox regression. RESULTS: A total of 213 eligible patients with breast cancer were recruited. The five-year OS probability of the breast cancer patient was 51.07%. The majority of the patients (151, 70.9%) presented an advanced stage at the time of diagnosis. In the bi-variable analysis, cases who were younger, of a lower educational status, at a more advanced stage, with a bigger tumor size, and a central tumor location showed a worse five-year OS compared to their counterparts (p = 0.005, 0.001, 0.004, 0.011, and 0.023, respectively). In the multivariable analysis, age was an independent predictor for the OS (HR = 3.73; 95% CI = 1.0-13.6, p = 0.046). CONCLUSION: The five-year OS of breast cancer patients in the local tertiary hospital was 51.07%. The patients' age at diagnosis was the only significant prognostic factor for the patients' survival.
Published: 2018
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15. Comment on 'Serological Evidence of Scrub Typhus among Cases of PUO in the Kashmir Valley- A Hospital Based Study'

Author: Bhuvanesh Sukhlal Kalal and Siddharudha Shivalli
Subjects: Medicine
Published: 2017
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16. Occupational exposure to unburnt tobacco and potential risk of toxic optic neuropathy: A cross-sectional study among beedi rollers in selected rural areas of coastal Karnataka, India.

Author: Soujanya Kaup, Ansaba Naseer, Siddharudha Shivalli, and Cynthia Arunachalam
Subjects: Medicine, Science
Abstract: Beedi also known as poor man's cigarette is manufactured in almost all major states of India. Beedi workers are exposed to various health risks. There is an increased risk of systemic absorption of tobacco through skin and mucous membrane. The optic nerve is susceptible to damage from several toxic substances including tobacco. This group of disorders is known as toxic optic neuropathy (TON). The association of TON with occupational exposure to unburnt tobacco in beedi rollers has not been explored.Among the beedi rollers in Mangaluru and Bantwal talukas of Dakshina Kannada District, Karnataka, India: to assess the magnitude of potential TON utilizing colour vision and contrast sensitivity as screening tools and to identify the demographic, biological and occupational factors associated with potential TON.A community-based cross-sectional study was conducted from April-Sept 2016 in Mangaluru and Bantwal talukas, of Dakshina Kannada district, Karnataka. Beedi rollers from twelve villages (six from each taluka) were included. In each of the selected villages, the investigators identified beedi collection centres and all the eligible beedi rollers were included in the study till the required number of beedi rollers for that village was achieved. Participants were screened at the study site for visual acuity, colour vision and contrast sensitivity and those with abnormal colour and contrast sensitivity in the presence of good visual acuity were considered to have potential TON.A total of 377 beedi rollers were approached; of which 365 consented to take part in the study (response rate: 96.81%). Women constituted the majority of the participants (n = 338, 92.6%). Based on the screening criteria, the prevalence of potential TON was 17.5% (n = 64, 95% CI: 13.5-21.9). On multiple logistic regression analysis, duration of beedi rolling (Adj OR: 1.061; 95% CI 1.015-1.109, p = 0.009), advancing age (Adj OR: 1.096; 95% CI 1.058-1.136, p
Published: 2017
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17. Birth preparedness and complication readiness among the women beneficiaries of selected rural primary health centers of Dakshina Kannada district, Karnataka, India.

Author: Kibballi Madhukeshwar Akshaya and Siddharudha Shivalli
Subjects: Medicine, Science
Abstract: Birth preparedness and complication readiness (BPCR) is a strategy to promote timely use of skilled maternal and neonatal care during childbirth. According to World Health Organization, BPCR should be a key component of focused antenatal care. Dakshina Kannada, a coastal district of Karnataka state, is categorized as a high-performing district (institutional delivery rate >25%) under the National Rural Health Mission. However, a substantial proportion of women in the district experience complications during pregnancy (58.3%), childbirth (45.7%), and postnatal (17.4%) period. There is a paucity of data on BPCR practice and the factors associated with it in the district. Exploring this would be of great use in the evidence-based fine-tuning of ongoing maternal and child health interventions.To assess BPCR practice and the factors associated with it among the beneficiaries of two rural Primary Health Centers (PHCs) of Dakshina Kannada district, Karnataka, India.A facility-based cross-sectional study was conducted among 217 pregnant (>28 weeks of gestation) and recently delivered (in the last 6 months) women in two randomly selected PHCs from June -September 2013. Exit interviews were conducted using a pre-designed semi-structured interview schedule. Information regarding socio-demographic profile, obstetric variables, and knowledge of key danger signs was collected. BPCR included information on five key components: identified the place of delivery, saved money to pay for expenses, mode of transport identified, identified a birth companion, and arranged a blood donor if the need arises. In this study, a woman who recalled at least two key danger signs in each of the three phases, i.e., pregnancy, childbirth, and postpartum (total six) was considered as knowledgeable on key danger signs. Optimal BPCR practice was defined as following at least three out of five key components of BPCR.Proportion, Odds ratio, and adjusted Odds ratio (adj OR) for optimal BPCR practice.A total of 184 women completed the exit interview (mean age: 26.9±3.9 years). Optimal BPCR practice was observed in 79.3% (95% CI: 73.5-85.2%) of the women. Multivariate logistic regression revealed that age >26 years (adj OR = 2.97; 95%CI: 1.15-7.7), economic status of above poverty line (adj OR = 4.3; 95%CI: 1.12-16.5), awareness of minimum two key danger signs in each of the three phases, i.e., pregnancy, childbirth, and postpartum (adj OR = 3.98; 95%CI: 1.4-11.1), preference to private health sector for antenatal care/delivery (adj OR = 2.9; 95%CI: 1.1-8.01), and woman's discussion about the BPCR with her family members (adj OR = 3.4; 95%CI: 1.1-10.4) as the significant factors associated with optimal BPCR practice.In this study population, BPCR practice was better than other studies reported from India. Healthcare workers at the grassroots should be encouraged to involve women's family members while explaining BPCR and key danger signs with a special emphasis on young (
Published: 2017
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18. Determinants of medication adherence to topical ocular hypotensives and application of health belief model among glaucoma patients visiting a tertiary care hospital in coastal Karnataka, India

Author: Soujanya Kaup, Sithara Sara Oomman, and Siddharudha Shivalli
Subjects: Ophthalmology, RE1-994
Published: 2018
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19. A Comparative Study of Sonographic Grading of Renal Parenchymal Changes and Estimated Glomerular Filtration Rate (eGFR) using Modified Diet in Renal Disease Formula

Author: VINAYAKA UNDEMANE SHIVASHANKARA, SIDDHARUDHA SHIVALLI, B.H. SANTHOSH PAI, KOTESHWARA DEVADASA ACHARYA, RAVICHANDRA GOPALAKRISHNAN, VIVEK SRIKANTH, VISHWANATH REDDY, and ARAFAT HARIS
Subjects: correlation, kidney disease, ultrasound, Medicine
Abstract: Introduction: The sonographic findings are of help in evaluating the nephrological diseases. Glomerular filtration rate is another parameter for assessing the reserved renal function and an indicator of prognosis. In clinical practice GFR estimation (eGFR) is done by using a mathematical formula. In our study, we compared the sonographic grading of renal parenchymal changes with eGFR calculated using Modified Diet in Renal Diseases formula based on serum creatinine, age, gender and ethnicity. Aim: To evaluate the relevance of sonographic grading of renal parenchymal changes in assessing the severity of the renal disease and comparing it to the eGFR calculated using MDRD formula based on the age, gender and serum creatinine value of the patient. Materials and Methods: The adult patients with suspected kidney disease referred for sonography of abdomen were our study participants. As per our study design following strict inclusion and exclusion criteria, patients were selected as study participants and for each of the patient’s renal parenchymal status, serum creatinine, age, gender and ethnicity were documented. Results: A total of 70 patients were our study participants, out of which 67.1% were males and 32.9% were females. Our study showed a linear correlation between sonographic grading of renal parenchymal changes with eGFR. Conclusion: We conclude that by evaluating the kidneys with sonography and calculating eGFR using MDRD formula the renal status will be more accurately interpreted.
Published: 2016
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20. Pre-Hypertension among Young Adults (20-30 Years) in Coastal Villages of Udupi District in Southern India: An Alarming Scenario.

Author: Sanjay Kini, Veena G Kamath, Muralidhar M Kulkarni, Asha Kamath, and Siddharudha Shivalli
Subjects: Medicine, Science
Abstract: INTRODUCTION:According to Joint National Committee-7 (JNC-7) guidelines, a systolic blood pressure (SBP) of 120 to 139 mm Hg and/or diastolic blood pressure (DBP) of 80 to 89 mm Hg is considered as pre-hypertension. Existing evidence suggest that the cardiovascular morbidities are increasing among pre-hypertensive individuals compared to normal. OBJECTIVE:To assess the magnitude and factors associated with pre-hypertension among young adults (20-30 years) in coastal villages of Udupi Taluk (an area of land with a city or town that serves as its administrative centre and usually a number of villages), Udupi District, Karnataka state, India. DESIGN:Community based cross sectional study. SETTING:6 (out of total 14) coastal villages of Udupi Taluk, Karnataka state, India. SAMPLE:1,152 young adults (age group: 20-30 years) selected by stratified random sampling in 6 coastal villages of Udupi Taluk, Karnataka state, India. METHOD:A semi structured pre-tested questionnaire was used to elicit the details on socio-demographic variables, dietary habits, tobacco use, alcohol consumption, physical activity, family history of hypertension and stress levels. Anthropometric measurements and blood pressure were recorded according to standard protocols. Serum cholesterol was measured in a sub sample of the study population. Multivariate logistic regression was applied to identify the independent correlates of pre-hypertension among young adults (20-30 years). MAIN OUTCOME MEASURES:Prevalence, Odds ratio (OR) and adjusted (adj) OR for pre-hypertension among young adults (20-30 years). RESULTS:The prevalence of pre-hypertension in the study population was 45.2% (95%CI: 42.4-48). Multivariate logistic regression analysis revealed that age group of 25-30 years (adj OR: 4.25, 95% CI: 2.99-6.05), white collared (adj OR: 2.29, 95% CI: 1.08-4.85) and skilled occupation (adj OR: 3.24, 95% CI: 1.64-6.42), students (adj OR: 2.46, 95% CI: 1.22-4.95), using refined cooking oil (adj OR: 0.53, 95% CI: 0.29-0.95), extra salt in meals (adj OR: 2.46, 95% CI: 1.52-3.99), salty food items (adj OR: 6.99, 95% CI: 3.63-13.48), pre-obese (adj OR: 1.66, 95% CI: 1.03-2.67) and obese (adj OR: 9.16, 95% CI: 2.54, 36.4) were the significant correlates of pre-hypertension. CONCLUSION:In the study population, prevalence of pre-hypertension among young adults (20-30 years) was high (45.2%). Biological (age 25-30 years, pre-obesity and obesity) and behavioral (sedentary occupation, intake of extra salt in meals/salty food and not using refined cooking oil) factors were associated with pre-hypertension. Study emphasizes the need of community based screening of pre-hypertension under National Rural Health Mission. It also provides apt information for the evidence based designing of interventions for lifestyle modifications among high risk young adults in the study area.
Published: 2016
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21. Comment on 'Attitudes and Health Behavior of Lawyers in Coimbatore, Tamil Nadu'

Author: Siddharudha Shivalli
Subjects: Technology, Medicine, Science
Published: 2016
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22. Trials of Improved Practices (TIPs) to Enhance the Dietary and Iron-Folate Intake during Pregnancy- A Quasi Experimental Study among Rural Pregnant Women of Varanasi, India.

Author: Siddharudha Shivalli, Ratan Kumar Srivastava, and Gyan Prakash Singh
Subjects: Medicine, Science
Abstract: Behavior Change Communications (BCC) play a decisive role in modifying socio-cultural norms affecting the perception and nutritional practices during pregnancy.To examine the effectiveness of 'Trials of Improved Practices' (TIPs) on dietary and iron-folate intake during pregnancy.Community based quasi experimental study with a control group.Four villages of Chiraigaon Community Development Block of Varanasi, India from May 2010 and recruited from August 2010. End line assessment, after 12 weeks of intervention, was completed in April 2011.Pregnant women in 13-28 weeks of gestation.TIPs was implemented in addition to ongoing essential obstetric care services in two villages through 3 home (assessment, negotiation and evaluation) visits and only assessment and evaluation visits in the other two control villages. Interpersonal communication, endorsing the active participation of family members and home based reminder materials were the TIPs based strategies. The effect of TIPs was assessed by comparing key outcome variables at baseline and after 12 weeks of intervention.Hemoglobin%, anemia prevalence, weight gain, compliance for iron-folate supplementation and dietary intake of calorie, protein, calcium and iron.A total of 86 participants completed the study. At the end, mean hemoglobin levels were 11.5±1.24 g/dl and 10.37±1.38 g/dl in the TIPs and control groups, respectively. The prevalence of anemia reduced by half in TIPs group and increased by 2.4% in the control group. Weight gain (grams/week) was significantly (p
Published: 2015
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23. Postnatal depression among rural women in South India: do socio-demographic, obstetric and pregnancy outcome have a role to play?

Author: Siddharudha Shivalli and Nandihal Gururaj
Subjects: Medicine, Science
Abstract: Postnatal depression (PND) is one of the most common psychopathology and is considered as a serious public health issue because of its devastating effects on mother, family, and infant or the child.To elicit socio-demographic, obstetric and pregnancy outcome predictors of Postnatal Depression (PND) among rural postnatal women in Karnataka state, India.Hospital based analytical cross sectional study.A rural tertiary care hospital of Mandya District, Karnataka state, India.PND prevalence based estimated sample of 102 women who came for postnatal follow up from 4th to 10th week of lactation.Study participants were interviewed using validated kannada version of Edinburgh Postnatal Depression Scale (EPDS). Cut-off score of ≥ 13 was used as high risk of PND. The percentage of women at risk of PND was estimated, and differences according to socio-demographic, obstetric and pregnancy outcome were described. Logistic regression was applied to identify the independent predictors of PND risk.Prevalence, Odds ratio (OR) and adjusted (adj) OR of PND.Prevalence of PND was 31.4% (95% CI 22.7-41.4%). PND showed significant (P < 0.05) association with joint family, working women, non-farmer husbands, poverty, female baby and pregnancy complications or known medical illness. In binomial logistic regression poverty (adjOR: 11.95, 95% CI:1.36-105), birth of female baby (adjOR: 3.6, 95% CI:1.26-10.23) and pregnancy complications or known medical illness (adjOR: 17.4, 95% CI:2.5-121.2) remained as independent predictors of PND.Risk of PND among rural postnatal women was high (31.4%). Birth of female baby, poverty and complications in pregnancy or known medical illness could predict the high risk of PND. PND screening should be an integral part of postnatal care. Capacity building of grass root level workers and feasibility trials for screening PND by them are needed.
Published: 2015
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24. Family Centered Approach in Primary Health Care: Experience from an Urban Area of Mangalore, India

Author: Siddharudha Shivalli, J. P. Majra, K. M. Akshaya, and Ghulam Jeelani Qadiri
Subjects: Technology, Medicine, Science
Abstract: Introduction. “Health for All” still eludes public health experts despite many approaches to prevent disease and promote health among urban poor. Several key illness factors lie beyond the conventional healthcare boundaries. Objective. To examine the effectiveness of family centered approach (FCA) in addressing health and related issues in an urban area of Mangalore, India. Method. A longitudinal study was conducted in Bengre, an outreach centre of Mangalore from June 2011 to November 2013. Family folders were created with pertinent details. Demand generation and health education activities were conducted through two female community health link workers. An FCA package was implemented by medical and nursing interns, under supervision, to address the priority issues. Effect was assessed by comparing their practices and service utilization before and after the study. Results. About 809 families participated in this study. Social, cultural, and religious factors were responsible for viciousness of malaria and maternal and child health issues. FCA improved their perceptions and practices towards health and related issues. Significant (P
Published: 2015
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25. Comment on: Role of subconjunctival bevacizumab in primary pterygium surgery

Author: Siddharudha Shivalli and Soujanya Kaup
Subjects: Ophthalmology, RE1-994
Published: 2016
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26. Diagnostic Accuracy of High Resolution Ultrasound to Differentiate Neoplastic and Non Neoplastic Causes of Cervical Lymphadenopathy

Author: Vinayaka U S, Siddharudha Shivalli, Sheethal Rai, Arafat Haris, Rohit Madhurkar, and Sandhya Hemraj
Subjects: cervical lymphadenopathy, high resolution ultrasound, neoplastic, Medicine
Abstract: Introduction: Lymph nodes are normal structures distributed throughout the human body and are enlarged in various disease entities. Identifying the relevant lymph nodes is important in treating these patients. High resolution sonography (HRSG) and fine needle aspiration cytology (FNAC) play crucial role in planning the treatment. Objective: To assess the diagnostic accuracy of HRSG differentiate neoplastic and non neoplastic causes of enlarged cervical lymph nodes. Materials and Methods: HRSG evaluation of enlarged cervical lymph nodes were performed to differentiate neoplastic from non neoplastic lymph nodes followed by FNAC correlation and the accuracy of HRSG was studied. Results: One hundred and fourteen lymph nodes of 106 patients were analysed to accomplish the study objective. In our study, HRSG had 96% sensitivity and 90.6% specificity for differentiating between neoplatic and non-neoplastic cervical lymphadenopathy. Similarly positive and negative predictive values were 88.9% and 96.7% respectively. Overall accuracy of HRSG was 93%. Conclusion: Owing to high sensitivity and negative predictive value, HRSG with Doppler is an excellent first line investigating tool for enlarged lymph nodes and avoids invasive procedures like FNAC in cases of reactive/ inflammatory (non-neoplastic) lymph nodes. However, neoplastic diagnosis of HRSG needs further confirmation by FNAC.
Published: 2014
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27. Healthcare Waste Management: Qualitative and Quantitative Appraisal of Nurses in a Tertiary Care Hospital of India

Author: Siddharudha Shivalli and Vasudha Sanklapur
Subjects: Technology, Medicine, Science
Abstract: Background. The nurse’s role in healthcare waste management is crucial. Objectives. (1) To appraise nurses quantitatively and qualitatively regarding healthcare waste management; (2) to elicit the determinants of knowledge and attitudes of healthcare waste management. Method. A cross-sectional study was undertaken at a tertiary care hospital of Mangalore, India. Self-administered pretested questionnaire and “nonparticipatory observation” were used for quantitative and qualitative appraisals. Percentage knowledge score was calculated based on their total knowledge score. Nurses’ knowledge was categorized as excellent (>70%), good (50–70%), and poor (70% score). Most (86%) expressed the need of refresher training. No study variable displayed significant association (P>0.05) with knowledge. Apt segregation practices were followed except in casualty. Patients and entourages misinterpreted the colored containers. Conclusion. Nurses’ knowledge and healthcare waste management practices were not satisfactory. There is a need of refresher trainings at optimum intervals to ensure sustainability and further improvement. Educating patients and their entourages and display of segregation information board in local language are recommended.
Published: 2014
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28. Biomedical Waste Management Practices of Doctors: An Online Snapshot

