Deworming and micronutrient status by community open defecation prevalence: An observational study using nationally representative data from India, 2016-2018

BACKGROUND

Micronutrient deficiencies are widespread in India. Soil-transmitted helminth (STH) infections are acquired by interaction with soil and water contaminated by human feces and lead to blood loss and poor micronutrient absorption. The current recommendation for control of STH-related morbidity is targeted deworming, yet little is known about the effectiveness of deworming on micronutrient status in varying sanitation contexts. Ranging between 1% and 40% prevalence across Indian states, open defecation (OD) remains high despite India's investments at elimination by promoting community-wide sanitation. This variation provides an opportunity to study the relationship between deworming, micronutrient status, and OD at-scale.

METHODS AND FINDINGS

Cross-sectional datasets that were representative for India were obtained the Comprehensive National Nutrition Survey in 2016 to 2018 (n = 105,060 individuals aged 1 to 19 years). Consumption of deworming medication was described by age and community OD level. Logistic regression models were used to examine the relationship between deworming, cluster OD, and their interactions, with anemia and micronutrient deficiencies (iron, zinc, vitamin A, folate, and vitamin B12), controlling for age, sex, wealth, diet, and seasonality. These regression models further allowed us to identify a minimum OD rate after which deworming becomes ineffective. In sensitivity analyses, the association between deworming and deficiencies were tested in subsamples of communities classified into 3 OD levels based on statistical tertiles: OD free (0% of households in the community practicing OD), moderate OD (>0% and <30%), or high OD (at least 30%). Average deworming coverage and OD prevalence in the sample were 43.4% [IQR 26.0, 59.0] and 19.1% [IQR 0, 28.5], respectively. Controlling for other determinants of nutritional status, adolescents living in communities with higher OD levels had lower coverage of deworming and higher prevalence of anemia, zinc, vitamin A, and B12 deficiencies. Compared to those who were not dewormed, dewormed children and adolescents had lower odds of anemia (adjusted odds ratio 0.72, (95% CI [0.67, 0.78], p < 0.001) and deficiencies of iron 0.78, (95% CI [0.74, 0.82], p < 0.001) and folate 0.69, (95% CI [0.64,0.74], p<0.001)) in OD free communities. These protective effects remained significant for anemia but diminished for other micronutrient deficiencies in communities with moderate or high OD. Analysis of community OD indicated a threshold range of 30% to 60%, above which targeted deworming was no longer significantly associated with lower anemia, iron, and folate deficiency. The primary limitations of the study included potential for omitted variables bias and inability to capture longitudinal effects.

CONCLUSIONS

Moderate to high rates of OD significantly modify the association between deworming and micronutrient status in India. Public health policy could involve sequencing interventions, with focus on improving deworming coverage in communities that have achieved minimum thresholds of OD and re- triggering sanitation interventions in high OD communities prior to deworming days, ensuring high coverage for both. The efficacy of micronutrient supplementation as a complementary strategy to improve nutritional outcomes alongside deworming and OD elimination in this age group needs further study.

Utilization of Integrated Child Development Services (ICDS) and its linkages with undernutrition in India

The Integrated Child Development Services (ICDS) programme has been the central focus of the POSHAN Abhiyaan to combat maternal and child malnutrition under the national nutrition mission in India. This paper examined the linkages between utilization of ICDS and underweight among children aged 6-59 months. The study utilized data from two recent rounds of the National Family Health Survey (NFHS-4 [2015-2016] and NFHS-5 [2019-2021]). Descriptive analyses were used to assess the change in utilization of ICDS and the prevalence of underweight at the national and state levels. Multivariable logistic regressions were performed to examine factors associated with the utilization of ICDS and underweight. Linkages between utilization of ICDS and underweight were examined using the difference-in-differences (DID) approach. Utilization of ICDS increased from 58% in 2015-2016 to 71% in 2019-2021. The prevalence of underweight decreased from 37% to 32% in the same period. Changes in ICDS utilization and underweight prevalence varied considerably across states, socioeconomic and demographic characteristics. Results from decomposition of DID models suggest that improvements in ICDS explained 9%-12% of the observed reduction in underweight children between 2016 and 2021, suggesting that ICDS made a modest but meaningful contribution in addressing undernutrition among children aged 6-59 months in this period.

Missing Black males among preterm births in the US, 1995 to 2019

BACKGROUND

In the US, non-Hispanic (NH) Black birthing persons show a two-fold greater risk of fetal death relative to NH white birthing persons. Since males more than females show a greater risk of fetal death, such loss in utero may affect the sex composition of live births born preterm (PTB; <37 weeks gestational age). We examine US birth data from 1995 to 2019 to determine whether the ratio of male to female preterm (i.e., PTB sex ratios) among NH Black births falls below that of NH whites and Hispanics.

METHODS

We acquired data on all live births in the US from January 1995 to December 2019. We arrayed 63 million live births into 293 "conception cohort" months of which 2,475,928 NH Black, 5,746,953 NH white, and 2,511,450 Hispanic infants were PTB. We used linear regression methods to identify trend and seasonal patterns in PTB sex ratios. We also examined subgroup differences in PTB sex ratios (e.g., advanced maternal ages, twin gestations, and narrower gestational age ranges).

RESULTS

The mean PTB sex ratio for NH Black births over the entire test period (1.06, 95% Confidence Interval [CI]: 1.05, 1.07) is much lower than that for NH white births (1.18, 95% CI: 1.17, 1.19). NH Black PTB sex ratios are especially low for twins and for births to mothers 35 years or older. Only NH white PTB sex ratios show a trend over the test period.

CONCLUSIONS

Analysis of over 10 million PTBs reveals a persistently low male PTB frequency among NH Black conception cohorts relative to NH white cohorts. Low PTB sex ratios among NH Black births concentrate among subgroups that show an elevated risk of fetal death. PTB sex ratios may serve as an indicator of racial/ethnic and subgroup differences in fetal death, especially among male gestations.

Down-conversion luminescence nanocomposites based on nitrogen-doped carbon quantum dots@bioplastic for applications in optical displays, LEDs and UVC tubes

Carbon quantum dots (CQDs)-based composites as luminous down-conversion materials are becoming more popular due to several advantages such as steady fluorescence, ease of functionalization, tailoring of emission in the visible range, and so on. We report an inexpensive and environmentally sustainable synthesis of fluorescent nitrogen doped-CQDs produced from Cissus quadrangularis, a low-cost plant precursor with therapeutic value. The morphological, structural, and physicochemical features of the material were carefully investigated. Under UV stimulation (365 nm), almost spherical shaped N-CQDs with an average diameter of 5.1 nm were discovered to generate yellow-green fluorescence, have excellent photostability, and strong water solubility, with a quantum yield of up to 5 %. Furthermore, as a solid-phase dispersion matrix for CQDs, ecologically friendly and biodegradable bioplastic is appealing. The down-conversion of solid-state fluorescence of LEDs and UVC tubes was demonstrated by creating a nanocomposite by inserting N-CQDs into the solid matrix of a wheat starch-based bioplastic. Furthermore, employing constructed quantum dot-based optical displays, down-converted LEDs, and UVC tubes, the impacts of varied CQD concentrations and pH sensitivity were examined.

