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Rising adult mortality is an essential feature of the mortality transition. Vulnerability to disease and infection decreases with age, and adult mortality is more likely to be from unnatural causes such as suicide, homicide and road traffic accidents. This study aimed to assess the patterns of unnatural deaths in India as a whole and for various population subgroups. Data were obtained from the fourth wave of the National Family Health Survey (NFHS-4) conducted in 2015–16 in 29 states and 7 union territories of India. The survey collected information on deaths in households occurring in the 3 years before the survey. Rate of unnatural mortality and years of life lost were calculated separately for males and females as well as for urban and rural populations. Unnatural mortality in India was found to make up 10.3% of total deaths, and was greater among the population aged 10 to 45 years. The unnatural mortality rate in India was 0.67 per 1000 population: 0.84 per 1000 among the male population and 0.49 per 1000 among the female population. A strict positive association was found between the unnatural mortality rate and a state’s development level. In addition, a substantial loss of person-years of life due to unnatural mortality was observed. The results serve as a reminder of the need to adopt measures to reduce this avoidable loss of life in India. Prevention strategies should be targeted at the most vulnerable populations to limit young-age fatality, with its resulting loss of productive years of life.
Patients with chronic schizophrenia require long term treatment. Attitude towards antipsychotic medications is a crucial determinant of medication adherence and is influenced by multiple factors.
The present study was conducted to investigate clinical and socio-demographic correlates of attitude of patients with schizophrenia to the antipsychotic medications and its correlation with psychopathology and insight.
A cross-sectional sample of 361 patients (194 males, 167 females) with schizophrenia diagnosed as per DSM IV, aged 16-55, having illness for ≤ 6 years and not having co morbid psychiatric, physical and substance use disorders, were assessed on Positive and Negative Syndrome Scale (PANSS) . The subjects were also assessed on drug attitude inventory -30 (DAI-30) and schedule for assessment of insight (SAI) to evaluate insight.
Mean age (±SD) of sample was 32.9 (SD 9.25) years and mean duration of illness was 286.39 (± 293.63) weeks. The subjects got a mean (±SD) score on PANSS, SAI and DAI 56.38 (± 17.04), 8.27 (±2.76) and 18.95 (±6.83) respectively. Most (92.8%) of patients had a positive attitude towards antipsychotic medications. A negative correlation (r= – 3.78, p=0.00) was observed between scores on DAI and PANSS and a positive correlation (0.06, p=0.00) was seen between scores on DAI and SAI. No correlation was observed between scores on DAI and other clinical and socio-demographic variables.
Majority of patients with chronic schizophrenia, who are on treatment, have positive attitude towards antipsychotic medications. There is a need for community based studies on the subject.
To compare the white matter structural changes in specific axonal tracts detailed by diffusion tensor imaging (DTI) tractography in patients of bipolar disorder I, non-ill first degree relatives of the patients, and healthy controls in Indian population.
In a cross sectional study, we studied right-handed subjects consisting of 15 euthymic bipolar disorder I patients, 15 first degree relatives and 15 healthy controls. White matter tracts, including the anterior thalamic radiation, uncinate fasciculus, corpus callosum, and cingulum bundle were reconstructed by DTI tractography. Mean fractional anisotropy (FA) values were compared for group differences followed by post hoc analysis.
The three groups did not differ in terms of socio-demographic variables. There were significant group differences in the FA values between the bipolar disorder I, first degree relatives and the healthy control groups for corpus callosum (H=35.922, p<0.001), dorsal part of right cingulum bundle (H=23.562, p<0.001), hippocampal part of right cingulum bundle (H=8.992, p<0.001), hippocampal part of left cingulum bundle (H=26.034, p<0.001), right uncinate fasciculus (H=33.563, p<0.001) and left uncinate fasciculus (H=34.093, p<0.001). No significant difference was found between the groups for FA values of dorsal part of left cingulum bundle and right and left anterior thalamic radiations. FA values were significantly lower in bipolar disorder I patients as compared to family control group which in turn had significantly lower levels, compared to healthy controls.
The findings suggest that bipolar disorder patients and their first degree relatives show alterations in microstructural integrity of white matter tracts, compared to healthy population.
The aim of this study was to evaluate contact endoscopy in detecting local treatment failures post-radiotherapy in squamous cell carcinoma of the upper aerodigestive tract.
A total of 135 consecutive patients with suspected residual or recurrent cancer after definitive radiotherapy underwent contact endoscopy before biopsy. Contact endoscopy findings were compared with histopathological examination findings. Contact endoscopy could not be completed in 7 patients (5.9 per cent) and histopathological examination was inconclusive in 5 patients (3.7 per cent). The findings of the remaining 123 patients were compared.
The sensitivity, specificity and accuracy of contact endoscopy were 88.75, 88.72 and 86.99 per cent, respectively, with similar results across various sites of upper aerodigestive tract. Inter-observer kappa value was 0.86 (95 per cent confidence interval: 0.79–0.93). The intra-observer kappa value was 0.93 (95 per cent confidence interval: 0.87–1.00) for the first observer and 0.95 (95 per cent confidence interval: 0.90–1.00) for second and third observers.