Author: Mohapatra Archisman, Manoj K Gupta, Siddharudha Shivalli, CP Mishra, and SC Mohapatra
Subjects: Biomedical waste, doctor, professional behavior, respondent-driven technique, Public aspects of medicine, RA1-1270
Abstract: Objective: This study was undertaken with the objective to assess the professional behavior of doctors in India regarding Bio-Medical Waste (BMW) management. Methods: A predesigned questionnaire containing a set of nine open-ended questions was sent to 557 email contacts obtained randomly from social networking sites by using respondent-driven sampling technique. Non-duplicated opinions from only those respondents who had completed their medical education in India and working in the country were included for analyses. Results: Remnant knowledge of BMW management as self-adjudged was significantly (p
Published: 2012

29. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050

Author: Manuela L Ferreira, Katie de Luca, Lydia M Haile, Jaimie D Steinmetz, Garland T Culbreth, Marita Cross, Jacek A Kopec, Paulo H Ferreira, Fiona M Blyth, Rachelle Buchbinder, Jan Hartvigsen, Ai-Min Wu, Saeid Safiri, Anthony D Woolf, Gary S Collins, Kanyin Liane Ong, Stein Emil Vollset, Amanda E Smith, Jessica A Cruz, Kai Glenn Fukutaki, Semagn Mekonnen Abate, Mitra Abbasifard, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Ahmed Abdelalim, Aidin Abedi, Hassan Abidi, Qorinah Estiningtyas Sakilah Adnani, Ali Ahmadi, Rufus Olusola Akinyemi, Abayneh Tadesse Alamer, Adugnaw Zeleke Alem, Yousef Alimohamadi, Mansour Abdullah Alshehri, Mohammed Mansour Alshehri, Hosam Alzahrani, Saeed Amini, Sohrab Amiri, Hubert Amu, Catalina Liliana Andrei, Tudorel Andrei, Benny Antony, Jalal Arabloo, Judie Arulappan, Ashokan Arumugam, Tahira Ashraf, Seyyed Shamsadin Athari, Nefsu Awoke, Sina Azadnajafabad, Till Winfried Bärnighausen, Lope H Barrero, Amadou Barrow, Akbar Barzegar, Lindsay M Bearne, Isabela M Bensenor, Alemshet Yirga Berhie, Bharti Bhandari Bhandari, Vijayalakshmi S Bhojaraja, Ali Bijani, Belay Boda Abule Bodicha, Srinivasa Rao Bolla, Javier Brazo-Sayavera, Andrew M Briggs, Chao Cao, Periklis Charalampous, Vijay Kumar Chattu, Flavia M Cicuttini, Benjamin Clarsen, Sarah Cuschieri, Omid Dadras, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Azizallah Dehghan, Takele Gezahegn G Demie, Edgar Denova-Gutiérrez, Syed Masudur Rahman Dewan, Samath Dhamminda Dharmaratne, Mandira Lamichhane Dhimal, Meghnath Dhimal, Daniel Diaz, Mojtaba Didehdar, Lankamo Ena Digesa, Mengistie Diress, Hoa Thi Do, Linh Phuong Doan, Michael Ekholuenetale, Muhammed Elhadi, Sharareh Eskandarieh, Shahriar Faghani, Jawad Fares, Ali Fatehizadeh, Getahun Fetensa, Irina Filip, Florian Fischer, Richard Charles Franklin, Balasankar Ganesan, Belete Negese Belete Gemeda, Motuma Erena Getachew, Ahmad Ghashghaee, Tiffany K Gill, Mahaveer Golechha, Pouya Goleij, Bhawna Gupta, Nima Hafezi-Nejad, Arvin Haj-Mirzaian, Pawan Kumar Hamal, Asif Hanif, Netanja I Harlianto, Hamidreza Hasani, Simon I Hay, Jeffrey J Hebert, Golnaz Heidari, Mohammad Heidari, Reza Heidari-Soureshjani, Mbuzeleni Mbuzeleni Hlongwa, Mohammad-Salar Hosseini, Alexander Kevin Hsiao, Ivo Iavicoli, Segun Emmanuel Ibitoye, Irena M Ilic, Milena D Ilic, Sheikh Mohammed Shariful Islam, Manthan Dilipkumar Janodia, Ravi Prakash Jha, Har Ashish Jindal, Jost B Jonas, Gebisa Guyasa Kabito, Himal Kandel, Rimple Jeet Kaur, Vikash Ranjan Keshri, Yousef Saleh Khader, Ejaz Ahmad Khan, Md Jobair Khan, Moien AB Khan, Hamid Reza Khayat Kashani, Jagdish Khubchandani, Yun Jin Kim, Adnan Kisa, Jitka Klugarová, Ali-Asghar Kolahi, Hamid Reza Koohestani, Ai Koyanagi, G Anil Kumar, Narinder Kumar, Tea Lallukka, Savita Lasrado, Wei-Chen Lee, Yo Han Lee, Ata Mahmoodpoor, Jeadran N Malagón-Rojas, Mohammad-Reza Malekpour, Reza Malekzadeh, Narges Malih, Man Mohan Mehndiratta, Entezar Mehrabi Nasab, Ritesh G Menezes, Alexios-Fotios A Mentis, Mohamed Kamal Mesregah, Ted R Miller, Mohammad Mirza-Aghazadeh-Attari, Maryam Mobarakabadi, Yousef Mohammad, Esmaeil Mohammadi, Shafiu Mohammed, Ali H Mokdad, Sara Momtazmanesh, Lorenzo Monasta, Mohammad Ali Moni, Ebrahim Mostafavi, Christopher J L Murray, Tapas Sadasivan Nair, Javad Nazari, Seyed Aria Nejadghaderi, Subas Neupane, Sandhya Neupane Kandel, Cuong Tat Nguyen, Ali Nowroozi, Hassan Okati-Aliabad, Emad Omer, Abderrahim Oulhaj, Mayowa O Owolabi, Songhomitra Panda-Jonas, Anamika Pandey, Eun-Kee Park, Shrikant Pawar, Paolo Pedersini, Jeevan Pereira, Mario F P Peres, Ionela-Roxana Petcu, Mohammadreza Pourahmadi, Amir Radfar, Shahram Rahimi-Dehgolan, Vafa Rahimi-Movaghar, Mosiur Rahman, Amir Masoud Rahmani, Nazanin Rajai, Chythra R Rao, Vahid Rashedi, Mohammad-Mahdi Rashidi, Zubair Ahmed Ratan, David Laith Rawaf, Salman Rawaf, Andre M N Renzaho, Negar Rezaei, Zahed Rezaei, Leonardo Roever, Guilherme de Andrade Ruela, Basema Saddik, Amirhossein Sahebkar, Sana Salehi, Francesco Sanmarchi, Sadaf G Sepanlou, Saeed Shahabi, Shayan Shahrokhi, Elaheh Shaker, MohammadBagher Shamsi, Mohammed Shannawaz, Saurab Sharma, Maryam Shaygan, Rahim Ali Sheikhi, Jeevan K Shetty, Rahman Shiri, Siddharudha Shivalli, Parnian Shobeiri, Migbar Mekonnen Sibhat, Ambrish Singh, Jasvinder A Singh, Helen Slater, Marco Solmi, Ranjani Somayaji, Ker-Kan Tan, Rekha Thapar, Seyed Abolfazl Tohidast, Sahel Valadan Tahbaz, Rohollah Valizadeh, Tommi Juhani Vasankari, Narayanaswamy Venketasubramanian, Vasily Vlassov, Bay Vo, Yuan-Pang Wang, Taweewat Wiangkham, Lalit Yadav, Ali Yadollahpour, Seyed Hossein Yahyazadeh Jabbari, Lin Yang, Fereshteh Yazdanpanah, Naohiro Yonemoto, Mustafa Z Younis, Iman Zare, Armin Zarrintan, Mohammad Zoladl, Theo Vos, Lyn M March, Surgery, Erasmus MC other, Public Health, and Pharmacy
Subjects: Rheumatology, Immunology, Immunology and Allergy
Abstract: Background: Low back pain is highly prevalent and the main cause of years lived with disability (YLDs). We present the most up-to-date global, regional, and national data on prevalence and YLDs for low back pain from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. Methods: Population-based studies from 1980 to 2019 identified in a systematic review, international surveys, US medical claims data, and dataset contributions by collaborators were used to estimate the prevalence and YLDs for low back pain from 1990 to 2020, for 204 countries and territories. Low back pain was defined as pain between the 12th ribs and the gluteal folds that lasted a day or more; input data using alternative definitions were adjusted in a network meta-regression analysis. Nested Bayesian meta-regression models were used to estimate prevalence and YLDs by age, sex, year, and location. Prevalence was projected to 2050 by running a regression on prevalence rates using Socio-demographic Index as a predictor, then multiplying them by projected population estimates. Findings: In 2020, low back pain affected 619 million (95% uncertainty interval 554–694) people globally, with a projection of 843 million (759–933) prevalent cases by 2050. In 2020, the global age-standardised rate of YLDs was 832 per 100 000 (578–1070). Between 1990 and 2020, age-standardised rates of prevalence and YLDs decreased by 10·4% (10·9–10·0) and 10·5% (11·1–10·0), respectively. A total of 38·8% (28·7–47·0) of YLDs were attributed to occupational factors, smoking, and high BMI. Interpretation: Low back pain remains the leading cause of YLDs globally, and in 2020, there were more than half a billion prevalent cases of low back pain worldwide. While age-standardised rates have decreased modestly over the past three decades, it is projected that globally in 2050, more than 800 million people will have low back pain. Challenges persist in obtaining primary country-level data on low back pain, and there is an urgent need for more high-quality, primary, country-level data on both prevalence and severity distributions to improve accuracy and monitor change. Funding: Bill and Melinda Gates Foundation.
Published: 2023
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30. Can ultrasonic biometric indices with optimal cut-offs be a potential screening tool for primary angle closure disease? A case-control study

Author: Sheetal Savur, Soujanya Kaup, Anagha Dinesh, Siddharudha Shivalli, and Dimple Kondal
Subjects: Ophthalmology
Abstract: BACKGROUND/OBJECTIVES: Despite a significant disease burden and potential to cause blindness, primary angle closure disease (PACD) does not have a population-based screening programme. Biometric indices using ultrasound A-scan is a potential tool for glaucoma case-detection. Given that genetic and environmental factors influence these parameters and paucity of data on their discrimination thresholds in Indian populace, we conducted a matched case-control study to determine the biometric indices and their discrimination thresholds associated with PACD. METHODS: We studied 172 eyes of 86 participants (43 cases; 43 controls). We compared the following biometric parameters of cases (PACD, occludable angle ≥180° ± raised intraocular pressure) with age and gender-matched controls (1:1): Anterior chamber depth (ACD), lens thickness (LT), axial length (AXL), lens position (LP), relative lens position (RLP), lens axial factor (LAF), simple crowding value (Cs), ACD/AXL). We performed conditional logistic regression (to identify factors associated with PACD) and Receiver operating characteristic (ROC) analysis (to determine discrimination thresholds). RESULTS: Reduced ACD (Adj OR 0.01; 95% CI: 0.0003-0.15, p
Published: 2022

31. Factors associated with good near vision after cataract surgery with monofocal intraocular lens implantation at a tertiary eye hospital in southern India

Author: Soujanya, Kaup, Abhilasha, Charugundla, and Siddharudha, Shivalli
Abstract: Although multifocal intraocular lenses (IOLs) are effective methods of dealing with surgical presbyopia, there are associated limitations (cost, technique, and patient-reported symptoms). Given their scalability challenge (due to economic factors), it is imperative to explore alternative low-cost and sustainable solutions to achieve good near vision postcataract surgery. This study aimed to determine the proportion of and the factors associated with good near vision in patients following cataract surgery with monofocal IOL implantation.We conducted a hospital-based cross-sectional study at a tertiary eye hospital in southern India from September 2019 to January 2020. Inclusion criteria: Uncomplicated postcataract surgery cases with monofocal IOL at least 30 days ago. Exclusion criteria: patients with any ocular condition (other than refractive errors) that could decrease the vision with best-corrected distance visual acuity0.18 Logarithm of the Minimum Angle of Resolution (LogMAR) units. Data collection: we assessed near vision (at 40 cm distance by using near vision card with Early Treatment of Diabetic Retinopathy Study format), distance visual acuity (uncorrected and best-corrected), refractive error (amount and type), type of astigmatism, pupil size, axial length, and contrast sensitivity. We considered a near vision of 0.2 LogMAR units or better as good near vision.Of the 82 patients (82 eyes), 71 (86.59%) had good near vision. Multiple logistic regression analysis found found that the presence of myopia or myopic astigmatism was significantly associated with good near vision (adjusted odds ratio: 72.63; 95% confidence interval: 1.02-5193.5,About eight of every ten participants had good near vision postcataract surgery with monofocal IOL implantation. Myopia/myopic astigmatism was associated with good near vision.
Published: 2022

32. The global burden of cancer attributable to risk factors, 2010–19 : A systematic analysis for the Global Burden of Disease Study 2019