Disparities in preterm birth following the July 1995 Chicago heat wave

PURPOSE

To evaluate if changes in preterm birth (PTB, <37 weeks of gestation) incidence differed between non-Hispanic (NH) Black and NH white births following the July 1995 Chicago heat wave-among the most severe U.S. heat waves since 1950.

METHODS

We used an ecologic study design. We obtained birth data from January 1990-December 1996 from the National Vital Statistics File to calculate the mean monthly PTB incidence in Chicago's Cook County, Illinois. Births between July 1995 and February 1996 were potentially exposed to the heat wave in utero. We generated time series models for NH Black and NH white births, which incorporated synthetic controls of Cook County based on unexposed counties. We ran a secondary analysis considering socioeconomic status (SES).

RESULTS

From 1990-1996, the mean monthly PTB incidence among NH Black births was 18.6% compared to 7.8% among NH white births. The mean monthly PTB incidence among NH Black births from August 1995-January 1996 was 16.7% higher than expected (three additional PTBs per 100 live births per month [95% confidence interval (CI): 1, 5]). A similar increase occurred among low-SES NH Black births. No increase appeared among NH white births.

CONCLUSIONS

Severe heat waves may increase racial disparities in PTB incidence.

Estimated Global Proportions of Individuals With Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021

Importance

Some individuals experience persistent symptoms after initial symptomatic SARS-CoV-2 infection (often referred to as Long COVID).

Objective

To estimate the proportion of males and females with COVID-19, younger or older than 20 years of age, who had Long COVID symptoms in 2020 and 2021 and their Long COVID symptom duration.

Design, Setting, and Participants

Bayesian meta-regression and pooling of 54 studies and 2 medical record databases with data for 1.2 million individuals (from 22 countries) who had symptomatic SARS-CoV-2 infection. Of the 54 studies, 44 were published and 10 were collaborating cohorts (conducted in Austria, the Faroe Islands, Germany, Iran, Italy, the Netherlands, Russia, Sweden, Switzerland, and the US). The participant data were derived from the 44 published studies (10 501 hospitalized individuals and 42 891 nonhospitalized individuals), the 10 collaborating cohort studies (10 526 and 1906), and the 2 US electronic medical record databases (250 928 and 846 046). Data collection spanned March 2020 to January 2022.

Exposures

Symptomatic SARS-CoV-2 infection.

Main Outcomes and Measures

Proportion of individuals with at least 1 of the 3 self-reported Long COVID symptom clusters (persistent fatigue with bodily pain or mood swings; cognitive problems; or ongoing respiratory problems) 3 months after SARS-CoV-2 infection in 2020 and 2021, estimated separately for hospitalized and nonhospitalized individuals aged 20 years or older by sex and for both sexes of nonhospitalized individuals younger than 20 years of age.

Results

A total of 1.2 million individuals who had symptomatic SARS-CoV-2 infection were included (mean age, 4-66 years; males, 26%-88%). In the modeled estimates, 6.2% (95% uncertainty interval [UI], 2.4%-13.3%) of individuals who had symptomatic SARS-CoV-2 infection experienced at least 1 of the 3 Long COVID symptom clusters in 2020 and 2021, including 3.2% (95% UI, 0.6%-10.0%) for persistent fatigue with bodily pain or mood swings, 3.7% (95% UI, 0.9%-9.6%) for ongoing respiratory problems, and 2.2% (95% UI, 0.3%-7.6%) for cognitive problems after adjusting for health status before COVID-19, comprising an estimated 51.0% (95% UI, 16.9%-92.4%), 60.4% (95% UI, 18.9%-89.1%), and 35.4% (95% UI, 9.4%-75.1%), respectively, of Long COVID cases. The Long COVID symptom clusters were more common in women aged 20 years or older (10.6% [95% UI, 4.3%-22.2%]) 3 months after symptomatic SARS-CoV-2 infection than in men aged 20 years or older (5.4% [95% UI, 2.2%-11.7%]). Both sexes younger than 20 years of age were estimated to be affected in 2.8% (95% UI, 0.9%-7.0%) of symptomatic SARS-CoV-2 infections. The estimated mean Long COVID symptom cluster duration was 9.0 months (95% UI, 7.0-12.0 months) among hospitalized individuals and 4.0 months (95% UI, 3.6-4.6 months) among nonhospitalized individuals. Among individuals with Long COVID symptoms 3 months after symptomatic SARS-CoV-2 infection, an estimated 15.1% (95% UI, 10.3%-21.1%) continued to experience symptoms at 12 months.

Conclusions and Relevance

This study presents modeled estimates of the proportion of individuals with at least 1 of 3 self-reported Long COVID symptom clusters (persistent fatigue with bodily pain or mood swings; cognitive problems; or ongoing respiratory problems) 3 months after symptomatic SARS-CoV-2 infection.

Indian Guidelines on Nebulization Therapy

Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.

A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021

Importance:

While much of the attention on the COVID-19 pandemic was directed at the daily counts of cases and those with serious disease overwhelming health services, increasingly, reports have appeared of people who experience debilitating symptoms after the initial infection. This is popularly known as long COVID.

Objective:

To estimate by country and territory of the number of patients affected by long COVID in 2020 and 2021, the severity of their symptoms and expected pattern of recovery

Design:

We jointly analyzed ten ongoing cohort studies in ten countries for the occurrence of three major symptom clusters of long COVID among representative COVID cases. The defining symptoms of the three clusters (fatigue, cognitive problems, and shortness of breath) are explicitly mentioned in the WHO clinical case definition. For incidence of long COVID, we adopted the minimum duration after infection of three months from the WHO case definition. We pooled data from the contributing studies, two large medical record databases in the United States, and findings from 44 published studies using a Bayesian meta-regression tool. We separately estimated occurrence and pattern of recovery in patients with milder acute infections and those hospitalized. We estimated the incidence and prevalence of long COVID globally and by country in 2020 and 2021 as well as the severity-weighted prevalence using disability weights from the Global Burden of Disease study.

Results:

Analyses are based on detailed information for 1906 community infections and 10526 hospitalized patients from the ten collaborating cohorts, three of which included children. We added published data on 37262 community infections and 9540 hospitalized patients as well as ICD-coded medical record data concerning 1.3 million infections. Globally, in 2020 and 2021, 144.7 million (95% uncertainty interval [UI] 54.8–312.9) people suffered from any of the three symptom clusters of long COVID. This corresponds to 3.69% (1.38–7.96) of all infections. The fatigue, respiratory, and cognitive clusters occurred in 51.0% (16.9–92.4), 60.4% (18.9–89.1), and 35.4% (9.4–75.1) of long COVID cases, respectively. Those with milder acute COVID-19 cases had a quicker estimated recovery (median duration 3.99 months [IQR 3.84–4.20]) than those admitted for the acute infection (median duration 8.84 months [IQR 8.10–9.78]). At twelve months, 15.1% (10.3–21.1) continued to experience long COVID symptoms.