Contact endoscopy showed the same high sensitivity and specificity with low inter- and intra-observer variability in detecting post-radiotherapy failures in cancer of the upper aerodigestive tract as has been shown in non-irradiated tissues in earlier studies.
Traditionally past suicide attempt is considered a strong reliable factor in predicting an immediate or short-term suicide risk. Considering the complex interplay of different variables associated with suicide, the absence of past attempts may not prove to be of lesser risk for a consequent attempt.
To compare sociodemographic and clinical correlates within high-risk suicidal patients who have made a recent suicide attempt in the presence versus absence of past suicide attempts.
Retrospective review of patient's records admitted to intensive care unit, applied suicide intervention and supportive treatment (ASIST) between 1st January 2015 and 31st May 2016 was conducted. Data was extracted for all consecutive admissions to ASIST, of adults (16 to 60 years) male patients with high risk for suicide.
Out of 109 at risk inpatients, 31% were recent attempters without past attempts and 13.5% were recent and past attempters. Rest included past attempters without recent attempt and non-attempters. Except for poor coping skills, which were significantly higher (Chi2= 13.97; P = 0.001) in the group consisting recent and past attempters, all other relevant sociodemographic and illness related correlates were comparable across these groups.
Suicide risk may be associated with multiple factors. Apart from past attempts, a faulty coping style can be associated with risk for further attempts. Other correlates like age, marital status, employment and illness profile did not follow the traditional pattern in our study which makes them equally important while addressing suicide risk in Indian men.
Disclosure of interest
The author has not supplied his/her declaration of competing interest.
This is a cross-sectional study aiming to understand the early characteristics and background of bone health impairment in clinically well children with Fontan circulation.
We enrolled 10 clinically well children with Fontan palliation (operated >5 years before study entrance, Tanner stage ≤3, age 12.1 ± 1.77 years, 7 males) and 11 healthy controls (age 12.0 ± 1.45 years, 9 males) at two children’s hospitals. All patients underwent peripheral quantitative CT. For the Fontan group, we obtained clinical characteristics, NYHA class, cardiac index by MRI, dual x-ray absorptiometry, and biochemical studies. Linear regression was used to compare radius and tibia peripheral quantitative CT measures between Fontan patients and controls.
All Fontan patients were clinically well (NYHA class 1 or 2, cardiac index 4.85 ± 1.51 L/min/m2) and without significant comorbidities. Adjusted trabecular bone mineral density, cortical thickness, and bone strength index at the radius were significantly decreased in Fontan patients compared to controls with mean differences −30.13 mg/cm3 (p = 0.041), −0.31 mm (p = 0.043), and −6.65 mg2/mm4 (p = 0.036), respectively. No differences were found for tibial measures. In Fontan patients, the mean height-adjusted lumbar bone mineral density and total body less head z scores were −0.46 ± 1.1 and −0.63 ± 1.1, respectively, which are below the average, but within normal range for age and sex.
In a clinically well Fontan cohort, we found significant bone deficits by peripheral quantitative CT in the radius but not the tibia, suggesting non-weight-bearing bones may be more vulnerable to the unique haemodynamics of the Fontan circulation.
The binary metal oxides are increasingly used as supercapacitor electrode materials in energy storing devices. Particularly NiCo2O4 has shown promising electrocapacitive performance with high specific capacitance and energy density. The electrocapacitive performance of these oxides largely depends on their morphology and electrical properties governed by their energy band-gaps and defects. The morphological structure of NiCo2O4 can be altered via the synthesis route, while the energy band-gap could be altered by doping. Also, doping can enhance crystal stability and bring in grain refinement, which can further improve the much-needed surface area for high specific capacitance. Given the above, this study evaluates the electrochemical performance of Ca-doped Ni1-xCaxCo2O4 (0 ≤ x ≤ 0.8) compounds. This stipulates promising applications for electrodes in future supercapacitors.
Suicide is a major global health concern. Bhutanese refugees resettled in the USA are disproportionately affected by suicide, yet little research has been conducted to identify factors contributing to this vulnerability. This study aims to investigate the issue of suicide of Bhutanese refugee communities via an in-depth qualitative, social-ecological approach.
Focus groups were conducted with 83 Bhutanese refugees (adults and children), to explore the perceived causes, and risk and protective factors for suicide, at individual, family, community, and societal levels. Audio recordings were translated and transcribed, and inductive thematic analysis conducted.
Themes identified can be situated across all levels of the social-ecological model. Individual thoughts, feelings, and behaviors are only fully understood when considering past experiences, and stressors at other levels of an individual's social ecology. Shifting dynamics and conflict within the family are pervasive and challenging. Within the community, there is a high prevalence of suicide, yet major barriers to communicating with others about distress and suicidality. At the societal level, difficulties relating to acculturation, citizenship, employment and finances, language, and literacy are influential. Two themes cut across several levels of the ecosystem: loss; and isolation, exclusion, and loneliness.