Author: Khanh Bao Tran, Justin J Lang, Kelly Compton, Rixing Xu, Alistair R Acheson, Hannah Jacqueline Henrikson, Jonathan M Kocarnik, Louise Penberthy, Amirali Aali, Qamar Abbas, Behzad Abbasi, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Hedayat Abbastabar, Michael Abdelmasseh, Sherief Abd-Elsalam, Ahmed Abdelwahab Abdelwahab, Gholamreza Abdoli, Hanan Abdulkadir Abdulkadir, Aidin Abedi, Kedir Hussein Abegaz, Hassan Abidi, Richard Gyan Aboagye, Hassan Abolhassani, Abdorrahim Absalan, Yonas Derso Abtew, Hiwa Abubaker Ali, Eman Abu-Gharbieh, Basavaprabhu Achappa, Juan Manuel Acuna, Daniel Addison, Isaac Yeboah Addo, Oyelola A Adegboye, Miracle Ayomikun Adesina, Mohammad Adnan, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Sumia Afrin, Muhammad Sohail Afzal, Manik Aggarwal, Bright Opoku Ahinkorah, Araz Ramazan Ahmad, Rizwan Ahmad, Sajjad Ahmad, Sohail Ahmad, Sepideh Ahmadi, Haroon Ahmed, Luai A Ahmed, Muktar Beshir Ahmed, Tarik Ahmed Rashid, Wajeeha Aiman, Marjan Ajami, Gizachew Taddesse Akalu, Mostafa Akbarzadeh-Khiavi, Addis Aklilu, Maxwell Akonde, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Fares Alahdab, Fahad Mashhour Alanezi, Turki M Alanzi, Saleh Ali Alessy, Abdelazeem M Algammal, Mohammed Khaled Al-Hanawi, Robert Kaba Alhassan, Beriwan Abdulqadir Ali, Liaqat Ali, Syed Shujait Ali, Yousef Alimohamadi, Vahid Alipour, Syed Mohamed Aljunid, Motasem Alkhayyat, Sadeq Ali Ali Al-Maweri, Sami Almustanyir, Nivaldo Alonso, Shehabaldin Alqalyoobi, Rajaa M Al-Raddadi, Rami H Hani Al-Rifai, Salman Khalifah Al-Sabah, Ala'a B Al-Tammemi, Haya Altawalah, Nelson Alvis-Guzman, Firehiwot Amare, Edward Kwabena Ameyaw, Javad Javad Aminian Dehkordi, Mohammad Hosein Amirzade-Iranaq, Hubert Amu, Ganiyu Adeniyi Amusa, Robert Ancuceanu, Jason A Anderson, Yaregal Animut Animut, Amir Anoushiravani, Ali Arash Anoushirvani, Alireza Ansari-Moghaddam, Mustafa Geleto Ansha, Benny Antony, Maxwell Hubert Antwi, Sumadi Lukman Anwar, Razique Anwer, Anayochukwu Edward Anyasodor, Jalal Arabloo, Morteza Arab-Zozani, Olatunde Aremu, Ayele Mamo Argaw, Hany Ariffin, Timur Aripov, Muhammad Arshad, Al Artaman, Judie Arulappan, Raphael Taiwo Aruleba, Armin Aryannejad, Malke Asaad, Mulusew A Asemahagn, Zatollah Asemi, Mohammad Asghari-Jafarabadi, Tahira Ashraf, Reza Assadi, Mohammad Athar, Seyyed Shamsadin Athari, Maha Moh'd Wahbi Atout, Sameh Attia, Avinash Aujayeb, Marcel Ausloos, Leticia Avila-Burgos, Atalel Fentahun Awedew, Mamaru Ayenew Awoke, Tewachew Awoke, Beatriz Paulina Ayala Quintanilla, Tegegn Mulatu Ayana, Solomon Shitu Ayen, Davood Azadi, Sina Azadnajafabad, Saber Azami-Aghdash, Melkalem Mamuye Azanaw, Mohammadreza Azangou-Khyavy, Amirhossein Azari Jafari, Hosein Azizi, Ahmed Y Y Azzam, Amirhesam Babajani, Muhammad Badar, Ashish D Badiye, Nayereh Baghcheghi, Nader Bagheri, Sara Bagherieh, Saeed Bahadory, Atif Amin Baig, Jennifer L Baker, Ahad Bakhtiari, Ravleen Kaur Bakshi, Maciej Banach, Indrajit Banerjee, Mainak Bardhan, Francesco Barone-Adesi, Fabio Barra, Amadou Barrow, Nasir Z Bashir, Azadeh Bashiri, Saurav Basu, Abdul-Monim Mohammad Batiha, Aeysha Begum, Alehegn Bekele Bekele, Alemayehu Sayih Belay, Melaku Ashagrie Belete, Uzma Iqbal Belgaumi, Arielle Wilder Bell, Luis Belo, Habib Benzian, Alemshet Yirga Berhie, Amiel Nazer C Bermudez, Eduardo Bernabe, Akshaya Srikanth Bhagavathula, Neeraj Bhala, Bharti Bhandari Bhandari, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Soumitra S Bhuyan, Sadia Bibi, Awraris Hailu Bilchut, Bagas Suryo Bintoro, Antonio Biondi, Mesfin Geremaw Birega Birega, Habitu Eshetu Birhan, Tone Bjørge, Oleg Blyuss, Belay Boda Abule Bodicha, Srinivasa Rao Bolla, Archith Boloor, Cristina Bosetti, Dejana Braithwaite, Michael Brauer, Hermann Brenner, Andrey Nikolaevich Briko, Nikolay Ivanovich Briko, Christina Maree Buchanan, Norma B Bulamu, Maria Teresa Bustamante-Teixeira, Muhammad Hammad Butt, Nadeem Shafique Butt, Zahid A Butt, Florentino Luciano Caetano dos Santos, Luis Alberto Cámera, Chao Cao, Yin Cao, Giulia Carreras, Márcia Carvalho, Francieli Cembranel, Ester Cerin, Promit Ananyo Chakraborty, Periklis Charalampous, Vijay Kumar Chattu, Odgerel Chimed-Ochir, Jesus Lorenzo Chirinos-Caceres, Daniel Youngwhan Cho, William C S Cho, Devasahayam J Christopher, Dinh-Toi Chu, Isaac Sunday Chukwu, Aaron J Cohen, Joao Conde, Sandra Cortés, Vera Marisa Costa, Natália Cruz-Martins, Garland T Culbreth, Omid Dadras, Fentaw Teshome Dagnaw, Saad M A Dahlawi, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Parnaz Daneshpajouhnejad, Anna Danielewicz, An Thi Minh Dao, Reza Darvishi Cheshmeh Soltani, Aso Mohammad Darwesh, Saswati Das, Dragos Virgil Davitoiu, Elham Davtalab Esmaeili, Fernando Pio De la Hoz, Sisay Abebe Debela, Azizallah Dehghan, Biniyam Demisse, Fitsum Wolde Demisse, Edgar Denova-Gutiérrez, Afshin Derakhshani, Meseret Derbew Molla, Diriba Dereje, Kalkidan Solomon Deribe, Rupak Desai, Markos Desalegn Desalegn, Fikadu Nugusu Dessalegn, Samuel Abebe A Dessalegni, Gashaw Dessie, Abebaw Alemayehu Desta, Syed Masudur Rahman Dewan, Samath Dhamminda Dharmaratne, Meghnath Dhimal, Mostafa Dianatinasab, Nancy Diao, Daniel Diaz, Lankamo Ena Digesa, Shilpi Gupta Dixit, Saeid Doaei, Linh Phuong Doan, Paul Narh Doku, Deepa Dongarwar, Wendel Mombaque dos Santos, Tim Robert Driscoll, Haneil Larson Dsouza, Oyewole Christopher Durojaiye, Sareh Edalati, Fatemeh Eghbalian, Elham Ehsani-Chimeh, Ebrahim Eini, Michael Ekholuenetale, Temitope Cyrus Ekundayo, Donatus U Ekwueme, Maha El Tantawi, Mostafa Ahmed Elbahnasawy, Iffat Elbarazi, Hesham Elghazaly, Muhammed Elhadi, Waseem El-Huneidi, Mohammad Hassan Emamian, Luchuo Engelbert Bain, Daniel Berhanie Enyew, Ryenchindorj Erkhembayar, Tegegne Eshetu, Babak Eshrati, Sharareh Eskandarieh, Juan Espinosa-Montero, Farshid Etaee, Azin Etemadimanesh, Tahir Eyayu, Ifeanyi Jude Ezeonwumelu, Sayeh Ezzikouri, Adeniyi Francis Fagbamigbe, Saman Fahimi, Ildar Ravisovich Fakhradiyev, Emerito Jose A Faraon, Jawad Fares, Abbas Farmany, Umar Farooque, Hossein Farrokhpour, Abidemi Omolara Fasanmi, Ali Fatehizadeh, Wafa Fatima, Hamed Fattahi, Ginenus Fekadu, Berhanu Elfu Feleke, Allegra Allegra Ferrari, Simone Ferrero, Lorenzo Ferro Desideri, Irina Filip, Florian Fischer, Roham Foroumadi, Masoud Foroutan, Takeshi Fukumoto, Peter Andras Gaal, Mohamed M Gad, Muktar A Gadanya, Abduzhappar Gaipov, Nasrin Galehdar, Silvano Gallus, Tushar Garg, Mariana Gaspar Fonseca, Yosef Haile Gebremariam, Teferi Gebru Gebremeskel, Mathewos Alemu Gebremichael, Yohannes Fikadu Geda, Yibeltal Yismaw Gela, Belete Negese Belete Gemeda, Melaku Getachew, Motuma Erena Getachew, Kazem Ghaffari, Mansour Ghafourifard, Seyyed-Hadi Ghamari, Mohammad Ghasemi Nour, Fariba Ghassemi, Ajnish Ghimire, Nermin Ghith, Maryam Gholamalizadeh, Jamshid Gholizadeh Navashenaq, Sherief Ghozy, Syed Amir Gilani, Paramjit Singh Gill, Themba G Ginindza, Abraham Tamirat T Gizaw, James C Glasbey, Justyna Godos, Amit Goel, Mahaveer Golechha, Pouya Goleij, Davide Golinelli, Mohamad Golitaleb, Giuseppe Gorini, Bárbara Niegia Garcia Goulart, Giuseppe Grosso, Habtamu Alganeh Guadie, Mohammed Ibrahim Mohialdeen Gubari, Temesgen Worku Gudayu, Maximiliano Ribeiro Guerra, Damitha Asanga Gunawardane, Bhawna Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Mekdes Kondale Gurara, Alemu Guta, Parham Habibzadeh, Atlas Haddadi Avval, Nima Hafezi-Nejad, Adel Hajj Ali, Arvin Haj-Mirzaian, Esam S Halboub, Aram Halimi, Rabih Halwani, Randah R Hamadeh, Sajid Hameed, Samer Hamidi, Asif Hanif, Sanam Hariri, Netanja I Harlianto, Josep Maria Haro, Risky Kusuma Hartono, Ahmed I Hasaballah, S M Mahmudul Hasan, Hamidreza Hasani, Seyedeh Melika Hashemi, Abbas M Hassan, Soheil Hassanipour, Khezar Hayat, Golnaz Heidari, Mohammad Heidari, Zahra Heidarymeybodi, Brenda Yuliana Herrera-Serna, Claudiu Herteliu, Kamal Hezam, Yuta Hiraike, Mbuzeleni Mbuzeleni Hlongwa, Ramesh Holla, Marianne Holm, Nobuyuki Horita, Mohammad Hoseini, Md Mahbub Hossain, Mohammad Bellal Hossain Hossain, Mohammad-Salar Hosseini, Ali Hosseinzadeh, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mowafa Househ, Junjie Huang, Fernando N Hugo, Ayesha Humayun, Salman Hussain, Nawfal R Hussein, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Pulwasha Maria Iftikhar, Kevin S Ikuta, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Kaire Innos, Pooya Iranpour, Lalu Muhammad Irham, Md Shariful Islam, Rakibul M Islam, Farhad Islami, Nahlah Elkudssiah Ismail, Gaetano Isola, Masao Iwagami, Linda Merin J, Abhishek Jaiswal, Mihajlo Jakovljevic, Mahsa Jalili, Shahram Jalilian, Elham Jamshidi, Sung-In Jang, Chinmay T Jani, Tahereh Javaheri, Umesh Umesh Jayarajah, Shubha Jayaram, Seyed Behzad Jazayeri, Rime Jebai, Bedru Jemal, Wonjeong Jeong, Ravi Prakash Jha, Har Ashish Jindal, Yetunde O John-Akinola, Jost B Jonas, Tamas Joo, Nitin Joseph, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Ali Kabir, Salah Eddine Oussama Kacimi, Vidya Kadashetti, Farima Kahe, Pradnya Vishal Kakodkar, Laleh R Kalankesh, Leila R Kalankesh, Rohollah Kalhor, Vineet Kumar Kamal, Farin Kamangar, Ashwin Kamath, Tanuj Kanchan, Eswar Kandaswamy, Himal Kandel, HyeJung Kang, Girum Gebremeskel Kanno, Neeti Kapoor, Sitanshu Sekhar Kar, Shama D Karanth, Ibraheem M Karaye, André Karch, Amirali Karimi, Bekalu Getnet Kassa, Patrick DMC Katoto, Joonas H Kauppila, Harkiran Kaur, Abinet Gebremickael Kebede, Leila Keikavoosi-Arani, Gemechu Gemechu Kejela, Phillip M Kemp Bohan, Maryam Keramati, Mohammad Keykhaei, Himanshu Khajuria, Abbas Khan, Abdul Aziz Khan Khan, Ejaz Ahmad Khan, Gulfaraz Khan, Md Nuruzzaman Khan, Moien AB Khan, Javad Khanali, Khaled Khatab, Moawiah Mohammad Khatatbeh, Mahalaqua Nazli Khatib, Maryam Khayamzadeh, Hamid Reza Khayat Kashani, Mohammad Amin Khazeei Tabari, Mehdi Khezeli, Mahmoud Khodadost, Min Seo Kim, Yun Jin Kim, Adnan Kisa, Sezer Kisa, Miloslav Klugar, Jitka Klugarová, Ali-Asghar Kolahi, Pavel Kolkhir, Farzad Kompani, Parvaiz A Koul, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Kewal Krishan, Yuvaraj Krishnamoorthy, Burcu Kucuk Bicer, Nuworza Kugbey, Mukhtar Kulimbet, Akshay Kumar, G Anil Kumar, Narinder Kumar, Om P Kurmi, Ambily Kuttikkattu, Carlo La Vecchia, Arista Lahiri, Dharmesh Kumar Lal, Judit Lám, Qing Lan, Iván Landires, Bagher Larijani, Savita Lasrado, Jerrald Lau, Paolo Lauriola, Caterina Ledda, Sang-woong Lee, Shaun Wen Huey Lee, Wei-Chen Lee, Yeong Yeh Lee, Yo Han Lee, Samson Mideksa Legesse, James Leigh, Elvynna Leong, Ming-Chieh Li, Stephen S Lim, Gang Liu, Jue Liu, Chun-Han Lo, Ayush Lohiya, Platon D Lopukhov, László Lorenzovici, Mojgan Lotfi, Joana A Loureiro, Raimundas Lunevicius, Farzan Madadizadeh, Ahmad R Mafi, Sameh Magdeldin, Soleiman Mahjoub, Ata Mahmoodpoor, Morteza Mahmoudi, Marzieh Mahmoudimanesh, Rashidul Alam Mahumud, Azeem Majeed, Jamal Majidpoor, Alaa Makki, Konstantinos Christos Makris, Elaheh Malakan Rad, Mohammad-Reza Malekpour, Reza Malekzadeh, Ahmad Azam Malik, Tauqeer Hussain Mallhi, Sneha Deepak Mallya, Mohammed A Mamun, Ana Laura Manda, Fariborz Mansour-Ghanaei, Borhan Mansouri, Mohammad Ali Mansournia, Lorenzo Giovanni Mantovani, Santi Martini, Miquel Martorell, Sahar Masoudi, Seyedeh Zahra Masoumi, Clara N Matei, Elezebeth Mathews, Manu Raj Mathur, Vasundhara Mathur, Martin McKee, Jitendra Kumar Meena, Khalid Mehmood, Entezar Mehrabi Nasab, Ravi Mehrotra, Addisu Melese, Walter Mendoza, Ritesh G Menezes, SIsay Derso Mengesha, Laverne G Mensah, Alexios-Fotios A Mentis, Andry Yasmid Mera Mera-Mamián, Tuomo J Meretoja, Mehari Woldemariam Merid, Amanual Getnet Mersha, Belsity Temesgen Meselu, Mahboobeh Meshkat, Tomislav Mestrovic, Junmei Miao Jonasson, Tomasz Miazgowski, Irmina Maria Michalek, Gelana Fekadu Worku Mijena, Ted R Miller, Shabir Ahmad Mir, Seyed Kazem Mirinezhad, Seyyedmohammadsadeq Mirmoeeni, Mohammad Mirza-Aghazadeh-Attari, Hamed Mirzaei, Hamid Reza Mirzaei, Abay Sisay Misganaw, Sanjeev Misra, Karzan Abdulmuhsin Mohammad, Esmaeil Mohammadi, Mokhtar Mohammadi, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Arif Mohammed, Shafiu Mohammed, Syam Mohan, Mohammad Mohseni, Nagabhishek Moka, Ali H Mokdad, Alex Molassiotis, Mariam Molokhia, Kaveh Momenzadeh, Sara Momtazmanesh, Lorenzo Monasta, Ute Mons, Ahmed Al Montasir, Fateme Montazeri, Arnulfo Montero, Mohammad Amin Moosavi, Abdolvahab Moradi, Yousef Moradi, Mostafa Moradi Sarabi, Paula Moraga, Lidia Morawska, Shane Douglas Morrison, Jakub Morze, Abbas Mosapour, Ebrahim Mostafavi, Seyyed Meysam Mousavi, Haleh Mousavi Isfahani, Amin Mousavi Khaneghah, Christine Mpundu-Kaambwa, Sumaira Mubarik, Francesk Mulita, Daniel Munblit, Sandra B Munro, Efrén Murillo-Zamora, Jonah Musa, Ashraf F Nabhan, Ahamarshan Jayaraman Nagarajan, Shankar Prasad Nagaraju, Gabriele Nagel, Mohammadreza Naghipour, Mukhammad David Naimzada, Tapas Sadasivan Nair, Atta Abbas Naqvi, Sreenivas Narasimha Swamy, Aparna Ichalangod Narayana, Hasan Nassereldine, Zuhair S Natto, Biswa Prakash Nayak, Rawlance Ndejjo, Sabina Onyinye Nduaguba, Wogene Wogene Negash, Seyed Aria Nejadghaderi, Kazem Nejati, Sandhya Neupane Kandel, Huy Van Nguyen Nguyen, Robina Khan Niazi, Nurulamin M Noor, Maryam Noori, Nafise Noroozi, Hasti Nouraei, Ali Nowroozi, Virginia Nuñez-Samudio, Chimezie Igwegbe Nzoputam, Ogochukwu Janet Nzoputam, Bogdan Oancea, Oluwakemi Ololade Odukoya, Onome Bright Oghenetega, Ropo Ebenezer Ogunsakin, Ayodipupo Sikiru Oguntade, In-Hwan Oh, Hassan Okati-Aliabad, Akinkunmi Paul Okekunle, Andrew T Olagunju, Tinuke O Olagunju, Babayemi Oluwaseun Olakunde, Isaac Iyinoluwa Olufadewa, Emad Omer, Abidemi E Emmanuel Omonisi, Sokking Ong, Obinna E Onwujekwe, Hans Orru, Stanislav S