Exposure to second-hand smoke down in India, but remains major concern – Here are survey details

Agencies
June 9, 2018

New Delhi, Jun 9: Exposure to second-hand smoke remains a major concern in India even though there has been a reduction in such exposure at home and public places since 2009-10, as per the Global Adult Tobacco Survey 2 (GATS 2), released here by the Health Ministry. However, exposure to second-hand smoke at healthcare facilities has increased in this period. The survey showed that little more than one-third (35 per cent) of the non-smokers were exposed to second hand smoke (SHS) at home in India. In urban areas 25 per cent of non-smokers and in rural areas 40.4 per cent of non-smokers were exposed to SHS at home, respectively.

Among all adults, 5.3 per cent were exposed to second hand smoke in government buildings, 3.6 per cent at private work places, 5.6 per cent in healthcare facilities, 7.4 per cent in restaurants, 13.3 per cent in public transport, 2.1 per cent in bar/night club and 2.2 per cent in cinema halls. In all 25.7 per cent of adults were exposed to second hand smoke in any of these seven public places.

Nationally, 37.7 per cent pregnant women were exposed to SHS at home during the one month preceding the survey while 21.0 per cent pregnant women were exposed to SHS at their workplace and 25.9 per cent were exposed to SHS at any of the seven in public places. “The proportion of households in which smoking is allowed has decreased significantly from 60.4 per cent in GATS 1 (2009-10) to 48.8 per cent in GATS 2 (2016-17).

The proportion of non-smokers exposed to SHS at home has decreased significantly from 48 per cent in GATS 1 to 35 per cent in GATS 2,” the report stated. Among all adults, exposure to SHS at government buildings/offices has decreased significantly from 6.6 per cent in GATS 1 to 5.3 per cent in GATS 2 while at restaurants it has decreased from 11.3 per cent to 7.4 per cent.

In public transports, exposure to SHS has decreased significantly from 17.5 per cent in GATS 1 to 13.3 per cent in GATS 2. However, exposure to SHS at healthcare facilities has increased from 5.4 per cent in GATS 1 to 5.6 per cent in GATS 2. The survey showed that 28.6 per cent of people, aged 15 and above, currently use tobacco in some form in India even though the prevalence of tobacco use has declined significantly over the last seven years.

It also showed that every third adult (32.5 per cent) from rural areas and every fifth adult (21.2 per cent) from urban area reported current use of tobacco with the prevalence among men being 42.4 per cent and among women it was 14.2 per cent.

From GATS 1 in 2009-10 to GATS 2 in 2016-17, the prevalence of any form of tobacco use has decreased significantly by six percentage points from 34.6 per cent to 28.6 per cent. The prevalence of daily tobacco use has decreased by 4.2 percentage points (relative decrease of 14.4 per cent) and the prevalence of occasional tobacco use has decreased by 1.7 percentage points (relative decrease of 31.5 per cent).

The decrease in both is statistically significant. ? There is a significant increase of one year in the mean age at initiation of tobacco use from 17.9 years in GATS 1 to 18.9 years in GATS 2, the report highlighted. According to the report, khaini, a tobacco, lime mixture, is the most commonly used with every ninth adult (11.2 per cent) in India using it followed by bidi, which is smoked by 7.7 per cent of adult Indians.

In urban areas, khaini (6.8 pc ) and gutka (6.3 pc ) are the two most commonly used tobacco products, whereas in rural areas khaini (13.5 pc) and bidi (9.3 pc ) are the most prevalent tobacco products. GATS 2 was carried out in 30 states of India and in the two union territories of Chandigarh and Puducherry from August 2016 to February 2017.

The analysis is based on 74,037 completed interviews, among which 33,772 were with men and 40,265 with women. Of these, 47,549 interviews were conducted in rural areas and 26,488 in urban areas.

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Agencies
June 17,2020

Leading physicians are celebrating a small dose of good news that arrived Tuesday about dexamethasone, a cheap and widely used steroid shown to be able to save lives among COVID-19 patients, but also cautioning against releasing study results by press release during a global health emergency, like in the case of the latest dexamethasone study by University of Oxford.

"It will be great news if dexamethasone, a cheap steroid, really does cut deaths by one-third in ventilated patients with COVID19, but after all the retractions and walk backs, it is unacceptable to tout study results by press release without releasing the paper", Atul Gawande, surgeon and CEO of Haven Healthcare, tweeted.

"Bottom line is, good news," Dr. Fauci, America's foremost infectious diseases expert told a US newswire on Tuesday, soon after the dexamethasone results were announced in the UK.

Fauci, who has long championed the therapeutics-first view said that dexamethasone is a "significant improvement" in the available therapeutic options currently available.

On Medical Twitter and Facebook, doctors broadly agree that dexamethasone use aligns well with the way COVID19 attacks the body's immune system. Fauci said the results in the Oxford study make "perfect sense" in that context.

"We should see the number of people who actually survive go up, if the study holds up," virologist and epidemiologist Dr. Joseph Fair told a television network.

Global coronavirus cases crossed 8 million on Tuesday. In the US, Texas and Florida are facing a new wave of cases after lifting lockdown orders earlier than medical experts recommended. Amidst the relentless graph upwards, the dexamethasone study results injected hope for better survival rates among those most seriously ill.

World Health Organization chief scientist Soumya Swaminathan welcomed the results from the randomised control trial.