Conclusions and relevance:

The occurrence of debilitating ongoing symptoms of COVID-19 is common. Knowing how many people are affected, and for how long, is important to plan for rehabilitative services and support to return to social activities, places of learning, and the workplace when symptoms start to wane.

Evidence-Based Nutrition Interventions Improved Adolescents' Knowledge and Behaviors in Indonesia

Adolescence is a nutritionally vulnerable and critical life stage. However, few programs and policies focus on improving adolescent nutrition in Indonesia. To address this gap, we implemented a gender-responsive package of interventions: (1) breakfast and weekly iron-folic acid supplementation (WIFS), (2) a school-based nutrition education program, and (3) a social behavior change communication strategy. We surveyed 514 adolescents at baseline (2019) and endline (2020) in Klaten and Lombok Barat districts in Indonesia. The survey included a knowledge assessment on nutrition, as well as indicators of attitudes and behaviors on diet, physical activity, and WIFS. We employed multivariable linear and logistic regression to test for pre–post intervention differences. Overall knowledge was significantly higher post-intervention (β: 3.3; 95% confidence interval [CI]: 2.6, 3.9). Diet diversity was high at both timepoints, however, at post-intervention there was significantly higher odds of consuming vitamin A-rich fruits and vegetables (Odds Ratio [OR]: 1.5; 95% CI: 1.1, 2.0) and lower odds of consuming sugar-sweetened beverages (OR: 0.4; 95% CI: 0.3, 0.5). Post-intervention, there was higher odds of reporting 60 min of daily physical activity (OR: 2.3; 95% CI: 1.7, 3.2) and WIFS among girls (OR: 6.7; 95% CI: 1.5, 30.9). The package of interventions may be a promising first step to improving adolescent nutrition in Indonesia.

Global and regional spending on dementia care from 2000-2019 and expected future health spending scenarios from 2020-2050: An economic modelling exercise

BACKGROUND

The global burden of dementia is increasing. As diagnosis and treatment rates increase and populations grow and age, additional diagnosed cases will present a challenge to healthcare systems globally. Even modelled estimates of the current and future healthcare spending attributable to dementia are valuable for decision makers and advocates to prepare for growing demand.

METHODS

We modelled healthcare spending attributable to dementia from 2000 to 2019 and expected estimated future spending from 2020 to 2050 under multiple scenarios. Data were from the Global Burden of Diseases 2019 study and from two systematic literature reviews. We used meta-regression to estimate the fraction of dementia spending that is attributable to dementia for those receiving nursing home-based care and for those receiving community-based care. We used spatiotemporal Gaussian process regression to account for data missingness and model diagnosis and treatment rates, nursing home-based care and community-based care rates, and unit costs for the many countries without their own underlying estimates. Projections of future spending estimate a baseline scenario from 2020 to 2050 based on ongoing growth. Alternative scenarios assessed faster growth rates for dementia diagnosis and treatment rates, nursing home-based care, and healthcare costs. All spending is reported in 2019 United States dollars or 2019 purchasing-power parity-adjusted dollars.

FINDINGS

Based on observed and modelled inputs, we estimated that global spending on dementia increased by 4.5% (95% uncertainty interval: 3.4-5.4%) annually from 2000 to 2019, reaching $263 billion (95% uncertainty interval [UI] $199- $333) attributable to dementia in 2019. We estimated total healthcare spending on patients with dementia was $594 billion (95% UI $457-$843). Under the baseline scenario, we estimated that attributable dementia spending will reach $1.6 trillion (95% UI $0.9-$2.6) by 2050. We project it will represent 11% (95% UI 6-18%) of all expected health spending, although it could be as high as 17% (95% UI 10-26%) under alternative scenarios.

INTERPRETATION

Health systems will experience increases in the burden of dementia in the near future. These modelled direct cost estimates, built from a relatively small set of data and linear time trends, highlight the magnitude of health system resources expected to be used to provide care and ensure sufficient and adequate resources for aging populations and their caretakers. More data are needed to corroborate these important trends.

Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic

BACKGROUND

Before 2020, mental disorders were leading causes of the global health-related burden, with depressive and anxiety disorders being leading contributors to this burden. The emergence of the COVID-19 pandemic has created an environment where many determinants of poor mental health are exacerbated. The need for up-to-date information on the mental health impacts of COVID-19 in a way that informs health system responses is imperative. In this study, we aimed to quantify the impact of the COVID-19 pandemic on the prevalence and burden of major depressive disorder and anxiety disorders globally in 2020.

METHODS

We conducted a systematic review of data reporting the prevalence of major depressive disorder and anxiety disorders during the COVID-19 pandemic and published between Jan 1, 2020, and Jan 29, 2021. We searched PubMed, Google Scholar, preprint servers, grey literature sources, and consulted experts. Eligible studies reported prevalence of depressive or anxiety disorders that were representative of the general population during the COVID-19 pandemic and had a pre-pandemic baseline. We used the assembled data in a meta-regression to estimate change in the prevalence of major depressive disorder and anxiety disorders between pre-pandemic and mid-pandemic (using periods as defined by each study) via COVID-19 impact indicators (human mobility, daily SARS-CoV-2 infection rate, and daily excess mortality rate). We then used this model to estimate the change from pre-pandemic prevalence (estimated using Disease Modelling Meta-Regression version 2.1 [known as DisMod-MR 2.1]) by age, sex, and location. We used final prevalence estimates and disability weights to estimate years lived with disability and disability-adjusted life-years (DALYs) for major depressive disorder and anxiety disorders.

FINDINGS

We identified 5683 unique data sources, of which 48 met inclusion criteria (46 studies met criteria for major depressive disorder and 27 for anxiety disorders). Two COVID-19 impact indicators, specifically daily SARS-CoV-2 infection rates and reductions in human mobility, were associated with increased prevalence of major depressive disorder (regression coefficient [B] 0·9 [95% uncertainty interval 0·1 to 1·8; p=0·029] for human mobility, 18·1 [7·9 to 28·3; p=0·0005] for daily SARS-CoV-2 infection) and anxiety disorders (0·9 [0·1 to 1·7; p=0·022] and 13·8 [10·7 to 17·0; p<0·0001]. Females were affected more by the pandemic than males (B 0·1 [0·1 to 0·2; p=0·0001] for major depressive disorder, 0·1 [0·1 to 0·2; p=0·0001] for anxiety disorders) and younger age groups were more affected than older age groups (-0·007 [-0·009 to -0·006; p=0·0001] for major depressive disorder, -0·003 [-0·005 to -0·002; p=0·0001] for anxiety disorders). We estimated that the locations hit hardest by the pandemic in 2020, as measured with decreased human mobility and daily SARS-CoV-2 infection rate, had the greatest increases in prevalence of major depressive disorder and anxiety disorders. We estimated an additional 53·2 million (44·8 to 62·9) cases of major depressive disorder globally (an increase of 27·6% [25·1 to 30·3]) due to the COVID-19 pandemic, such that the total prevalence was 3152·9 cases (2722·5 to 3654·5) per 100 000 population. We also estimated an additional 76·2 million (64·3 to 90·6) cases of anxiety disorders globally (an increase of 25·6% [23·2 to 28·0]), such that the total prevalence was 4802·4 cases (4108·2 to 5588·6) per 100 000 population. Altogether, major depressive disorder caused 49·4 million (33·6 to 68·7) DALYs and anxiety disorders caused 44·5 million (30·2 to 62·5) DALYs globally in 2020.