Otstavnov, Abderrahim Oulhaj, Bilcha Oumer, Oluwatomi Funbi Owopetu, Babatunji Emmanuel Oyinloye, Mahesh P A, Alicia Padron-Monedero, Jagadish Rao Padubidri, Babak Pakbin, Keyvan Pakshir, Reza Pakzad, Tamás Palicz, Adrian Pana, Anamika Pandey, Ashok Pandey, Suman Pant, Shahina Pardhan, Eun-Cheol Park, Eun-Kee Park, Seoyeon Park, Jay Patel, Siddhartha Pati, Rajan Paudel, Uttam Paudel, Mihaela Paun, Hamidreza Pazoki Toroudi, Minjin Peng, Jeevan Pereira, Renato B Pereira, Simone Perna, Navaraj Perumalsamy, Richard G Pestell, Raffaele Pezzani, Cristiano Piccinelli, Julian David Pillay, Zahra Zahid Piracha, Tobias Pischon, Maarten J Postma, Ashkan Pourabhari Langroudi, Akram Pourshams, Naeimeh Pourtaheri, Akila Prashant, Mirza Muhammad Fahd Qadir, Zahiruddin Quazi Syed, Mohammad Rabiee, Navid Rabiee, Amir Radfar, Raghu Anekal Radhakrishnan, Venkatraman Radhakrishnan, Mojtaba Raeisi, Ata Rafiee, Alireza Rafiei, Nasiru Raheem, Fakher Rahim, Md Obaidur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Shayan Rahmani, Vahid Rahmanian, Nazanin Rajai, Aashish Rajesh, Pradhum Ram, Kiana Ramezanzadeh, Juwel Rana, Kamal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Sowmya J Rao, Sina Rashedi, Amirfarzan Rashidi, Mahsa Rashidi, Mohammad-Mahdi Rashidi, Zubair Ahmed Ratan, David Laith Rawaf, Salman Rawaf, Lal Rawal, Reza Rawassizadeh, Mohammad Sadegh Razeghinia, Ashfaq Ur Rehman, Inayat ur Rehman, Marissa B Reitsma, Andre M N Renzaho, Maryam Rezaei, Nazila Rezaei, Negar Rezaei, Nima Rezaei, Saeid Rezaei, Mohsen Rezaeian, Aziz Rezapour, Abanoub Riad, Reza Rikhtegar, Maria Rios-Blancas, Thomas J Roberts, Peter Rohloff, Esperanza Romero-Rodríguez, Gholamreza Roshandel, Godfrey M Rwegerera, Manjula S, Maha Mohamed Saber-Ayad, Bahar Saberzadeh-Ardestani, Siamak Sabour, Basema Saddik, Erfan Sadeghi, Mohammad Reza Saeb, Umar Saeed, Mohsen Safaei, Azam Safary, Maryam Sahebazzamani, Amirhossein Sahebkar, Harihar Sahoo, Mirza Rizwan Sajid, Hedayat Salari, Sana Salehi, Marwa Rashad Salem, Hamideh Salimzadeh, Yoseph Leonardo Samodra, Abdallah M Samy, Juan Sanabria, Senthilkumar Sankararaman, Francesco Sanmarchi, Milena M Santric-Milicevic, Muhammad Arif Nadeem Saqib, Arash Sarveazad, Fatemeh Sarvi, Brijesh Sathian, Maheswar Satpathy, Nicolas Sayegh, Ione Jayce Ceola Schneider, Michaël Schwarzinger, Mario Šekerija, Subramanian Senthilkumaran, Sadaf G Sepanlou, Allen Seylani, Kenbon Seyoum, Feng Sha, Omid Shafaat, Pritik A Shah, Saeed Shahabi, Izza Shahid, Mohammad Amin Shahrbaf, Hamid R Shahsavari, Masood Ali Shaikh, Mohammed Feyisso Shaka, Elaheh Shaker, Mohammed Shannawaz, Mequannent Melaku Sharew Sharew, Azam Sharifi, Javad Sharifi-Rad, Purva Sharma, Bereket Beyene Shashamo, Aziz Sheikh, Mahdi Sheikh, Sara Sheikhbahaei, Rahim Ali Sheikhi, Ali Sheikhy, Peter Robin Shepherd, Adithi Shetty, Jeevan K Shetty, Ranjitha S Shetty, Kenji Shibuya, Reza Shirkoohi, Hesamaddin Shirzad-Aski, K M Shivakumar, Siddharudha Shivalli, Velizar Shivarov, Parnian Shobeiri, Zahra Shokri Varniab, Seyed Afshin Shorofi, Sunil Shrestha, Migbar Mekonnen Sibhat, Sudeep K Siddappa Malleshappa, Negussie Boti Sidemo, Diego Augusto Santos Silva, Luís Manuel Lopes Rodrigues Silva, Guilherme Silva Julian, Nicola Silvestris, Wudneh Simegn, Achintya Dinesh Singh, Ambrish Singh, Garima Singh, Harpreet 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Melinda Gates Foundation, Kuwait University (Kuwait), Ministry of Higher Education (Malasia), Lega Italiana per la Lotta ai Tumori, Health Effects Institute (Estados Unidos), Unión Europea. Comisión Europea. European Research Council (ERC), Unión Europea. Comisión Europea. H2020, Fundação para a Ciência e Tecnologia (Portugal), African-German Network of Excellence in Science (AGNES), Federal Ministry of Education & Research (Alemania), Alexander von Humboldt Foundation, Novo Nordisk Foundation, National Institute for Health Research (Reino Unido), National Health and Medical Research Council (Australia), Romanian National Authority for Scientific Research and Innovation, Romanian Ministry of Research Innovation and Digitalization, Ministry of Education, Science and Technological Development (Serbia), Sigrid Jusélius Foundation, Finnish Cancer Foundation, Datta Meghe Institute of Medical Sciences (India), Xiamen University (Malasia), Manipal Academy of Higher Education (India), Panjab University (India), Sistema Nacional de Investigación (Panamá), Secretaría Nacional de Ciencia, Tecnología e Innovación (Panamá), Ministry of Science and Technology (Taiwan), Lung Foundation Australia, National Natural Science Foundation of China, Wellcome Trust, UNSW Sydney (Australia), ICMR - National Institute of Epidemiology (India), University of Tasmania (Australia), National Council for Scientific and Technological Development (Brasil), Coordenação de Aperfeicoamento de Pessoal de Nível Superior (Brasil), Institute for Advanced Studies in Basic Sciences (Irán), Ain Shams University (Egipto), International Center of Medical Sciences Research (Islamabad), National Institutes of Health (Estados Unidos), University of Oxford (Reino Unido), National Institute of Genetic Engineering and Biotechnology (Irán), Marga und Walter Boll - Stiftung, Ministero della Salute (Italia), IRCCS Materno Infantile Burlo Garofolo (Italia), King College London, Wellcome Trust/DBT India Alliance (India), Public Health, University of St Andrews. School of Medicine, and University of St Andrews. Population and Behavioural Science Division
Subjects: Male, DEATHS, DALY, cancer, risk factors, Medizin, systematic analysis, Global Health, Risk Assessment, Cancer prevention, Global Burden of Disease, RC0254, Risk-attributable cancer deaths, SDG 3 - Good Health and Well-being, RA0421, Risk Factors, RA0421 Public health. Hygiene. Preventive Medicine, Quality-Adjusted Life Year, Neoplasms, cancer, Humans, Global Burden of Disease Study, UK, Medicine(all), MCC, RC0254 Neoplasms. Tumors. Oncology (including Cancer), Risk Factor, Smoking, COVID-19, 3rd-DAS, General Medicine, Disability-adjusted life-years, SOCIAL DETERMINANTS, Risk assessments, risk factor, Cardiovascular and Metabolic Diseases, 3121 General medicine, internal medicine and other clinical medicine, OBESITY, Cancer burden, Neoplasm, Female, LIFE-STYLE, Quality-Adjusted Life Years, HEALTH, RA, Human, RC
Abstract: Background: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01-4·94) deaths and 105 million (95·0-116) DALYs for both sexes combined, representing 44·4% (41·3-48·4) of all cancer deaths and 42·0% (39·1-45·6) of all DALYs. There were 2·88 million (2·60-3·18) risk-attributable cancer deaths in males (50·6% [47·8-54·1] of all male cancer deaths) and 1·58 million (1·36-1·84) risk-attributable cancer deaths in females (36·3% [32·5-41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6-28·4) and DALYs by 16·8% (8·8-25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9-42·8] and 33·3% [25·8-42·0]). Interpretation: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. We are grateful to the surveillance systems, including cancer registries, that generated and shared observed cancer burden data. S M Aljunid acknowledges the Department of Health Policy and Management, College of Public Health, Kuwait University for the approval and support to participate in this research project. H Ariffin acknowledges support from the Ministry of Higher Education, Malaysia (grant FRGS/1/2021/SKK0/UM/01/1). F Barra acknowledges support from Lega Italiana per la Lotta contro i Tumori - LILT - Bando 5 x 1000 anno 2019. L Belo and M Carvalho acknowledge the support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. A J Cohen was supported by the Health Effects Institute, Boston, MA, USA. J Conde acknowledges financial support from the European Research Council - ERC Starting Grant 848325. V M Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. T C Ekundayo was supported by the African-German Network of Excellence in Science (AGNES), the Federal Ministry of Education and Research (BMBF) and the Alexander von Humboldt Foundation (AvH). N Ghith acknowledges support from a grant from Novo Nordisk Foundation (NNF16OC0021856). J C Glasbey is support by a Doctoral Research Fellowship from the National Institute of Health Research (NIHR300175). V K Gupta and V B Gupta acknowledge funding support from National Health and Medical Research Council (NHMRC), Australia. C Herteliu, A Pana, and M Ausloos acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. C Herteliu is also partially supported by a grant of the Romanian Ministry of Research Innovation and Digitalization, MCID, project number ID-585-CTR-42-PFE-2021. S Hussain was supported from Operational Programme Research, Development and Education–Project, Postdoc2MUNI (number CZ.02.2. 69/0.0/0.0/18_053/0016952). M Jakovljevic acknowledges partial support through the grant OI 175 014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. J H Kauppila acknowledges research grants from Sigrid Jusélius Foundation and the Finnish Cancer Foundation. M N Khatib acknowledges support from Datta Meghe Institute of Medical Sciences (deemed-to-be-university). Y J Kim was supported by the Research Management Centre, Xiamen University Malaysia [XMUMRF/2020-C6/ITCM/0004]. S L Koulmane Laxminarayana acknowledges institutional assistance by Manipal Academy of Higher Education, Manipal. K Krishan is supported by the UGC Centre of Advanced Study (Phase II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. I Landires is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). M-C Li was supported by the Ministry of Science and Technology, Taiwan (MOST 110-2314-B-003-001). G Liu acknowledges support from the CREATE Hope scientific fellowship from Lung Foundation Australia. J Liu acknowledges support from the National Natural Science Foundation (72122001). J A Loureiro was supported by Scientific Employment Stimulus (FCT; CEECINST/00049/2018). E Mathews is supported by a Clinical and Public Health Early Career Fellowship (grant number IA/CPHE/17/1/503345) from the DBT India Alliance/Wellcome Trust Department of Biotechnology, India Alliance (2018–2023). T J Meretoja was supported by an unrestricted grant from Cancer Foundation Finland sr. S Mohammed acknowledges a fellowship grant from Alexander von Humboldt Foundation, outside the submitted work. M Molokhia is supported by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. L Monasta received support from the Italian Ministry of Health at the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste - Italy (RC 34/2017). U Mons is supported by the Marga and Walter Boll Foundation, Kerpen, Germany. M A Moosavi acknowledges the financial support of National Institute of Genetics Engineering and Biotechnology (NIGEB). J Musa acknowledges support from the NIH/FICK43TW011416 for research-protected time for cervical cancer research and career development at University of Jos. V Nuñez-Samudio is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). O O Odukoya acknowledges support by the Fogarty International Center of the National Institutes of Health under the award number K43TW010704 for research-protected time. The content is solely the responsibility of all the authors and does not necessarily represent the official views of the National Institutes of Health. A S Oguntade acknowledges funding by a doctoral scholarship from the Nuffield Department of Population Health, University of Oxford (Oxford Population Health). J R Padubidri acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal for their constant support in research collaborations. R G Pestell acknowledges support from NIH grant W81XWH1810605 Breast Cancer Research, Breakthrough Grant R21 CA235139-01. Z Z Piracha acknowledges the International Center of Medical Sciences Research (ICMSR), Islamabad (44000), Pakistan. R A Radhakrishnan acknowledges support from Wellcome Trust/DBT India Alliance - IA/CPHI/18/1/503927. U Saeed acknowledges the International Center of Medical Sciences Research (ICMSR), Islamabad, Pakistan. A M Samy acknowledges the support from Ain Shams University and the Egyptian Fulbright Mission Program. F Sha was supported by the Shenzhen Science and Technology Program (grant number KQTD20190929172835662). H R Shahsavari acknowledges the Institute for Advanced Studies in Basic Sciences (IASBS) Research Council. A Shetty acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal for all the academic support. D A S Silva acknowledges financing in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001 and D A S Silva is supported in part by CNPq-Brazil (309589/2021-5). L M L R Silva was supported by project CENTRO-04-3559-FSE-000162, Fundo Social Europeu (FSE). Am Singh is supported by the International Graduate Research Scholarship, University of Tasmania. R Suliankatchi Abdulkader acknowledges support from ICMR—National Institute of Epidemiology. B Unnikrishnan acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. H Xiao acknowledges support from the Public Health Sciences Division of the Fred Hutchinson Cancer Research Center. X Xu is supported by the University of New South Wales (Australia) Scientia Program. C Yu was supported by the National Natural Science Foundation of China (grant number 82173626) and Wuhan Medical Research Program of Joint Fund of Hubei Health Committee (grant number WJ2019H304). Sí
Published: 2022
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33. Age–sex differences in the global burden of lower respiratory infections and risk factors, 1990–2019: results from the Global Burden of Disease Study 2019