Dr Eugene Gu, Founder and CEO of CoolQuit tweeted that he is "genuinely impressed" with the UK dexamethasone trial. This may be a "game changer", he wrote.

"There's no conflict of interest as dexamethasone is a generic steroid. The mechanism of action makes sense because steroids can reduce cytokine storms and overactive immune systems that makes COVID-19 so deadly. The number needed to treat is 8 ventilated patients which is great."

The Oxford study found that dexamethasone reduced deaths by 35 percent in patients who needed treatment with breathing machines and by 20 percent in those only needing supplemental oxygen. Dexamethasone was one of 5 drugs studied in a large clinical trial in the United Kingdom named RECOVERY, short for Randomised Evaluation of COVID-19 Therapy.

Peter Horby, chief investigator of the University of Oxford clinical trial, said dexamethasone is the first drug to be shown to improve survival in COVID-19. Details of the study have not been released. The trial organisers said they made their announcement via a news release because of "the public health importance of these results." According to Horby's public comments, there was a lot of initial resistance to studying steroids.

During the study, 2,104 patients were randomly selected to be given 6 milligrams of dexamethasone once a day (either by mouth or by intravenous injection) for 10 days. That group was compared with 4,321 patients who received the usual care alone.

Researchers estimated that dexamethasone would prevent one death for every eight patients treated while on ventilators and one for every 25 patients on extra oxygen alone.

UK experts have called the study results a breakthrough in the fight against the virus. The researchers have promised they would publish the results soon.

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Agencies
June 19,2020

While coughing, fever and difficulty in breathing are common symptoms of COVID-19, a new case study has found that pink eye is also a reason to be tested for the disease.

The study, published in the Canadian Journal of Ophthalmology, determined that conjunctivitis and keratoconjunctivitis can also be primary symptoms of COVID-19.

The researchers noted that in March, a 29-year-old woman arrived at the Royal Alexandra Hospital's Eye Institute of Alberta with a severe case of conjunctivitis and minimal respiratory symptoms.

After the patient had undergone several days of treatment with little improvement -- and after it had been determined that the woman had recently returned home from Asia -- a resident ordered a COVID-19 test.

The test came back positive, according to the researchers.

"What is interesting in this case, and perhaps very different to how it had been recognised at that specific time, was that the main presentation of the illness was not a respiratory symptom. It was the eye," said Carlos Solarte, an assistant professor at the University of Alberta in Canada.

"There was no fever and no cough, so we weren't led to suspect COVID-19 at the beginning. We didn't know it could present primarily with the eye and not with the lungs," Solarte said.

Academic studies at the outset of the pandemic identified conjunctivitis as a secondary symptoms in about 10 to 15 per cent of COVID-19 cases, he said.

Since then, scientists have gained greater knowledge of how the virus can transmit through and affect the body's mucous membrane system, of which the conjunctiva -- the clear, thin membrane that covers the front surface of the eye -- is an extension.

While the finding provides important new health information for the public, it also makes eye exams more complicated for ophthalmologists and staff, the researchers noted.

"The patient in this case eventually recovered well without any issues. But several of the residents and staff who were in close contact with the patient had to be under quarantine," said Solarte.

"Fortunately, none who were involved in her care also tested positive," he said.

Patients coming into an eye clinic with conjunctivitis and keratoconjunctivitis are now treated as potential cases of COVID-19 and extra precautions are taken by staff, according to the researchers.

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Agencies
February 4,2020

Despite tremendous advances in treatment of congenital heart disease (CHD), a new global study shows that the chances for a child to survive a CHD diagnosis is significantly less in low-income countries.

The research revealed that nearly 12 million people are currently living with CHD globally, 18.7 per cent more than in 1990.

The findings, published in The Lancet, is drawn from the first comprehensive study of congenital heart disease across 195 countries, prepared using data from the Global Burden of Diseases, Injuries and Risk Factors Study 2017 (GBD).

"Previous congenital heart estimates came from few data sources, were geographically narrow and did not evaluate CHD throughout the life course," said the study authors from Children's National Hospital in the US.

This is the first time the GBD study data was used along with all available data sources and previous publications - making it the most comprehensive study on the congenital heart disease burden to date.

The study found a 34.5 per cent decline in deaths from congenital disease between 1990 to 2017. Nearly 70 per cent of deaths caused by CHD in 2017 (180,624) were in infants less than one year old.

Most CHD deaths occurred in countries within the low and low-middle socio-demographic index (SDI) quintiles.

Mortality rates get lower as a country's Socio-demographic Index (SDI) rises, the study said.

According to the researchers, birth prevalence of CHD was not related to a country's socio-demographic status, but overall prevalence was much lower in the poorest countries of the world.

This is because children in these countries do not have access to life saving surgical services, they added.

"In high income countries like the United States, we diagnose some heart conditions prenatally during the 20-week ultrasound," said Gerard Martin from Children's National Hospital who contributed to the study.

"For children born in middle- and low-income countries, these data draw stark attention to what we as cardiologists already knew from our own work in these countries -- the lack of diagnostic and treatment tools leads to lower survival rates for children born with CHD," said researcher Craig Sable.

"The UN has prioritised reduction of premature deaths from heart disease, but to meet the target of 'ending preventable deaths of newborns and children under 5 years of age,' health policy makers will need to develop specific accountability measures that address barriers and improve access to care and treatment," the authors wrote.

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