INTERPRETATION

This pandemic has created an increased urgency to strengthen mental health systems in most countries. Mitigation strategies could incorporate ways to promote mental wellbeing and target determinants of poor mental health and interventions to treat those with a mental disorder. Taking no action to address the burden of major depressive disorder and anxiety disorders should not be an option.

FUNDING

Queensland Health, National Health and Medical Research Council, and the Bill and Melinda Gates Foundation.

Magnetic resonance imaging in the evaluation of idiopathic frequent premature ventricular complexes with normal ventricular function

Background

The role of cardiac magnetic resonance (CMR) imaging in the diagnostic evaluation of patients with frequent premature ventricular complexes (PVCs) and normal left ventricular ejection fraction (LVEF) remains unclear. Existing data has been predominantly derived from highly selected populations, that may overestimate the true prevalence of abnormal findings on CMR in this patient population.

Purpose

The aim of this study was 2-fold: 1) to establish the prevalence of CMR imaging abnormalities in a cohort with normal LVEF and high PVC burden; 2) to identify predictors of CMR imaging abnormalities in patients with frequent PVCs and normal LVEF.

Methods

In this cohort study, 211 patients (age 53.2±19 years; 41% male) with frequent PVCs (≥5%/24 h), of normal LVEF (≥50% by echocardiography) and no known underlying structural heart disease were prospectively enrolled from 2016–2020. Of these, 166 (79%) patients were symptomatic from their PVCs in the form of palpitations, fatigue, chest pain, dizziness, and/or dyspnea. Patients underwent CMR imaging (1.5 Tesla) with a late gadolinium enhancement (LGE) protocol at the time of enrollment for the detection of scarring and/or fibrosis.

Results

Patients had a median baseline echocardiographic LVEF of 60% (± 5%) with 195 (92%) of patients having a normal native QRS morphology. Median PVC burden of the study cohort was 16% (± 14%). CMR LGE abnormalities were found in 19 (9%) patients including 17 scans with non-ischemic LGE and 2 with ischemic LGE. Age &gt;60 (odds ratio [OR]: 3.20, 95% confidence interval [CI]: 1.20–8.51, p=0.020), male sex (OR: 4.67, 95% CI: 1.61–13.50, p=0.004), history of hypertension (OR: 3.43, 95% CI: 1.31–8.97, p=0.012), native QRS duration (OR: 1.03, 95% CI: 1.00–1.05, p=0.031), and history of non-sustained ventricular tachycardia (OR: 2.81, 95% CI: 1.03–7.68, p=0.044) were significantly associated with the presence of imaging abnormalities on CMR. Dominant PVC origin from the left ventricle had a positive trend (OR: 2.60, 95% CI: 0.99–7.66, p=0.083) to association with CMR imaging abnormalities. On multivariate analysis, male sex (OR: 4.10, 95% CI: 1.40–12.04, p=0.010) and history of hypertension (OR: 2.89, 95% CI: 1.08–7.75, p=0.035) remained significantly associated with the presence of CMR abnormalities. There was no association between CMR imaging abnormalities and the burden of PVCs or the number of PVC morphologies.

Conclusion

In this cohort, only 9% of patients with apparently idiopathic frequent PVCs and normal LVEF had concealed myocardial abnormalities on CMR imaging. Male sex and history of hypertension were associated with a higher rate of CMR abnormalities.

Funding Acknowledgement

Type of funding sources: None.

Reduced water collection time improves learning achievement among primary school children in India

In low-and-middle-income countries, the provisioning of safe drinking water is a challenge that will likely worsen with climate change. Securing water will require more work and time, burdening women and children the most. Currently, the consequences of this time burden to children's development remain understudied. To address this gap, we examine the tradeoff between children's household water collection responsibilities and learning achievement. Using nationally representative data from India, we measure the effect of daily fetching time on primary school children's learning achievement in a two-stage regression model, with rainfall as the instrument. Our analyses indicate that higher fetching times predict lower mathematics (-1.23 standard deviations, 95CI[-2.32, -0.14]), reading (-1.13 standard deviations, 95CI[-2.07, -0.19]), and writing (-1.21 standard deviations, 95CI[-1.89, -0.51]) test scores. These effects are heterogeneous across sex and infrastructure type. For example, we find girls' mathematical and reading skills profit more from reductions in fetching time than boys' (score less affected for boys by β amount: mathematics: β=0.26 points, 95CI[0.095, 0.42]; reading: β=0.27 points, 95CI[0.054, 0.49]). Children using hand pumps, open wells, or tube wells are hurt more academically in mathematics and writing by increases in fetching time than children with mostly off-premises piped access (e.g., writing scores more affected by β amount: hand pump: β=-0.18, 95CI[-0.29, -0.081]; open well: β=-0.18, 95CI[-0.33, -0.040]; tube well: β=-0.14, 95CI[-0.29, -0.00072]). Given these results, we recommend off-premises piped infrastructure in the absence of piped-to-premises water in water-insecure contexts and offer guidance for targeting infrastructure investments in India.

Maternal and Child Health Benefits of the Mamata Conditional Cash Transfer Program in Odisha, India

BACKGROUND

Conditional cash transfers (CCTs) are demand-side interventions that link cash receipt to fulfilment of health-promoting conditions such as regular health check-ups and investment in human capital. In 2011, the Indian state of Odisha, implemented a statewide CCT program-the Mamata Scheme-towards improving maternal/child health outcomes and promoting health-seeking behavior. Mamata targets pregnant and lactating women aged ≥19 y, and provides a sizable financial incentive relative to household income levels.

OBJECTIVES

We aimed to longitudinally examine whether, and to what extent, initiation of the Mamata scheme corresponded with changes in health and nutrition outcomes in Odisha, relative to comparison states in India.

METHODS

Outcomes included maternal health service utilization [antenatal care (ANC), iron-folic acid supplementation, breastfeeding counseling, full child immunization, tetanus vaccination, vitamin A supplementation] and nutrition [anemia during pregnancy and stunting, anemia in children <5 y old (U5)]. Data on outcomes and covariates were obtained from 3 waves of India's National Family Health Surveys corresponding to the years 1999, 2006, and 2016. We used difference-in-differences (DID) estimation strategy to estimate the impact of the program.