Author: Hmwe Hmwe Kyu, Avina Vongpradith, Sarah Brooke Sirota, Amanda Novotney, Christopher E Troeger, Matthew C Doxey, Rose G Bender, Jorge R Ledesma, Molly H Biehl, Samuel B Albertson, Joseph Jon Frostad, Katrin Burkart, Fiona B Bennitt, Jeff T Zhao, William M Gardner, Hailey Hagins, Dana Bryazka, Regina-Mae Villanueva Dominguez, Semagn Mekonnen Abate, Michael Abdelmasseh, Amir Abdoli, Gholamreza Abdoli, Aidin Abedi, Vida Abedi, Tadesse M Abegaz, Hassan Abidi, Richard Gyan Aboagye, Hassan Abolhassani, Yonas Derso Abtew, Hiwa Abubaker Ali, Eman Abu-Gharbieh, Ahmed Abu-Zaid, Kidist Adamu, Isaac Yeboah Addo, Oyelola A Adegboye, Mohammad Adnan, Qorinah Estiningtyas Sakilah Adnani, Muhammad Sohail Afzal, Saira Afzal, Bright Opoku Ahinkorah, Aqeel Ahmad, Araz Ramazan Ahmad, Sajjad Ahmad, Ali Ahmadi, Sepideh Ahmadi, Haroon Ahmed, Jivan Qasim Ahmed, Tarik Ahmed Rashid, Mostafa Akbarzadeh-Khiavi, Hanadi Al Hamad, Luciana Albano, Mamoon A Aldeyab, Bezatu Mengistie Alemu, Kefyalew Addis Alene, Abdelazeem M Algammal, Fadwa Alhalaiqa Naji Alhalaiqa, Robert Kaba Alhassan, Beriwan Abdulqadir Ali, Liaqat Ali, Musa Mohammed Ali, Syed Shujait Ali, Yousef Alimohamadi, Vahid Alipour, Adel Al-Jumaily, Syed Mohamed Aljunid, Sami Almustanyir, Rajaa M Al-Raddadi, Rami H Hani Al-Rifai, Saif Aldeen S AlRyalat, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Edward Kwabena Ameyaw, Javad Javad Aminian Dehkordi, John H Amuasi, Dickson A Amugsi, Etsay Woldu Anbesu, Adnan Ansar, Anayochukwu Edward Anyasodor, Jalal Arabloo, Demelash Areda, Ayele Mamo Argaw, Zeleke Gebru Argaw, Judie Arulappan, Raphael Taiwo Aruleba, Mulusew A Asemahagn, Seyyed Shamsadin Athari, Daniel Atlaw, Engi F Attia, Sameh Attia, Avinash Aujayeb, Tewachew Awoke, Tegegn Mulatu Ayana, Martin Amogre Ayanore, Sina Azadnajafabad, Mohammadreza Azangou-Khyavy, Samad Azari, Amirhossein Azari Jafari, Muhammad Badar, Ashish D Badiye, Nayereh Baghcheghi, Sara Bagherieh, Atif Amin Baig, Maciej Banach, Indrajit Banerjee, Mainak Bardhan, 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H., Vongpradith, A., Sirota, S. B., Novotney, A., Troeger, C. E., Doxey, M. C., Bender, R. G., Ledesma, J. R., Biehl, M. H., Albertson, S. B., Frostad, J. J., Burkart, K., Bennitt, F. B., Zhao, J. T., Gardner, W. M., Hagins, H., Bryazka, D., Dominguez, R. -M. V., Abate, S. M., Abdelmasseh, M., Abdoli, A., Abdoli, G., Abedi, A., Abedi, V., Abegaz, T. M., Abidi, H., Aboagye, R. G., Abolhassani, H., Abtew, Y. D., Abubaker Ali, H., Abu-Gharbieh, E., Abu-Zaid, A., Adamu, K., Addo, I. Y., Adegboye, O. A., Adnan, M., Adnani, Q. E. S., Afzal, M. S., Afzal, S., Ahinkorah, B. O., Ahmad, A., Ahmad, A. R., Ahmad, S., Ahmadi, A., Ahmadi, S., Ahmed, H., Ahmed, J. Q., Ahmed Rashid, T., Akbarzadeh-Khiavi, M., Al Hamad, H., Albano, L., Aldeyab, M. A., Alemu, B. M., Alene, K. A., Algammal, A. M., Alhalaiqa, F. A. N., Alhassan, R. K., Ali, B. A., Ali, L., Ali, M. M., Ali, S. S., Alimohamadi, Y., Alipour, V., Al-Jumaily, A., Aljunid, S. M., Almustanyir, S., Al-Raddadi, R. M., Al-Rifai, R. H. H., Alryalat, S. A. S., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Ameyaw, E. K., Aminian Dehkordi, J. J., Amuasi, J. H., Amugsi, D. A., Anbesu, E. W., Ansar, A., Anyasodor, A. E., Arabloo, J., Areda, D., Argaw, A. M., Argaw, Z. G., Arulappan, J., Aruleba, R. T., Asemahagn, M. A., Athari, S. S., Atlaw, D., Attia, E. F., Attia, S., Aujayeb, A., Awoke, T., Ayana, T. M., Ayanore, M. A., Azadnajafabad, S., Azangou-Khyavy, M., Azari, S., Azari Jafari, A., Badar, M., Badiye, A. D., Baghcheghi, N., Bagherieh, S., Baig, A. A., Banach, M., Banerjee, I., Bardhan, M., Barone-Adesi, F., Barqawi, H. J., Barrow, A., Bashiri, A., Bassat, Q., Batiha, A. -M. M., Belachew, A. B., Belete, M. A., Belgaumi, U. I., Bhagavathula, A. S., Bhardwaj, N., Bhardwaj, P., Bhatt, P., Bhojaraja, V. S., Bhutta, Z. A., Bhuyan, S. S., Bijani, A., Bitaraf, S., Bodicha, B. B. A., Briko, N. I., Buonsenso, D., Butt, M. H., Cai, J., Camargos, P., Camera, L. A., Chakraborty, P. A., Chanie, M. G., Charan, J., Chattu, V. K., Ching, P. R., Choi, S., Chong, Y. Y., Choudhari, S. G., Chowdhury, E. K., Christopher, D. J., Chu, D. -T., Cobb, N. L., Cohen, A. J., Cruz-Martins, N., Dadras, O., Dagnaw, F. T., Dai, X., Dandona, L., Dandona, R., Dao, A. T. M., Debela, S. A., Demisse, B., Demisse, F. W., Demissie, S., Dereje, D., Desai, H. D., Desta, A. A., Desye, B., Dhingra, S., Diao, N., Diaz, D., Digesa, L. E., Doan, L. P., Dodangeh, M., Dongarwar, D., Dorostkar, F., dos Santos, W. M., Dsouza, H. L., Dubljanin, E., Durojaiye, O. C., Edinur, H. A., Ehsani-Chimeh, E., Eini, E., Ekholuenetale, M., Ekundayo, T. C., El Desouky, E. D., El Sayed, I., El Sayed Zaki, M., Elhadi, M., Elkhapery, A. M. R., Emami, A., Engelbert Bain, L., Erkhembayar, R., Etaee, F., Ezati Asar, M., Fagbamigbe, A. F., Falahi, S., Fallahzadeh, A., Faraj, A., Faraon, E. J. A., Fatehizadeh, A., Ferrara, P., Ferrari, A. A., Fetensa, G., Fischer, F., Flavel, J., Foroutan, M., Gaal, P. A., Gaidhane, A. M., Gaihre, S., Galehdar, N., Garcia-Basteiro, A. L., Garg, T., Gebrehiwot, M. D., Gebremichael, M. A., Gela, Y. Y., Gemeda, B. N. B., Gessner, B. D., Getachew, M., Getie, A., Ghamari, S. -H., Ghasemi Nour, M., Ghashghaee, A., Gholamrezanezhad, A., Gholizadeh, A., Ghosh, R., Ghozy, S., Goleij, P., Golitaleb, M., Gorini, G., Goulart, A. C., Goyomsa, G. G., Guadie, H. A., Gudisa, Z., Guled, R. A., Gupta, S., Gupta, V. B., Gupta, V. K., Guta, A., Habibzadeh, P., Haj-Mirzaian, A., Halwani, R., Hamidi, S., Hannan, M. A., Harorani, M., Hasaballah, A. I., Hasani, H., Hassan, A. M., Hassani, S., Hassanian-Moghaddam, H., Hassankhani, H., Hayat, K., Heibati, B., Heidari, M., Heyi, D. Z., Hezam, K., Holla, R., Hong, S. H., Horita, N., Hosseini, M. -S., Hosseinzadeh, M., Hostiuc, M., Househ, M., Hoveidamanesh, S., Huang, J., Hussein, N. R., Iavicoli, I., Ibitoye, S. E., Ikuta, K. S., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Immurana, M., Ismail, N. E., Iwagami, M., Jaafari, J., Jamshidi, E., Jang, S. -I., Javadi Mamaghani, A., Javaheri, T., Javanmardi, F., Javidnia, J., Jayapal, S. K., Jayarajah, U., Jayaram, S., Jema, A. T., Jeong, W., Jonas, J. B., Joseph, N., Joukar, F., Jozwiak, J. J., K, V., Kabir, Z., Kacimi, S. E. O., Kadashetti, V., Kalankesh, L. R., Kalhor, R., Kamath, A., Kamble, B. D., Kandel, H., Kanko, T. K., Karaye, I. M., Karch, A., Karkhah, S., Kassa, B. G., Katoto, P. D., Kaur, H., Kaur, R. J., Keikavoosi-Arani, L., Keykhaei, M., Khader, Y. S., Khajuria, H., Khan, E. A., Khan, G., Khan, I. A., Khan, M., Khan, M. N., Khan, M. A., Khan, Y. H., Khatatbeh, M. M., Khosravifar, M., Khubchandani, J., Kim, M. S., Kimokoti, R. W., Kisa, A., Kisa, S., Kissoon, N., Knibbs, L. D., Kochhar, S., Kompani, F., Koohestani, H. R., Korshunov, V. A., Kosen, S., Koul, P. A., Koyanagi, A., Krishan, K., Kuate Defo, B., Kumar, G. A., Kurmi, O. P., Kuttikkattu, A., Lal, D. K., Lam, J., Landires, I., Ledda, C., Lee, S. -W., Levi, M., Lewycka, S., Liu, G., Liu, W., Lodha, R., Lorenzovici, L., Lotfi, M., Loureiro, J. A., Madadizadeh, F., Mahmoodpoor, A., Mahmoudi, R., Mahmoudimanesh, M., Majidpoor, J., Makki, A., Malakan Rad, E., Malik, A. A., Mallhi, T. H., Manla, Y., Matei, C. N., Mathioudakis, A. G., Maude, R. J., Mehrabi Nasab, E., Melese, A., Memish, Z. A., Mendoza-Cano, O., Mentis, A. -F. A., Meretoja, T. J., Merid, M. W., Mestrovic, T., Micheletti Gomide Nogueira de Sa, A. C., Mijena, G. F. W., Minh, L. H. N., Mir, S. A., Mirfakhraie, R., Mirmoeeni, S., Mirza, A. Z., Mirza, M., Mirza-Aghazadeh-Attari, M., Misganaw, A. S., Misganaw, A. T., Mohammadi, E., Mohammadi, M., Mohammed, A., Mohammed, S., Mohan, S., Mohseni, M., Moka, N., Mokdad, A. H., Momtazmanesh, S., Monasta, L., Moniruzzaman, M., Montazeri, F., Moore, C. E., Moradi, A., Morawska, L., Mosser, J. F., Mostafavi, E., Motaghinejad, M., Mousavi Isfahani, H., Mousavi-Aghdas, S. A., Mubarik, S., Murillo-Zamora, E., Mustafa, G., Nair, S., Nair, T. S., Najafi, H., Naqvi, A. A., Narasimha Swamy, S., Natto, Z. S., Nayak, B. P., Nejadghaderi, S. A., Nguyen, H. V. N., Niazi, R. K., Nogueira de Sa, A. T., Nouraei, H., Nowroozi, A., Nunez-Samudio, V., Nzoputam, C. I., Nzoputam, O. J., Oancea, B., Ochir, C., Odukoya, O. O., Okati-Aliabad, H., Okekunle, A. P., Okonji, O. C., Olagunju, A. T., Olufadewa, I. I., Omar Bali, A., Omer, E., Oren, E., Ota, E., Otstavnov, N., Oulhaj, A., P A, M., Padubidri, J. R., Pakshir, K., Pakzad, R., Palicz, T., Pandey, A., Pant, S., Pardhan, S., Park, E. -C., Park, E. -K., Pashazadeh Kan, F., Paudel, R., Pawar, S., Peng, M., Pereira, G., Perna, S., Perumalsamy, N., Petcu, I. -R., Pigott, D. M., Piracha, Z. Z., Podder, V., Polibin, R. V., Postma, M. J., Pourasghari, H., Pourtaheri, N., Qadir, M. M. F., Raad, M., Rabiee, M., Rabiee, N., Raeghi, S., Rafiei, A., Rahim, F., Rahimi, M., Rahimi-Movaghar, V., Rahman, A., Rahman, M. O., Rahman, M., Rahman, M. A., Rahmani, A. M., Rahmanian, V., Ram, P., Ramezanzadeh, K., Rana, J., Ranasinghe, P., Rani, U., Rao, S. J., Rashedi, S., Rashidi, M. -M., Rasul, A., Ratan, Z. A., Rawaf, D. L., Rawaf, S., Rawassizadeh, R., Razeghinia, M. S., Redwan, E. M. M., Reitsma, M. B., Renzaho, A. M. N., Rezaeian, M., Riad, A., Rikhtegar, R., Rodriguez, J. A. B., Rogowski, E. L. B., Ronfani, L., Rudd, K. E., Saddik, B., Sadeghi, E., Saeed, U., Safary, A., Safi, S. Z., Sahebazzamani, M., Sahebkar, A., Sakhamuri, S., Salehi, S., Salman, M., Samadi Kafil, H., Samy, A. M., Santric-Milicevic, M. M., Sao Jose, B. P., Sarkhosh, M., Sathian, B., Sawhney, M., Saya, G. K., Seidu, A. -A., Seylani, A., Shaheen, A. A., Shaikh, M. A., Shaker, E., Shamshad, H., Sharew, M. M., Sharhani, A., Sharifi, A., Sharma, P., Sheidaei, A., Shenoy, S. M., Shetty, J. K., Shiferaw, D. S., Shigematsu, M., Shin, J. I., Shirzad-Aski, H., Shivakumar, K. M., Shivalli, S., Shobeiri, P., Simegn, W., Simpson, C. R., Singh, H., Singh, J. A., Singh, P., Siwal, S. S., Skryabin, V. Y., Skryabina, A. A., Soltani-Zangbar, M. S., Song, S., Song, Y., Sood, P., Sreeramareddy, C. T., Steiropoulos, P., Suleman, M., Tabatabaeizadeh, S. -A., Tahamtan, A., Taheri, M., Taheri Soodejani, M., Taki, E., Talaat, I. M., Tampa, M., Tandukar, S., Tat, N. Y., Tat, V. Y., Tefera, Y. M., Temesgen, G., Temsah, M. -H., Tesfaye, A., Tesfaye, D. G., Tessema, B., Thapar, R., Ticoalu, J. H. V., Tiyuri, A., Tleyjeh, I. I., Togtmol, M., Tovani-Palone, M. R., Tufa, D. G., Ullah, I., Upadhyay, E., Valadan Tahbaz, S., Valdez, P. R., Valizadeh, R., Vardavas, C., Vasankari, T. J., Vo, B., Vu, L. G., Wagaye, B., Waheed, Y., Wang, Y., Waris, A., West, T. E., Wickramasinghe, N. D., Xu, X., Yaghoubi, S., Yahya, G. A. T., Yahyazadeh Jabbari, S. H., Yon, D. K., Yonemoto, N., Zaman, B. A., Zandifar, A., Zangiabadian, M., Zar, H. J., Zare, I., Zareshahrabadi, Z., Zarrintan, A., Zastrozhin, M. S., Zeng, W., Zhang, M., Zhang, Z. -J., Zhong, C., Zoladl, M., Zumla, A., Lim, S. S., Vos, T., Naghavi, M., Brauer, M., Hay, S. I., Murray, C. J. L., University of St Andrews. School of Medicine, University of St Andrews. Population and Behavioural Science Division, Tampere University, Health Sciences, Clinical Medicine, Kyu, H, Vongpradith, A, Sirota, S, Novotney, A, Troeger, C, Doxey, M, Bender, R, Ledesma, J, Biehl, M, Albertson, S, Frostad, J, Burkart, K, Bennitt, F, Zhao, J, Gardner, W, Hagins, H, Bryazka, D, Dominguez, R, Abate, S, Abdelmasseh, M, Abdoli, A, Abdoli, G, Abedi, A, Abedi, V, Abegaz, T, Abidi, H, Aboagye, R, Abolhassani, H, Abtew, Y, Abubaker Ali, H, Abu-Gharbieh, E, Abu-Zaid, A, Adamu, K, Addo, I, Adegboye, O, Adnan, M, Adnani, Q, Afzal, M, Afzal, S, Ahinkorah, B, Ahmad, A, Ahmad, S, Ahmadi, A, Ahmadi, S, Ahmed, H, Ahmed, J, Ahmed Rashid, T, Akbarzadeh-Khiavi, M, Al Hamad, H, Albano, L, Aldeyab, M, Alemu, B, Alene, K, Algammal, A, Alhalaiqa, F, Alhassan, R, Ali, B, Ali, L, Ali, M, Ali, S, Alimohamadi, Y, Alipour, V, Al-Jumaily, A, Aljunid, S, Almustanyir, S, Al-Raddadi, R, Al-Rifai, R, Alryalat, S, Alvis-Guzman, N, Alvis-Zakzuk, N, Ameyaw, E, Aminian Dehkordi, J, Amuasi, J, Amugsi, D, Anbesu, E, Ansar, A, Anyasodor, A, Arabloo, J, Areda, D, Argaw, A, Argaw, Z, Arulappan, J, Aruleba, R, Asemahagn, M, Athari, S, Atlaw, D, Attia, E, Attia, S, Aujayeb, A, Awoke, T, Ayana, T, Ayanore, M, Azadnajafabad, S, Azangou-Khyavy, M, Azari, S, Azari Jafari, A, Badar, M, Badiye, A, Baghcheghi, N, Bagherieh, S, Baig, A, Banach, M, Banerjee, I, Bardhan, M, Barone-Adesi, F, Barqawi, H, Barrow, A, Bashiri, A, Bassat, Q, Batiha, A, Belachew, A, Belete, M, Belgaumi, U, Bhagavathula, A, Bhardwaj, N, Bhardwaj, P, Bhatt, P, Bhojaraja, V, Bhutta, Z, Bhuyan, S, Bijani, A, Bitaraf, S, Bodicha, B, Briko, N, Buonsenso, D, Butt, M, Cai, J, Camargos, P, Camera, L, Chakraborty, P, Chanie, M, Charan, J, Chattu, V, Ching, P, Choi, S, Chong, Y, Choudhari, S, Chowdhury, E, Christopher, D, Chu, D, Cobb, N, Cohen, A, Cruz-Martins, N, Dadras, O, Dagnaw, F, Dai, X, Dandona, L, Dandona, R, Dao, A, Debela, S, Demisse, B, Demisse, F, Demissie, S, Dereje, D, Desai, H, Desta, A, Desye, B, Dhingra, S, Diao, N, Diaz, D, Digesa, L, Doan, L, Dodangeh, M, Dongarwar, D, Dorostkar, F, dos Santos, W, Dsouza, H, Dubljanin, E, Durojaiye, O, Edinur, H, Ehsani-Chimeh, E, Eini, E, Ekholuenetale, M, Ekundayo, T, El Desouky, E, El Sayed, I, El Sayed Zaki, M, Elhadi, M, Elkhapery, A, Emami, A, Engelbert Bain, L, Erkhembayar, R, Etaee, F, Ezati Asar, M, Fagbamigbe, A, Falahi, S, Fallahzadeh, A, Faraj, A, Faraon, E, Fatehizadeh, A, Ferrara, P, Ferrari, A, Fetensa, G, Fischer, F, Flavel, J, Foroutan, M, Gaal, P, Gaidhane, A, Gaihre, S, Galehdar, N, Garcia-Basteiro, A, Garg, T, Gebrehiwot, M, Gebremichael, M, Gela, Y, Gemeda, B, Gessner, B, Getachew, M, Getie, A, Ghamari, S, Ghasemi Nour, M, Ghashghaee, A, Gholamrezanezhad, A, Gholizadeh, A, Ghosh, R, Ghozy, S, Goleij, P, Golitaleb, M, Gorini, G, Goulart, A, Goyomsa, G, Guadie, H, Gudisa, Z, Guled, R, Gupta, S, Gupta, V, Guta, A, Habibzadeh, P, Haj-Mirzaian, A, Halwani, R, Hamidi, S, Hannan, M, Harorani, M, Hasaballah, A, Hasani, H, Hassan, A, Hassani, S, Hassanian-Moghaddam, H, Hassankhani, H, Hayat, K, Heibati, B, Heidari, M, Heyi, D, Hezam, K, Holla, R, Hong, S, Horita, N, Hosseini, M, Hosseinzadeh, M, Hostiuc, M, Househ, M, Hoveidamanesh, S, Huang, J, Hussein, N, Iavicoli, I, Ibitoye, S, Ikuta, K, Ilesanmi, O, Ilic, I, Ilic, M, Immurana, M, Ismail, N, Iwagami, M, Jaafari, J, Jamshidi, E, Jang, S, Javadi Mamaghani, A, Javaheri, T, Javanmardi, F, Javidnia, J, Jayapal, S, Jayarajah, U, Jayaram, S, Jema, A, Jeong, W, Jonas, J, Joseph, N, Joukar, F, Jozwiak, J, K, V, Kabir, Z, Kacimi, S, Kadashetti, V, Kalankesh, L, Kalhor, R, Kamath, A, Kamble, B, Kandel, H, Kanko, T, Karaye, I, Karch, A, Karkhah, S, Kassa, B, Katoto, P, Kaur, H, Kaur, R, Keikavoosi-Arani, L, Keykhaei, M, Khader, Y, Khajuria, H, Khan, E, Khan, G, Khan, I, Khan, M, Khan, Y, Khatatbeh, M, Khosravifar, M, Khubchandani, J, Kim, M, Kimokoti, R, Kisa, A, Kisa, S, Kissoon, N, Knibbs, L, Kochhar, S, Kompani, F, Koohestani, H, Korshunov, V, Kosen, S, Koul, P, Koyanagi, A, Krishan, K, Kuate Defo, B, Kumar, G, Kurmi, O, Kuttikkattu, A, Lal, D, Lam, J, Landires, I, Ledda, C, Lee, S, Levi, M, Lewycka, S, Liu, G, Liu, W, Lodha, R, Lorenzovici, L, Lotfi, M, Loureiro, J, Madadizadeh, F, Mahmoodpoor, A, Mahmoudi, R, Mahmoudimanesh, M, Majidpoor, J, Makki, A, Malakan Rad, E, Malik, A, Mallhi, T, Manla, Y, Matei, C, Mathioudakis, A, Maude, R, Mehrabi Nasab, E, Melese, A, Memish, Z, Mendoza-Cano, O, Mentis, A, Meretoja, T, Merid, M, Mestrovic, T, Micheletti Gomide Nogueira de Sa, A, Mijena, G, Minh, L, Mir, S, Mirfakhraie, R, Mirmoeeni, S, Mirza, A, Mirza, M, Mirza-Aghazadeh-Attari, M, Misganaw, A, Mohammadi, E, Mohammadi, M, Mohammed, A, Mohammed, S, Mohan, S, Mohseni, M, Moka, N, Mokdad, A, Momtazmanesh, S, Monasta, L, Moniruzzaman, M, Montazeri, F, Moore, C, Moradi, A, Morawska, L, Mosser, J, Mostafavi, E, Motaghinejad, M, Mousavi Isfahani, H, Mousavi-Aghdas, S, Mubarik, S, Murillo-Zamora, E, Mustafa, G, Nair, S, Nair, T, Najafi, H, Naqvi, A, Narasimha Swamy, S, Natto, Z, Nayak, B, Nejadghaderi, S, Nguyen, H, Niazi, R, Nogueira de Sa, A, Nouraei, H, Nowroozi, A, Nunez-Samudio, V, Nzoputam, C, Nzoputam, O, Oancea, B, Ochir, C, Odukoya, O, Okati-Aliabad, H, Okekunle, A, Okonji, O, Olagunju, A, Olufadewa, I, Omar Bali, A, Omer, E, Oren, E, Ota, E, Otstavnov, N, Oulhaj, A, P A, M, Padubidri, J, Pakshir, K, Pakzad, R, Palicz, T, Pandey, A, Pant, S, Pardhan, S, Park, E, Pashazadeh Kan, F, Paudel, R, Pawar, S, Peng, M, Pereira, G, Perna, S, Perumalsamy, N, Petcu, I, Pigott, D, Piracha, Z, Podder, V, Polibin, R, Postma, M, Pourasghari, H, Pourtaheri, N, Qadir, M, Raad, M, Rabiee, M, Rabiee, N, Raeghi, S, Rafiei, A, Rahim, F, Rahimi, M, Rahimi-Movaghar, V, Rahman, A, Rahman, M, Rahmani, A, Rahmanian, V, Ram, P, Ramezanzadeh, K, Rana, J, Ranasinghe, P, Rani, U, Rao, S, Rashedi, S, Rashidi, M, Rasul, A, Ratan, Z, Rawaf, D, Rawaf, S, Rawassizadeh, R, Razeghinia, M, Redwan, E, Reitsma, M, Renzaho, A, Rezaeian, M, Riad, A, Rikhtegar, R, Rodriguez, J, Rogowski, E, Ronfani, L, Rudd, K, Saddik, B, Sadeghi, E, Saeed, U, Safary, A, Safi, S, Sahebazzamani, M, Sahebkar, A, Sakhamuri, S, Salehi, S, Salman, M, Samadi Kafil, H, Samy, A, Santric-Milicevic, M, Sao Jose, B, Sarkhosh, M, Sathian, B, Sawhney, M, Saya, G, Seidu, A, Seylani, A, Shaheen, A, Shaikh, M, Shaker, E, Shamshad, H, Sharew, M, Sharhani, A, Sharifi, A, Sharma, P, Sheidaei, A, Shenoy, S, Shetty, J, Shiferaw, D, Shigematsu, M, Shin, J, Shirzad-Aski, H, Shivakumar, K, Shivalli, S, Shobeiri, P, Simegn, W, Simpson, C, Singh, H, Singh, J, Singh, P, Siwal, S, Skryabin, V, Skryabina, A, Soltani-Zangbar, M, Song, S, Song, Y, Sood, P, Sreeramareddy, C, Steiropoulos, P, Suleman, M, Tabatabaeizadeh, S, Tahamtan, A, Taheri, M, Taheri Soodejani, M, Taki, E, Talaat, I, Tampa, M, Tandukar, S, Tat, N, Tat, V, Tefera, Y, Temesgen, G, Temsah, M, Tesfaye, A, Tesfaye, D, Tessema, B, Thapar, R, Ticoalu, J, Tiyuri, A, Tleyjeh, I, Togtmol, M, Tovani-Palone, M, Tufa, D, Ullah, I, Upadhyay, E, Valadan Tahbaz, S, Valdez, P, Valizadeh, R, Vardavas, C, Vasankari, T, Vo, B, Vu, L, Wagaye, B, Waheed, Y, Wang, Y, Waris, A, West, T, Wickramasinghe, N, Xu, X, Yaghoubi, S, Yahya, G, Yahyazadeh Jabbari, S, Yon, D, Yonemoto, N, Zaman, B, Zandifar, A, Zangiabadian, M, Zar, H, Zare, I, Zareshahrabadi, Z, Zarrintan, A, Zastrozhin, M, Zeng, W, Zhang, M, Zhang, Z, Zhong, C, Zoladl, M, Zumla, A, Lim, S, Vos, T, Naghavi, M, Brauer, M, Hay, S, Murray, C, HUS Comprehensive Cancer Center, and Department of Oncology
Subjects: Adult, Male, Global Health, Time, Global Burden of Disease, SDG 3 - Good Health and Well-being, Risk Factors, RA0421, RA0421 Public health. Hygiene. Preventive Medicine, Humans, Ambient air-quality, Child, Respiratory Tract Infections, Aged, Aged, 80 and over, MCC, Sex Characteristics, Malnutrition, Pyridinolcarbamate, Bayes Theorem, 3rd-DAS, 3142 Public health care science, environmental and occupational health, Infectious Diseases, 3121 General medicine, internal medicine and other clinical medicine, Child, Preschool, Female, Particulate Matter, Quality-Adjusted Life Years, Covid-19, LRI
Abstract: Funding: Bill & Melinda Gates Foundation. Background: The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. Methods: In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466–469, 470.0, 480–482.8, 483.0–483.9, 484.1–484.2, 484.6–484.7, and 487–489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4–B97.6, J09–J15.8, J16–J16.9, J20–J21.9, J91.0, P23.0–P23.4, and U04–U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age–sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age–sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. Findings: Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240–275) LRI incident episodes in males and 232 million (217–248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18–1·42) male deaths and 1·20 million (1·07–1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16–1·18) and 1·31 times (95% UI 1·23–1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4–131·1]) and deaths (100·0% [83·4–115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (–70·7% [–77·2 to –61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7–61·8] in males and 56·4% [40·7–65·1] in females), and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6–35·5] for males and PAF 25·8% [16·3–35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4–25·2) in those aged 15–49 years, 30·5% (24·1–36·9) in those aged 50–69 years, and 21·9% (16·8–27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5–27·9) in those aged 15–49 years and 18·2% (12·5–24·5) in those aged 50–69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2–15·8) of LRI deaths. Interpretation: The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities. Publisher PDF
Published: 2022

