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
April 17,2020

Washington DC, Apr 17: In recent research, scientists have linked the emotional, social and psychiatric problems in children and adolescents with higher levels of genetic vulnerability for adult depression. The study implies that the genetics passed from parents may be linked with psychiatric problems in children and adolescents and may also leading to depression in adults.

University of Queensland scientists made the finding while analysing the genetic data of more than 42,000 children and adolescents from seven cohorts across Finland, the Netherlands, Norway, Sweden and the UK.

Professor Christel Middeldorp said that researchers have also found a link with a higher genetic vulnerability for insomnia, neuroticism and body mass index.

"By contrast, study participants with higher genetic scores for educational attainment and emotional well-being were found to have reduced childhood problems," Professor Middeldorp said.

"We calculated a person's level of genetic vulnerability by adding up the number of risk genes they had for a specific disorder or trait and then made adjustments based on the level of importance of each gene We found the relationship was mostly similar across ages," Middeldorp added.

The results indicate there are shared genetic factors that affect a range of psychiatric and related traits across a person's lifespan.

Middeldorp said that around 50 per cent of children and adolescents with psychiatric problems, such as attention deficit hyperactivity disorder (ADHD), continue to experience mental disorders as adults, and are at risk of disengaging with their school community among other social and emotional problems.

"Our findings are important as they suggest this continuity between childhood and adult traits is partly explained by genetic risk," the Professor said.

"Individuals at risk of being affected should be the focus of attention and targeted treatment," Middeldorp continued.

"Although the genetic vulnerability is not accurate enough at this stage to make individual predictions about how a person's symptoms will develop over time, it may become so in the future, in combination with other risk factors. And, this may support precision medicine by providing targeted treatments to children at the highest risk of persistent emotional and social problems," Middeldorp added.

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Agencies
May 19,2020

Researchers have found that patients with peripheral artery disease or stroke were less likely to receive recommended treatments to prevent heart attack than those with coronary artery disease. All three are types of atherosclerotic cardiovascular disease.

Depending on the location of the blockage, atherosclerosis increases the risk for three serious conditions: coronary artery disease, stroke and peripheral artery disease.

"Our study highlights the need for public health campaigns to direct equal attention to all three major forms of atherosclerotic cardiovascular disease," said senior study author Erin Michos from the Johns Hopkins University in the US.

"We need to generate awareness among both clinicians and patients that all of these diseases should be treated with aggressive secondary preventive medications, including aspirin and statins, regardless of whether people have heart disease or not," Michos added.

Since atherosclerosis can affect arteries in more than one part of the body, medical guidelines are to treat coronary artery disease, stroke and peripheral artery disease similarly with lifestyle changes and medication, including statins to lower cholesterol levels and aspirin to prevent blood clots.

Lifestyle changes include eating a healthy diet, being physically active, quitting smoking, controlling high cholesterol, controlling high blood pressure, treating high blood sugar and losing weight.

What was unclear was if people with stroke and peripheral artery disease received the same treatments prescribed for those with coronary artery disease.

This study compared more than 14,000 US adults enrolled in the 2006-2015 Medical Expenditure Panel Survey, a national survey of patient-reported health outcomes and conditions, and health care use and expenses.

Slightly more than half of the patients were men, the average age was 65, and all had either coronary artery disease, stroke or peripheral artery disease.

These individuals were the representative of nearly 16 million US adults living with one of the three forms of atherosclerotic cardiovascular disease.

Compared to participants with coronary artery disease, participants with peripheral artery disease were twice more likely to report no statin use and three times more likely to report no aspirin use.

Additionally, people with peripheral artery disease had the highest, annual, total out-of-pocket expenditures among the three atherosclerotic conditions.

The findings showed that participants with stroke were more than twice as likely to report no statin or aspirin use.

Moreover, those with stroke were more likely to report poor patient-provider communication, poor health care satisfaction and more emergency room visits.

"Our study highlights a missed opportunity for implementing life-saving preventive medications among these high-risk individuals," Michos said.

The study was presented in the virtual conference at the American Heart Association's Quality of Care & Outcomes Research Scientific Sessions 2020.

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