RESULTS

The pooled sampled size comprised >200,000 mother-child dyads. Tests of parallel trends indicated that preintervention trends were similar across all outcomes in Odisha with the exception of anemia. When comparing Odisha with other states for health services, DID models indicated that exposure to Mamata corresponded with increased odds of counseling for breastfeeding (OR: 2.74; 95% CI: 1.97, 3.80), ANC receipt (OR: 1.51; 95% CI: 1.15, 1.99), and full immunization (OR: 1.69; 95% CI: 1.37, 2.08). DID models also indicated decline in stunting (OR: 0.92; 95% CI: 0.84, 1.02) and anemia (OR: 0.62; 95% CI: 0.54, 0.71) among U5 children in Odisha following Mamata, relative to comparison states. Models comparing poor with nonpoor groups indicated the presence of heterogeneous effects.

CONCLUSIONS

This study provides proof-of-concept for potential improvements in maternal and child nutrition outcomes following CCTs that incentivize health care utilization in India.

Odderon Exchange from Elastic Scattering Differences between pp and pp[over ¯] Data at 1.96 TeV and from pp Forward Scattering Measurements

We describe an analysis comparing the pp[over ¯] elastic cross section as measured by the D0 Collaboration at a center-of-mass energy of 1.96 TeV to that in pp collisions as measured by the TOTEM Collaboration at 2.76, 7, 8, and 13 TeV using a model-independent approach. The TOTEM cross sections, extrapolated to a center-of-mass energy of sqrt[s]=1.96  TeV, are compared with the D0 measurement in the region of the diffractive minimum and the second maximum of the pp cross section. The two data sets disagree at the 3.4σ level and thus provide evidence for the t-channel exchange of a colorless, C-odd gluonic compound, also known as the odderon. We combine these results with a TOTEM analysis of the same C-odd exchange based on the total cross section and the ratio of the real to imaginary parts of the forward elastic strong interaction scattering amplitude in pp scattering for which the significance is between 3.4σ and 4.6σ. The combined significance is larger than 5σ and is interpreted as the first observation of the exchange of a colorless, C-odd gluonic compound.

Intergenerational nutrition benefits of India's national school feeding program

India has the world's highest number of undernourished children and the largest school feeding program, the Mid-Day Meal (MDM) scheme. As school feeding programs target children outside the highest-return "first 1000-days" window, they have not been included in the global agenda to address stunting. School meals benefit education and nutrition in participants, but no studies have examined whether benefits carry over to their children. Using nationally representative data on mothers and their children spanning 1993 to 2016, we assess whether MDM supports intergenerational improvements in child linear growth. Here we report that height-for-age z-score (HAZ) among children born to mothers with full MDM exposure was greater (+0.40 SD) than that in children born to non-exposed mothers. Associations were stronger in low socioeconomic strata and likely work through women's education, fertility, and health service utilization. MDM was associated with 13-32% of the HAZ improvement in India from 2006 to 2016.

Association of Human Mobility Restrictions and Race/Ethnicity-Based, Sex-Based, and Income-Based Factors With Inequities in Well-being During the COVID-19 Pandemic in the United States

Importance

An accurate understanding of the distributional implications of public health policies is critical for ensuring equitable responses to the COVID-19 pandemic and future public health threats.

Objective

To identify and quantify the association of race/ethnicity-based, sex-based, and income-based inequities of state-specific lockdowns with 6 well-being dimensions in the United States.

Design, Setting, and Participants

This pooled, repeated cross-sectional study used data from 14 187 762 households who participated in phase 1 of the population-representative US 2020 Household Pulse Survey (HPS). Households were invited to participate by email, text message, and/or telephone as many as 3 times. Data were collected via an online questionnaire from April 23 to July 21, 2020, and participants lived in all 50 US states and the District of Columbia.

Exposures

Indicators of race/ethnicity, sex, and income and their intersections.

Main Outcomes and Measures

Unemployment; food insufficiency; mental health problems; no medical care received for health problems; default on last month's rent or mortgage; and class cancellations with no distance learning. Race/ethnicity, sex, income, and their intersections were used to measure distributional implications across historically marginalized populations; state-specific, time-varying population mobility was used to measure lockdown intensity. Logistic regression models with pooled repeated cross-sections were used to estimate risk of dichotomous outcomes by social group, adjusted for confounding variables.

Results

The 1 088 314 respondents (561 570 [51.6%; 95% CI, 51.4%-51.9%] women) were aged 18 to 88 years (mean [SD], 51.55 [15.74] years), and 826 039 (62.8%; 95% CI, 62.5%-63.1%) were non-Hispanic White individuals; 86 958 (12.5%; 95% CI, 12.4%-12.7%), African American individuals; 86 062 (15.2%; 95% CI, 15.0%-15.4%), Hispanic individuals; and 50 227 (5.6%; 95% CI, 5.5%-5.7%), Asian individuals. On average, every 10% reduction in mobility was associated with higher odds of unemployment (odds ratio [OR], 1.3; 95% CI, 1.2-1.4), food insufficiency (OR, 1.1; 95% CI, 1.1-1.2), mental health problems (OR, 1.04; 95% CI, 1.0-1.1), and class cancellations (OR, 1.1; 95% CI, 1.1-1.2). Across most dimensions compared with White men with high income, African American individuals with low income experienced the highest risks (eg, food insufficiency, men: OR, 3.3; 95% CI, 2.8-3.7; mental health problems, women: OR, 1.9; 95% CI, 1.8-2.1; medical care inaccessibility, women: OR, 1.7; 95% CI, 1.6-1.9; unemployment, men: OR, 2.8; 95% CI, 2.5-3.2; rent/mortgage defaults, men: OR, 5.7; 95% CI, 4.7-7.1). Other high-risk groups were Hispanic individuals (eg, unemployment, Hispanic men with low income: OR, 2.9; 95% CI, 2.5-3.4) and women with low income across all races/ethnicities (eg, medical care inaccessibility, non-Hispanic White women: OR, 1.8; 95% CI, 1.7-2.0).

Conclusions and Relevance

In this cross-sectional study, African American and Hispanic individuals, women, and households with low income had higher odds of experiencing adverse outcomes associated with the COVID-19 pandemic and stay-at-home orders. Blanket public health policies ignoring existing distributions of risk to well-being may be associated with increased race/ethnicity-based, sex-based, and income-based inequities.

Have we forgotten about heller’s? a case report of childhood disintegrative disorder

Introduction

We report on the case of a 15 year old young person with a known diagnosis of autism presenting with a rapid and acute regression in functional abilities, decline in expressive speech and bizarre posturing. The symptoms first started during lockdown (April 2020) with anxiety related to school work followed by urinary incontinence, insomnia, muttering to self and incongruent smiling. Initial medical investigations including MRI, lumbar puncture and 24hour EEG were inconclusive, so she was referred to Paediatric Liaison for assessment.