34. Does the phaco TIp position during clear corneal Phacoemulsification Surgery adversely affect corneal endothelium? TIPS study protocol for a randomised, triple-masked, parallel-group trial of bevel-up versus bevel-down phacoemulsification

Author: John Buchan, Krishna Prasad Kudlu, Soujanya Kaup, Chinnappa Ajjinicanda Ganapathi, Cynthia Arunachalam, Suresh K Pandey, and Siddharudha Shivalli
Subjects: Corneal endothelium, medicine.medical_specialty, genetic structures, business.industry, medicine.medical_treatment, Visual impairment, Pseudoexfoliation syndrome, Medicine (miscellaneous), Phacoemulsification, Cataract surgery, medicine.disease, eye diseases, Bevel, General Biochemistry, Genetics and Molecular Biology, Surgery, Clinical trial, 03 medical and health sciences, 0302 clinical medicine, 030221 ophthalmology & optometry, medicine, 030212 general & internal medicine, medicine.symptom, business, Tip position
Abstract: Introduction: Globally, at least 30 million cataract surgeries are required annually to prevent cataract-related blindness. Corneal endothelial decompensation is one of the most common causes of poor visual outcome following cataract surgery, particularly in those with predisposing factors. The increasing ageing population and reduced visual impairment threshold for cataract surgery have resulted in rising cataract surgical rates and hence, an increase in corneal endothelial decompensation is expected. The role of phaco tip position on corneal endothelial damage is ambiguous. Previous studies have reported contradictory results and were also underpowered to detect a significant difference due to small sample sizes. With no consensus regarding the most cornea-friendly phaco tip position (bevel-up versus bevel-down) during phacoemulsification, we propose a randomised clinical trial with a robust design using direct chop phaco-technique. Objective: To compare the effect of phaco tip position (bevel-up vs. bevel-down) on corneal endothelial cell count during phacoemulsification. Methods: A randomised, multicentre, parallel-group, triple-masked (participant, outcome assessor, and statistician) trial with 1:1 allocation ratio is proposed. By adopting stratified randomisation (according to cataract grade), we will randomly allocate 480 patients aged >18 years with immature cataract into bevel-up and bevel-down groups at two centres. History of significant ocular trauma, previous intraocular surgery, shallow anterior chamber, low endothelial cell count, pseudoexfoliation syndrome, intraocular inflammation, and corneal endothelial dystrophy are the key exclusion criteria. The primary outcome is postoperative endothelial cell count at one month. Secondary outcomes are central corneal thickness on postoperative days 1, 15, and 30, and intraoperative complications. Trial registration: Clinical Trial Registry of India CTRI/2019/02/017464 (05/02/2019).
Published: 2023
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35. Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019: A systematic analysis from the Global Burden of Disease Study 2019

Author: Mohsen Naghavi, Saman Esmaeilnejad, Irena Ilic, Chhabi Lal Ranabhat, Hubert Amu, Jalil Jaafari, Walter Mendoza, Yanzhong Wang, Atta Abbas Naqvi, Mahesh P A, Afshin Maleki, Songhomitra Panda-Jonas, Akila Prashant, Jessica Y Islam, Ali H. Mokdad, Rahmatollah Moradzadeh, Roman Shrestha, Muhammad Naveed, Andre M. N. Renzaho, Santi Martini, Reza Rawassizadeh, Chisom Joyqueenet Akunna, Tudorel Andrei, Jason A. Anderson, Martin McKee, Iffat Elbarazi, Golnaz Heidari, Abdollah Mohammadian-Hafshejani, Soewarta Kosen, Davood Anvari, Randah R. Hamadeh, G. K. Mini, Emerito Jose A. Faraon, Farhad Islami, Yasir Waheed, Fahad Alanezi, Maciej Banach, Sheikh Mohammed Shariful Islam, Ismaeel Yunusa, Suresh Mehata, Tarun Gupta, Mavra A Riaz, Derrick A Bennett, Nithin Kumar, Ali Soroush, Kurt Straif, Muhammad Aziz Rahman, Hasan Yusefzadeh, Avirup Guha, Catalina Liliana Andrei, Muhammed Shahriar Zaman, Arief Hargono, Sandhya Neupane Kandel, Adam E. Berman, Giulia Carreras, Ali Bijani, Christoph Nowak, Rafael Alves Guimarães, Aziz Sheikh, Kamal Hezam, Carlo Eduardo Medina-Solís, Simon I. Hay, Deborah Carvalho Malta, Rahman Shiri, Ashok Pandey, Ramesh Holla, Gyu Ri Kim, Aidin Abedi, Sharath Burugina Nagaraja, Andem Effiong, Samad Azari, Bhaskar Thakur, Mohsen Mazidi, Vahid Yazdi-Feyzabadi, Prashant Mathur, Bay Vo, Robert Ancuceanu, Eun-Kee Park, Mehdi Fazlzadeh, Thomas Hsiao, Richard G Pestell, Sindhura Lakshmi Koulmane Laxminarayana, Doo Woong Lee, Bayew Kelkay, Erkin M. Mirrakhimov, Hualiang Lin, Mohsen Bayati, Florian Fischer, Wei Liu, Stefan Stortecky, Javad Nazari, Fatemeh Pashazadeh Kan, Virginia Núñez-Samudio, Nitish Naik, Sreenivas Narasimha Swamy, Rajat Gupta, Rakhi Dandona, Hermann Brenner, Chandrashekhar T Sreeramareddy, Mohammad Ali Mansournia, Yuichiro Yano, Pankaj Bhardwaj, Samath D Dharmaratne, Constantine I. Vardavas, Gabriela Fernanda Gil, Azeem Majeed, Akram Pourshams, Nachimuthu Senthil Kumar, Florentino Luciano Caetano dos Santos, Juan Sanabria, Iván Landires, Parkes J Kendrick, Dinh-Toi Chu, Asma Tahir Awan, Khem Narayan Pokhrel, Siddharudha Shivalli, Omid Shafaat, Shankar Prasad Nagaraju, Manu Raj Mathur, Rachel L Updike, Mohammad Ebrahimi Kalan, Ryan David Kennedy, Alessandra Lugo, Olalekan A. Uthman, Tarek Tawfik Amin, Jiregna Darega Gela, Zhi-Jiang Zhang, Yeshambel T. Nigatu, Bedanta Roy, Arielle Wilder Eagan, Jalal Arabloo, Milena Ilic, Mehdi Hosseinzadeh, Jost B. Jonas, Dian Kusuma, Shahrzad Bazargan-Hejazi, Yo Han Lee, Mohammed Shannawaz, Mohammad Ali Moni, Valery L. Feigin, Himal Kandel, Lalit Dandona, Milena Santric-Milicevic, Jasvinder A. Singh, Till Bärnighausen, Neeraj Bhala, Sara Sheikhbahaei, Alireza Ansari-Moghaddam, Borhan Mansouri, Narayana Manjunatha, Giuseppe Gorini, Saif Ullah, Sheikh M. Alif, Giang Thu Vu, Ai Koyanagi, Mahaveer Golechha, Ingan Ukur Tarigan, Sumaira Mubarik, Naohiro Yonemoto, Ahmad Ghashghaee, Yves Miel H Zuniga, Bach Xuan Tran, Sorin Hostiuc, Catherine P. Benziger, Ritesh G. Menezes, Leonardo Roever, Xiaochen Dai, Meghnath Dhimal, Medhat Farwati, Chenwen Zhong, Seyed Sina Naghibi Irvani, G Anil Kumar, Jaya Prasad Tripathy, Amirhossein Sahebkar, Simiao Chen, Zubair Kabir, Meseret Derbew Molla, Tilahun Ali, Animut Tagele Tamiru, Negussie Boti Sidemo, Monika Sawhney, Bright Opoku Ahinkorah, Ruxandra Irina Negoi, Segun Emmanuel Ibitoye, Vin Gupta, Mona Pathak, Lorenzo Monasta, Andrew T Olagunju, Nermin Ghith, Nuwan Darshana Wickramasinghe, Kazumasa Yamagishi, Virendra Singh, Takahiro Tabuchi, Gholamreza Roshandel, Andre R. Brunoni, Hayley D. Tymeson, Madhur Verma, Eyayou Girma Tadesse, Adrian Pana, Isabela M. Benseñor, Abdullah Al Mamun, Jianrong Zhang, Hai Quang Pham, Mihaela Hostiuc, Sung-In Jang, Vinay Nangia, Luca Ronfani, Rizwan Suliankatchi Abdulkader, Dhirendra N Sinha, Josip Car, Sohail Ahmad, Rekha Thapar, Salman Rawaf, Joanna L Whisnant, Sanjay Basu, Abdallah M. Samy, Michal Grivna, Zahid A Butt, Abera Getachew Obsa, Mahdi Nalini, Ted R. Miller, Sanjeev Misra, Utsav Parekh, Budi Aji, Saeed Amini, João Pedro Silva, Felix Akpojene Ogbo, Mihajlo Jakovljevic, Demosthenes B. Panagiotakos, Baye Dagnew, Yousef Khader, Atif Amin Baig, Habib Benzian, Keivan Ahmadi, Marco Vacante, Brijesh Sathian, Akshaya Srikanth Bhagavathula, Savita Lasrado, Maryam Khayamzadeh, Darshan B B, Mohammad Rifat Haider, Yonas Akalu, Irmina Maria Michalek, Simone Vidale, Getie Lake Aynalem, Rosa A. S. Couto, Yigizie Yeshaw, Syed Mohamed Aljunid, Pradhum Ram, Shrikant Pawar, Kevin Welding, Suzanne Barker-Collo, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Hiba Jawdat Barqawi, Marcos Roberto Tovani-Palone, K M Shivakumar, Gebiyaw Wudie Tsegaye, Fares Alahdab, Vafa Rahimi-Movaghar, Om P Kurmi, Nataliya Foigt, André Karch, Marina Pinheiro, Basema Saddik, Paschalis Steiropoulos, Chuanhua Yu, Graeme J. Hankey, Panniyammakal Jeemon, Abdul-Aziz Seidu, Ramaiah Itumalla, Befikadu Legesse Wubishet, Vera Marisa Costa, Shanshan Li, Ambrish Singh, Yuming Guo, Reza Malekzadeh, Nikha Bhardwaj, Mikhail Sergeevich Zastrozhin, Maryam Zamanian, Onyema greg Chido-Amajuoyi, Ibtihal Fadhil, Sabina O Nduaguba, Turki Alanzi, Eun-Cheol Park, Nicholas Arian, Salah Eddin Karimi, Parnaz Daneshpajouhnejad, Minale Tareke, Paramjit Gill, Chukwudi A Nnaji, Haroon Ahmed, Irina Filip, Juwel Rana, Aziz Rezapour, Huong Lan Thi Nguyen, Ashish Badiye, Kewal Krishan, Nima Hafezi-Nejad, Masood Ali Shaikh, Tanuj Kanchan, Shilpashree Madhava Kunjathur, Reza Ghanei Gheshlagh, Thomas R. Hird, Yousef Mohammad, Soraya Siabani, Falk Schwendicke, Ziyad Al-Aly, Desta Debalkie Atnafu, Krittika Bhattacharyya, Mika Kivimäki, Ayodipupo Sikiru Oguntade, Zabihollah Yousefi, Neeti Kapoor, Syed Mahboob Shah, Kavumpurathu Raman Thankappan, Mika Shigematsu, Ben Lacey, Ireneous N. Soyiri, Amir Radfar, Lemma Getacher, Sameer Vali Gopalani, David Laith Rawaf, Amir Masoud Rahmani, Birhan Gebresillassie Gebregiorgis, Morenike Oluwatoyin Folayan, Salime Goharinezhad, Ambuj Roy, Ruth W Kimokoti, Nuworza Kugbey, Getinet Ayano, Mohammad Hifz Ur Rahman, Benny Antony, Katrin Burkart, Christopher J L Murray, Khalid F. AlHabib, Mariam Molokhia, Mansour Ghafourifard, Abebaw Alemayehu Desta, Tariku Tesfaye Bekuma, Shailesh Advani, Kiomars Sharafi, Kurnia Dwi Artanti, E S Abhilash, Ejaz Ahmad Khan, Sana Salehi, Dan J. Stein, Pankaj Chaturvedi, Mahmoud A. Alomari, Kawkab Shishani, Dejana Braithwaite, Jung-Chen Chang, Rajeev Gupta, Giovanni Damiani, Maha El Tantawi, Maria Sofia Sofia Cattaruzza, Amir Abdoli, Narayanaswamy Venketasubramanian, Rakibul M Islam, Ibrahim Abdelmageed Ginawi, Victor Aboyans, Ganesh Kumar Saya, Silvano Gallus, João Mauricio Castaldelli-Maia, Vardhmaan Jain, Masoud Foroutan, Janni Leung, Mohammad Abdollahi, Mohammed Zewdu Yimmer, Vahid Alipour, Wondwossen Niguse Asmare, Ravi Prakash Jha, Gerhard Sulo, Brigid Unim, Sheng-Chia Chung, Sadaf G. Sepanlou, Hamed Mirzaei, Anna Aleksandrovna Skryabina, In-Hwan Oh, Rannveig Sigurvinsdottir, Oladimeji Adebayo, Farshad Farzadfar, Anasthasia Zastrozhina, Shafiu Mohammed, Johan Sundström, Ali Kabir, Paolo Lauriola, Tilahun Belete Mossie, Sadia Bibi, Bartosz Miazgowski, Erin C Mullany, Keyvan Pakshir, Srikanta Banerjee, Mowafa Househ, Mohamed M. Gad, Leila R Kalankesh, Mikk Jürisson, Ismail Tareque, Albertino Damasceno, Musliu Adetola Tolani, Andrea Werdecker, Shane D. Morrison, Inga Dora Sigfusdottir, Marcel Ausloos, Monika Arora, Marissa B Reitsma, Filippos Filippidis, Biniyam Sahiledengle Geberemariyam, Bruno Piassi Sao Jose, Leeberk Raja Inbaraj, Antonio Biondi, Mohsen Abbasi-Kangevari, Junjie Huang, Mohammad Mahdi Zamani, Jean Jacques Noubiap, Emmanuela Gakidou, Valentin Yurievich Skryabin, Mayowa O. Owolabi, Shubha Jayaram, Hiroyasu Iso, Charles Ugochukwu Ibeneme, Molly R Nixon, Rachel Feldman, Liliana G Ciobanu, Kristina Edvardsson, Claudiu Herteliu, Andreea Mirica, Kindie Mitiku Kebede, Department of Public Health, Collaborators, GBD 2019 Chewing Tobacco, and Lacey, B
Subjects: Male, Health Status, Smoking Prevention, DETERMINANTS, Global Health, 01 natural sciences, Global Burden of Disease, SMOKELESS TOBACCO, 0302 clinical medicine, Risk Factors, Global health, Prevalence, 030212 general & internal medicine, 610 Medicine & health, RISK, High prevalence, WOMEN, Public Health, Global Health, Social Medicine and Epidemiology, Articles, Middle Aged, 3142 Public health care science, environmental and occupational health, Chewing tobacco, Smokeless tobacco, Population Surveillance, A990 Medicine and Dentistry not elsewhere classified, Female, Quality-Adjusted Life Years, Burden of disease, Adult, medicine.medical_specialty, Tobacco, Smokeless, Adolescent, WHO Framework Convention on Tobacco Control, VALIDATION, 03 medical and health sciences, Young Adult, Age Distribution, SDG 3 - Good Health and Well-being, Environmental health, medicine, Humans, 0101 mathematics, Sex Distribution, Chewing tobacco, Prevalence, Global Burden, Smokeless tobacco, business.industry, Public health, Smoking Tobacco, 010102 general mathematics, Public Health, Environmental and Occupational Health, Global Burden, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, STATES, Socioeconomic Factors, Smoking Cessation, business
Abstract: Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. For complete list of authors see http://dx.doi.org/10.1016/S2468-2667(21)00065-7
Published: 2021
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36. Determinants of healthcare facility utilization for childbirth in Kuantan Singingi regency, Riau province, Indonesia 2017