Objectives

We demonstrate the value of a child psychiatry liaison service being involved with young people in an acute medical hospital

Methods

This young person had a thorough psychiatric assessment.

Results

Through daily psychiatric assessment and reviews with the young person, her parent, social care, wider community team, school and Paediatric Inpatient ward in order to expand on the understanding of the young person and develop a case formulation. She was started on oral Olanzapine 2.5mg which was gradually increased to 10mg OD with minimal improvement.

Conclusions

Childhood Disintegrative Disorder (CDD or Heller’s Syndrome) is a rare pervasive disorder presenting as a loss of previously acquired skills after at least two years of normal development. Despite no longer being included in DSM-V, it is important for Psychiatrists to have a working knowledge of CDD and consider other differentials when assessing young people.

Disclosure

No significant relationships.

Nanocomposite of functional silver metal containing curcumin biomolecule model systems: Protein BSA bioavailability

Curcumin, a constituent of Curcuma longa L-Zingiberaceae is used in traditional Indian and worldwide medicine and shows anticancer and antioxidant properties. Curcumin has numerous biological and pharmacological activities but due to its hydrophobic nature, the major drawback is poor absorption and rapid elimination, rendering curcumin with the tag of a poor biomaterial. Hence, there is a need to develop functional metal containing curcumin model systems (FMCCMS) as a metallo-biomolecule to enhance the bioavailability of curcumin. We designed the interaction of silver metal ion with curcumin to form curcumin-silver nanocomposite (CURC-AgNCP) via ultrasonic synthetic route. Formations of FMCCMS were characterized by spectroscopic techniques. The crystalline face-centered cubic pattern and particle size of the nanocomposite was evaluated using X-ray diffraction and high-resolution transmission electron microscopy. The bonding of silver metal to curcumin was confirmed by X-ray photon spectroscopy. Interaction of the nanocomposite with bovine serum albumin (BSA) protein was performed using excitation, emission, and circular dichroism spectroscopy. In binding interaction of BSA, the negative value of ∆S° (-358.04 J mol^-1 K^-1) and ∆H° (-129.42 KJ mol^-1) demonstrates the hydrophilic nature of the nanocomposite. The binding distance r evaluated according to the Forster resonance energy transfer theory and was 4.69 nm for CURC-AgNCP, which suggested non-radiative transfer of energy between CURC-AgNCP and BSA. The role of FMCCMS metallo-biomolecule CURC-AgNCP in medicine for cancer activity can have immense importance and hence we performed Sulphorhodamine B based in-vitro cytotoxicity assay on human breast cancer Michigan Cancer Foundation-7 cell line.

The Reduction in Total Fertility Rate Predicts One Fourth of the Gain in Child Height in the Last Decade: Evidence from 44 Low- and Middle-Income Countries

Objectives

Poor child growth is associated with losses in human capital and economic productivity. High fertility rates are an increasing concern in many low- and middle-income countries (LMICs). The link between population-level fertility and child height remains underexplored.

Methods

Data were from 88 cross-sectional Demographic and Health Surveys from 44 LMICs across three regions between 2000 and 2015. Sample sizes (number of children aged 0–59 months) were 287,032 for South Asia (SAS), 345,256 for sub-Saharan Africa (SSA), and 130,040 for South America (SAM). We explored the association between fertility and child height-for-age z-score (HAZ). Fertility was indexed using total fertility rate (TFR), the number of children born to a woman were she to survive through her childbearing years according to age-specific fertility rates. TFR was calculated at the village level using birth histories and age distributions of women aged 15–49 years. Fixed effects regression models were used to estimate the association between changes in village level TFR and changes in child HAZ. These models were adjusted for country fixed effects, survey-year fixed effects, clustering, and demographic and socioeconomic covariates for the child, mother, and household. Country-level regression decomposition analysis was used to estimate the contribution of the actual TFR reduction from World Bank data to the actual gain in child HAZ.

Results

On average, individual level HAZ was −1.46 (95% CI −1.47, −1.45) in SAS, −1.50 (95% CI −1.50, −1.49) in SSA and −1.19 (95% CI −1.20, −1.19) in SAM. Mean country level TFR was 2.69 (95% CI 2.36–3.01) in SAS, 5.21 (95% CI 4.96, 5.47) in SSA and 2.76 (95% CI 2.50, 3.02) in SAM. The adjusted fixed effects models showed that a 1-unit decrease in village level TFR was associated with a 0.20 (95% CI 0.18, 0.21) increase in child HAZ in SAS, 0.09 (95% CI 0.07, 0.10) in SSA and 0.15 (95% CI 0.14, 0.17) in SAM. Decomposition analysis showed that reductions in TFR explained 25.7% of the increase in mean HAZ across countries between 2000 and 2015.

Conclusions

These findings point to an underappreciated role of fertility in the global discourse on childhood stunting. Noncoercive policies, interventions and incentives leading to replacement level fertility have the potential to support rapid reductions in stunting required to achieve development goals.

Funding Sources

None.

Risk of acute respiratory infection from crop burning in India: estimating disease burden and economic welfare from satellite and national health survey data for 250 000 persons

Background

Respiratory infections are among the leading causes of death and disability globally. Respirable aerosol particles released by agricultural crop-residue burning (ACRB), practised by farmers in all global regions, are potentially harmful to human health. Our objective was to estimate the health and economic costs of ACRB in northern India.

Methods

The primary outcome was acute respiratory infection (ARI) from India’s fourth District Level Health Survey (DLHS-4). DLHS-4 data were merged with Moderate-Resolution Imaging Spectroradiometer satellite data on fire occurrence. Mutually adjusted generalized linear models were used to generate risk ratios for risk factors of ARI. Overall disease burden due to ACRB was estimated in terms of disability-adjusted life years.

Results

Seeking medical treatment for ARI in the previous 2 weeks was reported by 5050 (2%) of 252 539 persons. Living in a district with intense ACRB—the top quintile of fires per day—was associated with a 3-fold higher risk of ARI (mutually adjusted risk ratio 2.99, 95% confidence interval 2.77 to 3.23) after adjustment for socio-demographic and household factors. Children under 5 years of age were particularly susceptible (3.65, 3.06 to 4.34 in this subgroup). Additional ARI risk factors included motor-vehicle congestion (1.96, 1.72 to 2.23), open drainage (1.91, 1.73 to 2.11), cooking with biomass (1.73, 1.58 to 1.90) and living in urban areas (1.35, 1.26 to 1.44). Eliminating ACRB would avert 14.9 million disability-adjusted life years lost per year, valued at US$152.9 billion over 5 years.

Conclusions

Investments to stop crop burning and offer farmers alternative crop-residue disposal solutions are likely to improve population-level respiratory health and yield major economic returns.