Author: Siddharudha Shivalli, Tri Yunis Miko Wahyono, and Rajunitrigo Sukirman
Subjects: Adult, medicine.medical_specialty, Adolescent, Mothers, Developing country, Young Adult, 03 medical and health sciences, Delivery place, Healthcare facility, 0302 clinical medicine, Pregnancy, Surveys and Questionnaires, Environmental health, Epidemiology, Health care, medicine, Humans, Childbirth, 030212 general & internal medicine, Developing Countries, Determinants, Epidemiologic, 030219 obstetrics & reproductive medicine, business.industry, lcsh:Public aspects of medicine, Public health, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Prenatal Care, Middle Aged, Patient Acceptance of Health Care, Delivery, Obstetric, medicine.disease, Cross-Sectional Studies, Indonesia, Maternal Death, Female, Health education, Health Facilities, Biostatistics, business, Research Article
Abstract: Background Reducing maternal mortality ratio (MMR) is a high priority public health issue in developing countries such as Indonesia. The current MMR in Indonesia is 126/100,000 live births. Optimum use of available healthcare facilities for delivery can avert maternal deaths. This study aimed to determine the factors associated with healthcare facility utilization for childbirth in Kuantan Singingi regency, Riau province, Indonesia 2017. Methods We conducted a community-based cross-sectional study in 15 sub-districts of Kuantan Singingi regency from May–June 2017. We selected 320 mothers from 15 sub-districts who delivered in the last 3 months (February–April 2017). Trained data enumerators collected the relevant data by using a pre-tested semi-structured questionnaire. We used Cox regression analysis to determine the factors associated with delivery at healthcare facilities. Prevalence Ratio (PR) with a 95% confidence interval (CI) for childbirth at healthcare facilities was the key outcome measure. Results Only 54.4% (174) of the 320 mothers delivered at healthcare facilities. Knowledge about pregnancy danger signs (PR = 1.59, 95%CI:1.15–2.2), attitude towards healthcare services (PR = 0.79, 95%CI:0.33–1.89), and access to health care services (PR = 0.39, 95%CI:0.18–0.84) were the dominant factors of childbirth at healthcare facilities. There was an interaction between attitude and access to healthcare influencing delivery at healthcare facilities. Conclusions Utilization of healthcare facilities for childbirth was low in Kuantan Singingi regency. Knowledge of pregnancy danger signs was an independent correlate of childbirth at healthcare facilities. Also, the interaction between attitude and access to healthcare showed a significant influence on childbirth at healthcare facilities. We recommend strengthening of existing maternal and child health program with a particular emphasis on complete and quality antenatal care, health education on danger signs of pregnancy and childbirth, and promoting positive attitudes towards healthcare facilities.
Published: 2020
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37. Ergonomic practices and musculoskeletal disorders among ophthalmologists in India: An online appraisal

Author: Cynthia Arunachalam, Soujanya Kaup, Siddharudha Shivalli, and Uma Kulkarni
Subjects: Adult, Male, Self Disclosure, India, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Prevalence, Humans, Medicine, Musculoskeletal Diseases, Aged, Medical education, Ophthalmologists, business.industry, Professional development, Human factors and ergonomics, 030229 sport sciences, General Medicine, Middle Aged, Occupational Diseases, Clinical Practice, Ophthalmology, 030221 ophthalmology & optometry, Female, Ergonomics, business
Abstract: Introduction: Ergonomics in ophthalmology is neither taught during professional training nor does it readily receive consideration or priority in clinical practice. Owing to a high prevalence of musculoskeletal disorders among ophthalmologists, ergonomic awareness, and practices are vital in averting this modern epidemic. Objective: To assess the ergonomic practices and prevalence of self-reported musculoskeletal disorders among ophthalmologists in India. Method: An online survey was conducted among ophthalmologists who were registered with the All India Ophthalmological Society of India using a pre-tested and validated questionnaire. Results: The prevalence of self-reported musculoskeletal disorder in the 377 participants was 75.3% (284; 95% confidence interval: 70.6–79.5). Low back pain (149, 52.9%) was the most commonly reported symptom. Musculoskeletal disorder–attributed productivity loss was reported by 58.45% (166) of the respondents. Musculoskeletal disorder was most frequently associated with less than 10 years of work experience (odds ratio: 1.2; 95% confidence interval: 1.1–1.3, p = 0.01) and lack of good clinic (odds ratio: 1.7; 95% confidence interval: 1.1–2.7, p = 0.03) and operation room ergonomic practices (odds ratio: 1.8; 95% confidence interval: 1.1–2.9, p = 0.03). Only 27.9% (105) of the respondents had accessed information related to ergonomics in ophthalmic practice. Conclusion: The self-reported musculoskeletal disorder among ophthalmologists in India is quite high and significant enough to cause some degree of productivity loss. It is thus imperative to emphasize the implementation of good ergonomic practices, especially among relatively young ophthalmologists.
Published: 2018
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38. Combating the COVID-19 pandemic in a resource-constrained setting: insights from initial response in India

Author: Malatesh Undi, Kajal Davara, Sudhir Prabhu, Mihir Prafulbhai Rupani, Sithun Kumar Patro, Shib Sekhar Datta, Nilanjana Ghosh, Akhil Dhanesh Goel, Antony Stanley, Balaji Ramraj, Gaihemlung Pamei, Jasmin Nilima Panda, Shilpa Karir, Satyanarayana G. Konda, Rabbanie Tariq Wani, M Mohan Kumar, Hariom Kumar Solanki, Rashmi Agarwalla, Arvind Kumar Singh, Anirban Chatterjee, Manish Kumar Singh, Ramadass Sathiyamoorthy, Kaushik Sarkar, Harshal Ramesh Salve, Ravi Rohilla, Kapil Yadav, Shubhashri Sudhiendra Jahagirdar, Madhur Verma, Sabyasachi Behera, Shamshad Ahmad, Madan Mohan Majhi, Chinnadurai Aravinda, Nitika Sharma, Sumit Chawla, Rakesh N. Pillai, Dewesh Kumar, Shankar Reddy Dudala, Pritam Roy, Rachana R. Annadani, Paragkumar Chavda, Siddharudha Shivalli, Gitismita Naik, Anuj Mundra, Pallavi Shukla, Manoj Kumar Gupta, Soumya Swaroop Sahoo, Shashanka Shekhar Chakraborty, Santosh K. Yatnatti, Mohan Bairwa, Praveen Kulkarni, Archisman Mohapatra, Jaya Singh Kshatri, Bharti Chawla, Pranab Chatterjee, and Smrutiranjan Nayak
Subjects: 0301 basic medicine, Coronavirus disease 2019 (COVID-19), prevention strategies, 030106 microbiology, Resource constrained, India, control strategies, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, 0302 clinical medicine, Pandemic, Humans, lcsh:RC109-216, 030212 general & internal medicine, Poverty, Environmental planning, lcsh:R5-920, Practice, SARS-CoV-2, Health Policy, public health, Public Health, Environmental and Occupational Health, COVID-19, Health Planning, Geography, Communicable Disease Control, lcsh:Medicine (General), health systems
Abstract: The low-and-middle-income country (LMIC) context is volatile, uncertain and resource-constrained. India, an LMIC, has put up a complex response to the COVID-19 pandemic. Using an analytic approach, we have described India’s response to combat the pandemic during the initial months (from 17 January to 20 April 2020). India issued travel advisories and implemented graded international border controls between January and March 2020. By early March, cases started to surge. States scaled up movement restrictions. On 25 March, India went into a nationwide lockdown to ramp up preparedness. The lockdown uncovered contextual vulnerabilities and stimulated countermeasures. India leveraged existing legal frameworks, institutional mechanisms and administrative provisions to respond to the pandemic. Nevertheless, the cross-sectoral impact of the initial combat was intense and is potentially long-lasting. The country could have further benefited from evidence-based policy and planning attuned to local needs and vulnerabilities. Experience from India offers insights to nations, especially LMICs, on the need to have contextualised pandemic response plans.
Published: 2020
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39. Does mobile phone instructional video demonstrating sputum expectoration improve the sputum sample quality and quantity in presumptive pulmonary TB cases? Protocol for a prospective pragmatic non-randomised controlled trial in Karnataka state, India

Author: Abhay Subhashrao Nirgude, Raveendra Harohally Ramaiah Reddy, Narendra Varun, Amrut Hondappagol, Kibballi Madhukeshwar Akshaya, Siddharudha Shivalli, and Burugina Nagaraja Sharath
Subjects: Adult, medicine.medical_specialty, Tuberculosis, Non-Randomized Controlled Trials as Topic, media_common.quotation_subject, India, instructional video, quantity, law.invention, Patient Education as Topic, Randomized controlled trial, law, Research Methods, Humans, Multicenter Studies as Topic, Medicine, Quality (business), Prospective Studies, Tuberculosis, Pulmonary, media_common, Protocol (science), mobile phone, business.industry, Sputum, Mycobacterium tuberculosis, General Medicine, medicine.disease, Clinical trial, quality, Mobile phone, Family medicine, Feasibility Studies, Smartphone, medicine.symptom, business, pulmonary tuberculosis, Declaration of Helsinki
Abstract: IntroductionSputum smear microscopy is the cornerstone of tuberculosis (TB) diagnosis under the Revised National Tuberculosis Control Programme (RNTCP) in India. Instructions on how to produce a good sputum sample are a part of RNTCP training manuals, but its assessment is not emphasised. Healthcare provider’s instruction to expectorate a good sputum sample has limitations. Presumptive TB patients often submit inadequate (in quantity and/or quality) sputum samples, which may result in false-negative results. Objectives of the study are, among the selected RNTCP designated microscopy centres inDakshina Kannadadistrict, Karnataka, India, (a) to assess the effectiveness of mobile phone instructional video demonstrating sputum expectoration on sputum quality and quantity and (b) to explore the mobile phone video implementation challenges as perceived by the healthcare providers.Methods and analysisThis is a pragmatic, prospective, non-randomised controlled trial in two pairs of RNTCP Designated Microscopy Centres (located at secondary and primary healthcare facilities) ofDakshina Kannadadistrict, India. Presumptive pulmonary TB patients aged ≥18 years will be included. We will exclude who are severely ill, blind, hearing impaired, patients who have already brought their sputum for examination, and transported sputum. In the intervention group, participants will watch a mobile phone instructional video demonstrating submission of an adequate sputum sample. The control group will follow the usual ongoing procedure for sputum submission. This study would require 406 participants for each group to achieve a power of 90% for detecting a difference of 15% between the two groups. The participant enrolment started in December 2019.Ethics and disseminationYenepoya University Ethics Committee, Mangaluru, India, has approved the study protocol (YEC-1/158/2019). It complies with the Declaration of Helsinki, local laws, and the International Council for Harmonization-good clinical practices. Investigators will present the results in scientific forums, publish in a scientific journal, and share with RNTCP officers.Trial registration numberClinical Trial Registry of India (CTRI/2019/06/019887).
Published: 2020
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40. Neck Circumference as an Indicator of Obesity and its Comparison with Body Mass Index and Waist Circumference in Coastal Karnataka

Author: Bhaskaran Unnikrishnan, Siddharudha Shivalli, Prasanna Mithra, Sanjay Kini, Nithin Kumar, Avinash Kumar, and Vaman Kulkarni
Subjects: Neck circumference, Waist, business.industry, Public Health, Environmental and Occupational Health, Area under the curve, Overweight, Anthropometry, Circumference, medicine.disease, Obesity, Medicine, medicine.symptom, business, Body mass index, Demography
Abstract: Background: Neck circumference can be a simple screening tool for measurement of overweight and obesity. The present study aims to depict neck circumference as a valid measurement of obesity and tries to find out its correlation with BMI and waist circumference among young adults in the age group of 20-30 years. Methodology: A community based cross-sectional study was conducted in 6 coastal villages of Udupi taluk, Udupi district, Karnataka, among 750 subjects. A pre-tested, semi structured questionnaire was administered to the study subjects after obtaining their consent. The questionnaire comprised of details on socio-demographic variables and anthropometric measurements. Results: The study showed a strong positive correlation (r) between weight (0.7), waist circumference (0.7) and hip circumference (0.7) with neck circumference among the males, it showed a correlation of (0.6) for all the parameters like weight, waist circumference and hip circumference among the females. ROC analysis showed that the cut off for males at 36.25 cm has a sensitivity of 80% and specificity 77% and the area under the curve is 0.84. Whereas the cutoff for females was found to be 31.75 cm having the sensitivity of 69% and specificity 77% and the area under curve was 0.73. Conclusion: Neck circumference (NC) measurement is simple and time saving screening measure that can be used to identify overweight and obesity. Patients with NC >36.25 cm cm for men and >31.75 cm for women require additional evaluation of overweight/obesity.
Published: 2020
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41. Occupational Exposure to Infection: A study on Healthcare Waste Handlers of a Tertiary Care Hospital in South India

Author: Siddharudha, Shivalli and H, Sowmyashree
Subjects: Adult, Health Knowledge, Attitudes, Practice, Risk Management, Health Personnel, India, Middle Aged, Tertiary Care Centers, Cross-Sectional Studies, Research Design, Occupational Exposure, Humans, Female, Medical Waste Disposal, Workplace, Needs Assessment
Abstract: Occupational exposure to infection is an important public health concern. Such accidents are associated with a few, but pose significant risk to worker’s health, family and the community. Objectives: 1) To assess the knowledge and attitude of waste handlers regarding healthcare waste management in tertiary care hospital of Mangalore. 2) To assess the occupational risk of exposure to infection in their work settinA cross-sectional study was conducted among healthcare waste handlers (involved in collection, storage and safe disposal) in a tertiary care hospital of Mangalore, India. A semi-structured and pre-tested proforma was used to assess respondents’ knowledge and percentage score was calculated based on a scoring system. Chi square and independent sample t tests were applied to judge the association of study variables with knowledge and occupational risk of infection.A total of 43 healthcare waste handlers participated in the study and all were females. Almost half of them had poor knowledge (50% score) about healthcare waste management. As much as 41.8% of them had exposure to healthcare waste and ‘needle stick injury’ was the most common type. Age, literacy and experience did not significantly (p0.05) influence the knowledge and occupational risk of infection. Conclusion: Respondents’ knowledge regarding healthcare waste management was unsatisfactory. They were at high risk of occupational exposure to infection. It emphasizes the need of refresher training and reinforcement of personal protection measures in their work setting.
Published: 2018

42. Factors associated with pasung (physical restraint and confinement) of schizophrenia patients in Bogor regency, West Java Province, Indonesia 2017

Author: Tri Krianto, Siddharudha Shivalli, Nenden Hikmah Laila, Krisnawati Bantas, and Renti Mahkota
Subjects: Adult, Hospitals, Psychiatric, Male, Mental Health Services, Restraint, Physical, Aggressive, medicine.medical_specialty, lcsh:RC435-571, media_common.quotation_subject, Population, Discourse, Logistic regression, 03 medical and health sciences, Social support, Young Adult, 0302 clinical medicine, Pasung, lcsh:Psychiatry, medicine, Humans, 030212 general & internal medicine, education, Psychiatry, media_common, education.field_of_study, Middle Aged, medicine.disease, Mental health, 030227 psychiatry, Psychiatry and Mental health, Schizophrenia, Indonesia, Case-Control Studies, Unemployment, Violent, Health education, Female, Schizophrenic Psychology, Family Relations, Rural area, Psychology, Research Article
Abstract: Background Schizophrenia is a chronic mental disorder affecting more than 21 million worldwide. In Indonesia, 14.3% of households have a patient with a mental disorder, and the majority of these are in rural areas. Family members in Indonesia use repressive social measures like pasung (physical restraint and confinement) for these patients. A study was conducted with the objective to determine the factors associated with pasung among patients with schizophrenia in Bogor Regency, West Java Province, Indonesia 2017. Methods A case-control study was conducted in Bogor Regency from May–June 2017. A case subject was defined as a patient with schizophrenia who was ever subjected to pasung and a control subject was defined as a patient with schizophrenia residing in the same geographical area and never subjected to pasung. Multi-stage sampling was used to select case and control subjects from the registered reports of the Health Service of Bogor Regency (2012–16) in 34 sub districts and 59 health centers. Multivariate logistic regression was used to identify the factors associated with pasung. Attributable and population attributable risks (AR, PAR) for pasung were calculated. Results A total of 114 case and 136 control subjects were studied. Patient’s aggressive or violent behavior (AdjOR: 4.49, 95%CI: 2.52–8.0), unemployment (AdjOR: 2.74, 95%CI: 1.09–6.9) and informal employment (AdjOR: 2.5, 95%CI: 1.1–5.84) in the family and negative attitude of the family towards the patient (AdjOR: 2.52, 95%CI: 1.43–4.43) were associated with pasung. Patient’s aggressive or violent behavior (PAR = 44.3%) and unemployment in the family (PAR = 49.3%) were the predominant factors of pasung. Conclusions Patient’s aggressive or violent behavior, negative attitude of the family towards the patient and unemployment in the family were associated with pasung. We recommend health education and encouraging family members to shift patients with schizophrenia exhibiting aggressive or violent behavior to a mental health facility. Strengthening of basic mental health services and involving family members while treating patients with schizophrenia to develop positive attitudes could be considered. Creating employment opportunities and a social support system for treated patients with schizophrenia and family members could further avert pasung.
Published: 2018

43. Age at diagnosis predicted survival outcome of female patients with breast cancer at a tertiary hospital in Yogyakarta, Indonesia