Association of Poor Sanitation With Growth Measurements Among Children in India

Importance

Much research on sanitation and linear growth in low- and middle-income countries focuses on children younger than 5 years. However, poor sanitation may be associated with growth faltering during middle and late childhood to a greater extent than previously recognized.

Objective

To characterize the association of poor sanitation with height-for-age z (HAZ) scores in children and adolescents in India aged 0 to 18 years.

Design, Setting, and Participants

This cross-sectional study examined 134 882 children and adolescents aged 0 to 18 years who were surveyed in the fourth round of India's District Level Household and Facilities Survey (survey conducted August 2012 to February 2014). Data were analyzed from June 1, 2019, to August 20, 2019.

Exposures

Proportion of households reporting open defecation at the village level (to account for its high negative externality) and household-level access to boiled or filtered drinking water.

Main Outcomes and Measures

Individual-level HAZ scores were measured in standard deviations. The association of exposures with outcomes was estimated using ordinary least-squares regression stratified by sex (boys and girls) and 4 age groups (≤1, >1 to ≤7, >7 to ≤12, >12 to ≤18 years). Models controlled for parental height and education, socioeconomic status, maternal age at birth, hemoglobin level, and indicators for state and birth year to adjust for regional (state) and temporal (birth year) fixed effects.

Results

The sample comprised 70 463 male (52.5%) and 64 419 female (47.8%) children and adolescents aged 0 to 18 years; 46 722 participants (34.6%) were aged older than 12 to 18 years. Open defecation was inversely associated with HAZ score among all age groups except boys aged 1 year and younger (>1 to ≤7 years: β, -0.22; 95% CI, -0.35 to -0.10; >7 to ≤12 years: β, -0.15; 95% CI, -0.24 to -0.06; >12 to ≤18 years: β, -0.10; 95% CI, -0.19 to -0.01) and among girls aged between 7 and 18 years (>7 to ≤12 years: β, -0.22; 95% CI, -0.33 to -0.12; >12 to ≤18 years: β, -0.16; 95% CI, -0.23 to -0.09). Boiled or filtered drinking water was positively associated with HAZ score among younger girls (≤1 year: β, 0.26; 95% CI, 0.07 to 0.45; >1 to ≤7 years: β, 0.07; 95% CI, 0.01 to 0.14) and across all age groups in boys (≤1 years: β, 0.19; 95% CI, 0.03 to 0.35; >1 to ≤7 years: β, 0.07; 95% CI, 0.00 to 0.14; >7 to ≤12 years: β, 0.08; 95% CI, 0.03 to 0.13; >12 to ≤18 years: β, 0.06; 95% CI, 0.01 to 0.11).

Conclusions and Relevance

In this study, open defecation and lack of boiled or filtered drinking water were inversely associated with height-for-age measures across all ages in children and adolescents in India. Improved sanitation may benefit growth among children and adolescents older than 5 years.

India's Integrated Child Development Services programme; equity and extent of coverage in 2006 and 2016

Objective

To investigate coverage and equity of India's Integrated Child Development Services programme across the continuum of care from pregnancy to early childhood, before and after the programme was expanded to provide universal access.

Methods

The programme offers nutrition and health services to pregnant and lactating mothers and young children. We used data from nationally representative surveys in 2005-2006 and 2015-2016, including 36 850 mother-child pairs in 2006 and 190 804 in 2016. We assessed changes in the equity of use of programme services by socioeconomic quintile, caste, education and rural or urban residence. We used regression models to investigate the determinants of programme use.

Findings

The mean proportion of respondents using programme services increased between 2006 and 2016, from 9.6% to 37.9% for supplementary food, 3.2% to 21.0% for health and nutrition education, 4.5% to 28% for health check-ups and 10.4% to 24.2% for child-specific services (e.g. immunization, growth monitoring). Wealth, maternal education and caste showed the largest positive associations with use of services. However, expansion in service use varied at the sub-national level. Although overall use had improved and reached marginalized groups such as disadvantaged castes and tribes, the poorest quintiles of the population were still left behind, especially in the largest states that carry the highest burden of undernutrition.

Conclusion

India's policy reforms have increased coverage of the programme at the national level, including for marginalized groups. With further scaling-up, the programme needs to focus on reaching households from the lowest socioeconomic strata and women with low schooling levels.

Social networks, mobility, and political participation: The potential for women's self-help groups to improve access and use of public entitlement schemes in India

Women's self-help groups (SHGs) have increasingly been used as a vehicle for social, political, and economic empowerment as well as a platform for service delivery. Although a growing body of literature shows evidence of positive impacts of SHGs on various measures of empowerment, our understanding of ways in which SHGs improve awareness and use of public services is limited. To fill this knowledge gap, this paper first examines how SHG membership is associated with political participation, awareness, and use of government entitlement schemes. It further examines the effect of SHG membership on various measures of social networks and mobility. Using data collected in 2015 across five Indian states and matching methods to correct for endogeneity of SHG membership, we find that SHG members are more politically engaged. We also find that SHG members are not only more likely to know of certain public entitlements than non-members, they are significantly more likely to avail of a greater number of public entitlement schemes. Additionally, SHG members have wider social networks and greater mobility as compared to non-members. Our results suggest that SHGs have the potential to increase their members' ability to hold public entities accountable and demand what is rightfully theirs. An important insight, however, is that the SHGs themselves cannot be expected to increase knowledge of public entitlement schemes in absence of a deliberate effort to do so by an external agency.

Impact of subsidized fortified wheat on anaemia in pregnant Indian women

The World Health Assembly called for a 50% global anaemia reduction in women of reproductive age (15–49 years of age) from 2012 to 2025. India accounts for the most cases of anaemia in the world, and half of all pregnant Indian women are anaemic. In India, the government implemented a 4‐year food‐based safety net programme from 2008 to 2012 involving the provision of fortified wheat flour through its public distribution system. We assessed programme impact on anaemia among pregnant women (n = 10,186) using data from the 2002–2004 and 2012–2013 Indian District Level Health Surveys. The difference‐in‐differences method was used to estimate the impact on haemoglobin (Hb) and anaemia in pregnant women living in northern India (Punjab) and southern India (Tamil Nadu), with pregnant women in neighbouring states without wheat fortification programmes serving as controls. In northern India, we found no impact on Hb (β = −0.184, P = 0.793) or anaemia reduction (β = −0.01, P = 0.859), as expected, given that the intervention targeted only nonpoor households and demand for fortified wheat was low. In southern India, where intervention coverage was high, we found no impact on Hb (β = −0.001, P = 0.998) but did see an impact on anaemia reduction (β = −0.08, P = 0.042), which was unexpected given low consumption of wheat in this predominantly rice‐eating region. India's wheat fortification programmes were largely ineffective in terms of reducing anaemia among pregnant women. As policymakers expand fortification programs, it is critical to ensure that the fortified food is universally available and distributed widely through well‐functioning and popular outlets.