Author: Susanna Hilda Hutajulu, Riris Andono Ahmad, Evi Susanti Sinaga, and Siddharudha Shivalli
Subjects: medicine.medical_specialty, Age at diagnosis, Breast Neoplasms, Kaplan-Meier Estimate, Cohort Studies, Tertiary Care Centers, Breast cancer, Internal medicine, Female patient, medicine, Humans, Pathological, Survival analysis, Neoplasm Staging, Retrospective Studies, Proportional hazards model, business.industry, Research, Age Factors, five-year overall survival, Cancer, Retrospective cohort study, General Medicine, Middle Aged, Prognosis, medicine.disease, Survival Rate, age, Indonesia, Multivariate Analysis, Educational Status, Female, business
Abstract: INTRODUCTION: Breast cancer is the most common cancer in women in Indonesia. Patients’ survival depends on various factors, namely patient-, tumor-, and treatment-related factors. Survival analysis on Indonesian patients has only been reported in a few studies. This study aimed to identify the factors that are associated with five-year overall survival (OS) among patients with breast cancer at a local tertiary hospital in Indonesia. METHODS: A retrospective cohort study was conducted at Dr Sardjito Hospital, Yogyakarta. Female patients diagnosed with breast cancer between January and December 2009 were studied. Socio-demographic and clinicopathological data were collected from the medical and pathological records. The five-year OS rate was assessed using Kaplan Meier method and prognostic factors were analyzed using Cox regression. RESULTS: A total of 213 eligible patients with breast cancer were recruited. The five-year OS probability of the breast cancer patient was 51.07%. The majority of the patients (151, 70.9%) presented an advanced stage at the time of diagnosis. In the bi-variable analysis, cases who were younger, of a lower educational status, at a more advanced stage, with a bigger tumor size, and a central tumor location showed a worse five-year OS compared to their counterparts (p = 0.005, 0.001, 0.004, 0.011, and 0.023, respectively). In the multivariable analysis, age was an independent predictor for the OS (HR = 3.73; 95% CI = 1.0-13.6, p = 0.046). CONCLUSION: The five-year OS of breast cancer patients in the local tertiary hospital was 51.07%. The patients’ age at diagnosis was the only significant prognostic factor for the patients’ survival.
Published: 2018
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44. Occupational exposure to unburnt tobacco and potential risk of toxic optic neuropathy: A cross-sectional study among beedi rollers in selected rural areas of coastal Karnataka, India

Author: Siddharudha Shivalli, Cynthia Arunachalam, Ansaba Naseer, and Soujanya Kaup
Subjects: Male, Rural Population, Time Factors, Toxic optic neuropathy, Vision, Cross-sectional study, Visual Acuity, Social Sciences, lcsh:Medicine, Occupational safety and health, Geographical Locations, Endocrinology, 0302 clinical medicine, Sociology, Risk Factors, Medicine and Health Sciences, Psychology, Medicine, 030212 general & internal medicine, lcsh:Science, Geographic Areas, Multidisciplinary, Geography, Age Factors, Middle Aged, Neurology, Research Design, Social Systems, Sensory Perception, Female, Occupational exposure, Research Article, Adult, Asia, Optic Neuritis, Endocrine Disorders, Optic Neuropathy, India, Research and Analysis Methods, Contrast Sensitivity, 03 medical and health sciences, Occupational Exposure, Environmental health, Tobacco, Diabetes Mellitus, Humans, Risk factor, Color Vision, Potential risk, business.industry, lcsh:R, Biology and Life Sciences, Rural Areas, Neuropathy, Cross-Sectional Studies, Increased risk, Metabolic Disorders, People and Places, Earth Sciences, 030221 ophthalmology & optometry, Optometry, lcsh:Q, Rural area, business, Neuroscience
Abstract: BACKGROUND: Beedi also known as poor man's cigarette is manufactured in almost all major states of India. Beedi workers are exposed to various health risks. There is an increased risk of systemic absorption of tobacco through skin and mucous membrane. The optic nerve is susceptible to damage from several toxic substances including tobacco. This group of disorders is known as toxic optic neuropathy (TON). The association of TON with occupational exposure to unburnt tobacco in beedi rollers has not been explored. OBJECTIVES: Among the beedi rollers in Mangaluru and Bantwal talukas of Dakshina Kannada District, Karnataka, India: to assess the magnitude of potential TON utilizing colour vision and contrast sensitivity as screening tools and to identify the demographic, biological and occupational factors associated with potential TON. METHODS: A community-based cross-sectional study was conducted from April-Sept 2016 in Mangaluru and Bantwal talukas, of Dakshina Kannada district, Karnataka. Beedi rollers from twelve villages (six from each taluka) were included. In each of the selected villages, the investigators identified beedi collection centres and all the eligible beedi rollers were included in the study till the required number of beedi rollers for that village was achieved. Participants were screened at the study site for visual acuity, colour vision and contrast sensitivity and those with abnormal colour and contrast sensitivity in the presence of good visual acuity were considered to have potential TON. RESULTS: A total of 377 beedi rollers were approached; of which 365 consented to take part in the study (response rate: 96.81%). Women constituted the majority of the participants (n = 338, 92.6%). Based on the screening criteria, the prevalence of potential TON was 17.5% (n = 64, 95% CI: 13.5-21.9). On multiple logistic regression analysis, duration of beedi rolling (Adj OR: 1.061; 95% CI 1.015-1.109, p = 0.009), advancing age (Adj OR: 1.096; 95% CI 1.058-1.136, p
Published: 2017

45. Perceptions about

Author: Siddharudha Shivalli, Nenden Hikmah Laila, Tri Krianto, and Renti Mahkota
Subjects: Interview, Social stigma, Health Policy, Schizophrenia (object-oriented programming), Research, Public Health, Environmental and Occupational Health, Exploratory research, Mental health, 030227 psychiatry, Health administration, lcsh:RC321-571, 03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, Pasung, Nursing, Schizophrenia, Health education, 030212 general & internal medicine, Pshychiatric Mental Health, Psychology, Qualitative, lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry, Qualitative research
Abstract: Background The UN resolution recommends treating all mentally ill patients with humanity and respect. However, social stigma continues to prevail for patients with schizophrenia. Physical restraint and confinement of the mentally ill is a well-known phenomenon in Indonesia and is termed as pasung. Objective To explore the perceptions of family members of patients of schizophrenia and other key stakeholders concerning pasung in Bogor Regency, West Java Province 2017. Methods This qualitative exploratory study was conducted in Bogor Regency, West Java Province from May to June 2017. This study involved 12 key stakeholders including family members, neighbors, community leaders, and mental health officers. In-depth interviews were conducted with family members (n = 3) who practiced pasung for patients with schizophrenia and key informant interviews of neighbors, community leaders (two household heads and one from a health cadre) (n = 3) and mental health officers of puskesmas (three midwives). Data triangulation was performed by interviewing residents and mental health workers. Content analysis was conducted and themes were identified based on valid inference and interpretation. Results Family members and society in general perceived that pasung is necessary for security reasons due to the patient’s aggressive behavior such as physical violence to neighbors, stealing food etc. According to community leaders, families often do not respond to patient’s request to be released from pasung. Family members had financial constraints to seek mental healthcare and were also dissatisfied with available services. Healthcare providers highlighted the poor knowledge and prevailing misconceptions about schizophrenia in the community. Conclusion Concurrent efforts to strengthen basic mental health services and health education regarding schizophrenia, prevalent misconceptions, and importance of timely and appropriate treatment are needed, especially in rural settings.
Published: 2017

46. Birth preparedness and complication readiness among the women beneficiaries of selected rural primary health centers of Dakshina Kannada district, Karnataka, India

Author: Siddharudha Shivalli and Kibballi Madhukeshwar Akshaya
Subjects: Cross-sectional study, Economics, Maternal Health, lcsh:Medicine, Social Sciences, Academic Skills, Geographical Locations, Labor and Delivery, 0302 clinical medicine, Sociology, Pregnancy, Health care, Medicine and Health Sciences, Childbirth, Psychology, 030212 general & internal medicine, lcsh:Science, 030219 obstetrics & reproductive medicine, Multidisciplinary, Schools, Obstetrics and Gynecology, Obstetric labor complication, Female, Research Article, Adult, medicine.medical_specialty, Asia, Adolescent, Exit interview, India, Education, 03 medical and health sciences, Young Adult, Health Economics, Nursing, Literacy, Antenatal Care, medicine, Humans, Socioeconomic status, Health economics, National Rural Health Mission, business.industry, lcsh:R, Cognitive Psychology, Biology and Life Sciences, medicine.disease, Delivery, Obstetric, Obstetric Labor Complications, Health Care, Cross-Sectional Studies, Family medicine, People and Places, Birth, Women's Health, Cognitive Science, lcsh:Q, Rural Health Services, business, Neuroscience
Abstract: INTRODUCTION: Birth preparedness and complication readiness (BPCR) is a strategy to promote timely use of skilled maternal and neonatal care during childbirth. According to World Health Organization, BPCR should be a key component of focused antenatal care. Dakshina Kannada, a coastal district of Karnataka state, is categorized as a high-performing district (institutional delivery rate >25%) under the National Rural Health Mission. However, a substantial proportion of women in the district experience complications during pregnancy (58.3%), childbirth (45.7%), and postnatal (17.4%) period. There is a paucity of data on BPCR practice and the factors associated with it in the district. Exploring this would be of great use in the evidence-based fine-tuning of ongoing maternal and child health interventions. OBJECTIVE: To assess BPCR practice and the factors associated with it among the beneficiaries of two rural Primary Health Centers (PHCs) of Dakshina Kannada district, Karnataka, India. METHODS: A facility-based cross-sectional study was conducted among 217 pregnant (>28 weeks of gestation) and recently delivered (in the last 6 months) women in two randomly selected PHCs from June -September 2013. Exit interviews were conducted using a pre-designed semi-structured interview schedule. Information regarding socio-demographic profile, obstetric variables, and knowledge of key danger signs was collected. BPCR included information on five key components: identified the place of delivery, saved money to pay for expenses, mode of transport identified, identified a birth companion, and arranged a blood donor if the need arises. In this study, a woman who recalled at least two key danger signs in each of the three phases, i.e., pregnancy, childbirth, and postpartum (total six) was considered as knowledgeable on key danger signs. Optimal BPCR practice was defined as following at least three out of five key components of BPCR. OUTCOME MEASURES: Proportion, Odds ratio, and adjusted Odds ratio (adj OR) for optimal BPCR practice. RESULTS: A total of 184 women completed the exit interview (mean age: 26.9±3.9 years). Optimal BPCR practice was observed in 79.3% (95% CI: 73.5-85.2%) of the women. Multivariate logistic regression revealed that age >26 years (adj OR = 2.97; 95%CI: 1.15-7.7), economic status of above poverty line (adj OR = 4.3; 95%CI: 1.12-16.5), awareness of minimum two key danger signs in each of the three phases, i.e., pregnancy, childbirth, and postpartum (adj OR = 3.98; 95%CI: 1.4-11.1), preference to private health sector for antenatal care/delivery (adj OR = 2.9; 95%CI: 1.1-8.01), and woman's discussion about the BPCR with her family members (adj OR = 3.4; 95%CI: 1.1-10.4) as the significant factors associated with optimal BPCR practice. CONCLUSION: In this study population, BPCR practice was better than other studies reported from India. Healthcare workers at the grassroots should be encouraged to involve women's family members while explaining BPCR and key danger signs with a special emphasis on young (
Published: 2017

47. Occupational Exposure to HIV: Perceptions and Preventive Practices of Indian Nursing Students

Author: Siddharudha Shivalli
Subjects: medicine.medical_specialty, Article Subject, business.industry, lcsh:Public aspects of medicine, media_common.quotation_subject, Alternative medicine, Human immunodeficiency virus (HIV), lcsh:RA1-1270, General Medicine, medicine.disease_cause, Pro forma, Nursing, Universal precautions, Perception, medicine, Occupational exposure, Hiv transmission, business, Close contact, Research Article, media_common
Abstract: Introduction. Nurses have a frontier caring role that brings them in close contact with patients' blood and body fluids. An understanding of their professional behavior is essential to assess and minimize the occupational exposure to HIV among them.Objectives. (1) To appraise the knowledge, attitudes, and preventive practices of nursing students pertaining to occupational exposure to HIV. (2) To quantify the risk and correlates of exposure to HIV among them.Methodology. Cross-sectional study was conducted in a nursing college of Varanasi, India. A semistructured and pretested pro forma consisting of questions pertaining to modes of HIV transmission, universal precaution practices, and various aspects of nursing HIV patients was utilized. Independent samplet- andz-tests were applied to judge the association of study variables with the knowledge and risk of HIV.Results. The study sample consisted of 87 female and 16 male nurses. Participants' knowledge of HIV transmission was satisfactory. More than 80% of them had an exposure to blood/body fluid in the last year. Exposure rates for blood/body fluid did not show a significant associationP>0.05with study variables.Conclusion. There were serious lacunae in implementation of the universal precautions despite satisfactory knowledge. Reinforcement of universal precautions is required.
Published: 2014
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48. Comment on 'Serological Evidence of Scrub Typhus among Cases of PUO in the Kashmir Valley- A Hospital Based Study'

Author: Siddharudha Shivalli and Bhuvanesh Sukhlal Kalal
Subjects: medicine.medical_specialty, business.industry, lcsh:R, Clinical Biochemistry, lcsh:Medicine, Serological evidence, Microbiology Section, General Medicine, Scrub typhus, medicine.disease, Surgery, Hospital based study, Family medicine, Medicine, business
Published: 2016

49. Clinical and paraclinical profile, and predictors of outcome in 90 cases of scrub typhus, Meghalaya, India

Author: Sunuraj Sivarajan, Rittwick Barman, Siddharudha Shivalli, Michael Mawlong, and Debomallya Bhuyan
Subjects: 0301 basic medicine, Adult, Male, medicine.medical_specialty, Adolescent, 030231 tropical medicine, 030106 microbiology, India, Scrub typhus, Logistic regression, Communicable Diseases, Emerging, 03 medical and health sciences, Young Adult, Hospital, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, Longitudinal Studies, Mortality, Aged, Multiple Organ Dysfunction Syndrome (MODS), Rapid diagnostic test, business.industry, Public Health, Environmental and Occupational Health, Outbreak, General Medicine, Middle Aged, medicine.disease, bacterial infections and mycoses, Confidence interval, Surgery, Orientia tsutsugamushi, Infectious Diseases, Logistic Models, Scrub Typhus, Relative risk, Tropical medicine, Longitudinal, Female, Multiple organ dysfunction syndrome, business, Research Article
Abstract: Background India is an integral component of “tsutsugamushi triangle” which depicts a part of the globe endemic to scrub typhus. Owing to frequent outbreaks witnessed in different parts of the country in the recent past, scrub typhus is described as a re-emerging infectious disease in India. The present study aimed to study the clinical and paraclinical profile, complications and predictors of outcome among 90 cases of scrub typhus diagnosed in a hospital of north-eastern India from Sept 2011 to Aug 2012. Methods A longitudinal study was conducted in a hospital of Meghalaya, India between Sept 2011 and Aug 2012. Diagnosis of scrub typhus was arrived by SD BIOLINE tsutsugamushi (solid phase immunochromatographic assay) rapid diagnostic test for antibodies (IgM, IgG or IgA). Descriptive analyses of age, gender, geographic area, symptoms and signs, treatment, laboratory findings, complications, and outcome were conducted. Relative risk (RR) with 95 % confidence interval (CI) was computed for Multiple Organ Dysfunction Syndrome (MODS) and mortality. Binary logistic regression was applied to the significant correlates (P 1.5 mg/dl, and transaminase (AST, ALT or both) >500 U/L were associated with MODS (P 3 mg/dl was also associated with MODS (P 1.5 mg/dl was a predictor of MODS (OR: 76.1, 95 % CI: 4.9–1175.6) and mortality (OR: 18.03, 95 % CI: 1.38–235.1). Conclusion In this study setting, approximately one-seventh (13.6 %) of the acute undifferentiated febrile illness were due to scrub typhus. Systemic complications were common (33.3 %). Serum creatinine >1.5 mg/dl was a predictor of MODS and mortality. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0186-x) contains supplementary material, which is available to authorized users.
Published: 2016

50. Comment on: Role of subconjunctival bevacizumab in primary pterygium surgery

Author: Soujanya Kaup and Siddharudha Shivalli
Subjects: Adult, Male, Vascular Endothelial Growth Factor A, medicine.medical_specialty, Conjunctiva, Bevacizumab, Adolescent, Pterygium surgery, Treatment outcome, MEDLINE, India, Angiogenesis Inhibitors, Ophthalmologic Surgical Procedures, Antibodies, Monoclonal, Humanized, Transplantation, Autologous, Surgical Flaps, lcsh:Ophthalmology, Double-Blind Method, Recurrence, Medicine, Humans, Prospective Studies, pterygium, Letters to the Editor, subconjuctival, business.industry, Corneal Topography, Middle Aged, medicine.disease, Dermatology, Combined Modality Therapy, eye diseases, Pterygium, Ophthalmology, medicine.anatomical_structure, Treatment Outcome, lcsh:RE1-994, Monoclonal, Female, Original Article, sense organs, Injections, Intraocular, business, Ophthalmologic Surgical Procedure, medicine.drug
Abstract: Background: Pterygium is an ocular surface disorder with prevalence rates ranges from 0.3% to 29% in different parts of the world. Vascular endothelial growth factor (VEGF) has been detected in increased amounts in pterygium epithelium, compared with normal conjunctiva. Bevacizumab is a recombinant, humanized anti-VEGF antibody suggested as a possible adjunctive therapy for pterygium excision that appears to have a role in prevention of recurrence. We conducted this study to evaluate the role of subconjunctival bevacizumab in primary pterygium surgery in Indian patients. Methods: In this randomized prospective clinical study, the patients were randomized into two groups of 30 patients each. Study group received 1.25 mg/0.05 ml subconjunctival bevacizumab 1 week before pterygium surgery with conjunctival autograft. Control group received 1.25 mg (0.05 ml) subconjunctival normal saline 1 week prior to pterygium surgery with conjunctival autograft. Patients were followed up at day 1, day 7, 1 month and 3 months. The main outcome measures were morphology of pterygium after injection, intra-operative ease, recurrence of pterygia, and any complications. Results: After giving bevacizumab, there was statistically significant improvement in grade, color intensity, size of pterygium, and symptoms of patients. Intra-operatively, less bleeding was observed by the surgeon. No statistically significant difference regarding reduction in astigmatism, improvement of visual acuity, and complications were observed in two groups. Recurrence was noted in five patients (8.33%) in total study population at the end of 3 months. It was present in two patients (6.67%) in Group A and three patients (10%) in Group B. Conclusion: Single preoperative administration of subconjunctival injection bevacizumab given 1 week before the pterygium excision with conjunctival autograft decreases the vascularity of newly formed blood vessels, hence may decrease recurrence rate though not in our study.
Published: 2016

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