Identifying sociodemographic, programmatic and dietary drivers of anaemia reduction in pregnant Indian women over 10 years

OBJECTIVE

Anaemia is a major contributor to the global disease burden and half of pregnant women in India were anaemic in 2016. The aetiology of anaemia is complex, yet anaemia determinants are frequently examined in isolation. We sought to explore how shifts in sociodemographic (wealth, age at pregnancy, education, open defecation, cooking fuel type, household size), programmatic (iron-folic acid tablet consumption, antenatal care visits) and dietary factors (intake of Fe, folic acid, vitamin B12, phytate) predicted changes in anaemia prevalence.

DESIGN

Nutrient levels for eighty-eight food items were multiplied by household consumption of these foods to estimate household-level nutrient supply. A synthetic panel data set was created from two rounds of the District Level Household and Facility Survey (2002-04 and 2012-13) and Household Consumer Expenditures Survey (2004-05 and 2011-12). Ordinary least-squares multivariate regression models were used.

SETTING

Districts (n 446) spanning north, north-east, central and south India.

SUBJECTS

Pregnant women aged 15-49 years (n 17 138).

RESULTS

In the model accounting for both non-dietary and dietary factors, increased age at pregnancy (P<0·001), reduced village-level open defecation (P=0·001), consuming more Fe (P<0·001) and folic acid (P=0·018) and less phytate (P=0·002), and urbanization (P=0·015) were associated with anaemia reductions. A 10 mg increase in daily household Fe supply from 2012 levels was associated with a 10 % reduction in anaemia.

CONCLUSIONS

Public health interventions to combat anaemia in pregnant women should use a holistic approach, including promotion of delayed marriage, construction and use of toilets, and measures that facilitate adoption of nutrient-rich diets.

Measurement of the Effective Weak Mixing Angle in pp[over ¯]→Z/γ^{*}→ℓ^{+}ℓ^{-} Events

We present a measurement of the effective weak mixing angle parameter sin^{2}θ_{eff}^{ℓ} in pp[over ¯]→Z/γ^{*}→μ^{+}μ^{-} events at a center-of-mass energy of 1.96 TeV, collected by the D0 detector at the Fermilab Tevatron Collider and corresponding to 8.6  fb^{-1} of integrated luminosity. The measured value of sin^{2}θ_{eff}^{ℓ}[μμ]=0.23016±0.00064 is further combined with the result from the D0 measurement in pp[over ¯]→Z/γ^{*}→e^{+}e^{-} events, resulting in sin^{2}θ_{eff}^{ℓ}[comb]=0.23095±0.00040. This combined result is the most precise measurement from a single experiment at a hadron collider and is the most precise determination using the coupling of the Z/γ^{*} to light quarks.

Squamous cell carcinoma of the upper aerodigestive tract in exclusive smokers, chewers, and those with no habits

BACKGROUND

Tobacco consumption is the major risk factor for developing head and neck squamous cell cancer (SCC). The site of development of HNSCC may depend on the way the tobacco is consumed. While laryngeal cancers are more common among smokers, oral cancers are more common among tobacco chewers. Since the use of smokeless tobacco is increasing, it is important to know whether this difference is restricted only to site wise distribution or it has other clinical and pathological implications.

PATIENTS AND METHODS

We analyzed a prospectively collected dataset of HNSCC patients other than nasopharyngeal cancers attending our outpatient department at a single unit of the head and neck services at Tata Memorial Hospital, Mumbai, India, between January 2010 and September 2011. There were 747 eligible patients and were divided into three groups: Those with chewing as the only habit (chewers), those with smoking as the only habit (smokers), and those with no habits. Patients with regular use of alcohol were excluded from the study. The clinical and pathological parameters were analyzed.

RESULTS

Of the 747 patients, the tobacco chewers formed 69.3% followed by smokers (19.5%) and patients with no habits (11.1%). Majority of smokers were men (98%). Site distribution revealed patients with chewing as the only habit had oral cancers (most commonly gingivobuccal complex cancers) as the most common site and those with smoking as the only habit had larynx as the most common site. In patients with no habits, oral tongue was found to be the most common site. No statistically significant pathological differences were observed in between these groups in patients who underwent surgery (n = 366) at the initial modality of treatment.

CONCLUSIONS

There is a direct relationship between the form of tobacco use and site of appearance of HNSCC. However, there are no differences in clinical or pathological parameters between HNSCC caused by tobacco chewing or tobacco smoking.

Combined Forward-Backward Asymmetry Measurements in Top-Antitop Quark Production at the Tevatron

The CDF and D0 experiments at the Fermilab Tevatron have measured the asymmetry between yields of forward- and backward-produced top and antitop quarks based on their rapidity difference and the asymmetry between their decay leptons. These measurements use the full data sets collected in proton-antiproton collisions at a center-of-mass energy of sqrt[s]=1.96  TeV. We report the results of combinations of the inclusive asymmetries and their differential dependencies on relevant kinematic quantities. The combined inclusive asymmetry is A_{FB}^{tt[over ¯]}=0.128±0.025. The combined inclusive and differential asymmetries are consistent with recent standard model predictions.

Positive Aspects of Caregiving and Its Correlates among Caregivers of Bipolar Affective Disorder

OBJECTIVE

To evaluate the positive aspects of caregiving and its correlates (socio-demographic and clinical variables, caregiver burden, coping, quality of life, psychological morbidity) in the primary caregivers of patients with bipolar affective disorder (BPAD).

METHODS

A total of 60 primary caregivers of patients with a diagnosis of BPAD were evaluated on the Scale for Positive Aspects of Caregiving Experience (SPACE) and the Hindi version of Involvement Evaluation Questionnaire, Family Burden Interview Schedule (FBIS), modified Hindi version of Coping Checklist, shorter Hindi version of the World Health Organization Quality of Life (WHOQOL-BREF), and Hindi translated version of 12-item General Health Questionnaire (GHQ-12).

RESULTS

Caregivers of patients with BPAD had the highest mean score in the SPACE domain of Motivation for caregiving role (2.45), followed by Caregiver satisfaction (2.38) and Caregiving personal gains (2.20). The mean score was the lowest for the domain of Self-esteem and social aspect of caring (2.01). In terms of correlations, age of onset of BPAD had a negative correlation with various domains of SPACE. The mean number of total lifetime affective and depressive episodes correlated positively with Self-esteem and social aspect of caring. Caregiver satisfaction correlated negatively with FBIS domains of Disruption of routine family activities, Effect on mental health of others, and subjective burden. Coercion as a coping mechanism correlated positively with domains of Caregiving personal gains, Caregiver satisfaction, and the total score on SPACE. Three (Physical health, Psychological health, Environment) out of 5 domains of the WHOQOL-BREF correlated positively with the total SPACE score. No association was noted between GHQ-12 and SPACE scores.

CONCLUSION

Positive caregiving experience in primary caregivers of patients with BPAD is associated with better quality of life of the caregivers.