This study extends on existing research and highlights the necessity for future intervention models of suicide to move beyond an individual focus, and consider factors at all levels of refugees’ social-ecology. Simply focusing treatment at the individual level is not sufficient. Researchers and practitioners should strive for community-driven, culturally relevant, socio-ecological approaches for prevention and treatment.
To evaluate the survival outcomes and toxicities experienced by non-metastatic head and neck cancer (HNC) patients receiving modulated radiotherapy (RT).
Materials and methods
A total of 608 HNC patients treated consecutively from March 2010 to December 2014 with common subsites (oral cavity, oropharynx, hypopharynx, larynx and nasopharynx) of HNCs formed the study group. Eligible patients included those treated with radical or postoperative RT between March 2010 and December 2014. More than 90% patients received modulated RT [intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT)] with concurrent chemotherapy as per stage guidelines. Demographic parameters and disease-related factors were analysed. Disease-free survival (DFS) was calculated from end date of RT till last follow-up or last date of disease control. Overall survival (OS) was calculated from date of registration to last follow-up date if alive. The primary endpoint was survival. The statistical analyses were performed using SPSS version 20.0 and Kaplan–Meier method was used for calculation survival.
Among the evaluable patients, the median age was 60 years (range: 16–93) with male preponderance (male:female – 513:95). Majority were squamous cell carcinoma 93·4% (568/608). The subsites treated were oral cavity 36·8% (224). oropharynx 26·4% (161), larynx 19·7% (120), hypopharynx 10% (62) and nasopharynx 6·4% (41). RT intent was radical in 63·5% (386) and postoperative in 36·5% (222), with 59·5% (362) receiving concurrent chemotherapy. At last follow-up, 348 (57·2%) patients were alive, 169 (27·7%) patients had succumbed to disease and 120 (24·6%) patients had recurrent disease. Out of 120 recurrent cases loco-regional recurrence, nodal recurrence and distant metastases were seen in 62 (51·7%), 25 (20·8%), 33 (27·5%), respectively. In the entire study cohort at 2 year OS and DFS was 80 and 79% whereas 3 years OS and DFS was 70 and 75%, respectively.
In our study, 2 years and 3 years OS and DFS rates are found comparable to the international data with acceptable toxicity profile with the use of modulated RT. It seems to be possible because of stringent departmental protocols and good medical physics support. Our data re-validates need and benefit of advanced RT techniques like IG-IMRT and VMAT for both postoperative and radical HNC treatment at the cost of minimal long-term side effects. Future stringent follow-up and quality of life issues are being considered in a prospective manner.
Carbohydrate quantity and quality affect postprandial glucose response, glucose metabolism and risk of type 2 diabetes. The aim of this study was to examine the association of pre-pregnancy dietary carbohydrate quantity and quality with the risk of developing gestational diabetes mellitus (GDM). We used data from the Australian Longitudinal Study on Women’s Health that included 3607 women aged 25–30 years without diabetes who were followed up between 2003 and 2015. We examined carbohydrate quantity (total carbohydrate intake and a low-carbohydrate diet (LCD) score) and carbohydrate subtypes indicating quality (fibre, total sugar intake, glycaemic index, glycaemic load and intake of carbohydrate-rich food groups). Relative risks (RR) for development of GDM were estimated using multivariable regression models with generalised estimating equations. During 12 years of follow-up, 285 cases of GDM were documented in 6263 pregnancies (4·6 %). The LCD score, reflecting relatively high fat and protein intake and low carbohydrate intake, was positively associated with GDM risk (RR 1·54; 95 % CI 1·10, 2·15), highest quartile v. lowest quartile). Women in the quartile with highest fibre intake had a 33 % lower risk of GDM (RR 0·67; 95 % CI 0·45, 0·96)). Higher intakes of fruit (0·95 per 50 g/d; 95 % CI 0·90, 0·99) and fruit juice (0·89 per 100 g/d; 95 % CI 0·80, 1·00)) were inversely associated with GDM, whereas cereal intake was associated with a higher risk of GDM (RR 1·05 per 20 g/d; 95 % CI 1·01, 1·07)). Thus, a relatively low carbohydrate and high fat and protein intake may increase the risk of GDM, whereas higher fibre intake could decrease the risk of GDM. It is especially important to take the source of carbohydrates into account.
The suboptimal provision of analgesia to children in the emergency department (ED) is well-described. A yet unexplored barrier is caregiver or child refusal of analgesia. We sought to evaluate the frequency of caregiver/child acceptance of analgesia offered in the ED.
We conducted a two-centre cross-sectional study of 743 caregivers of children 4–17 years presenting to the pediatric ED with an acutely painful condition using a survey and medical record review. The primary outcome was the proportion of children/caregiver pairs who accepted analgesia in the ED.
The median (IQR) age of children was 11 (7) years, and 339/743 (45.6%) were female. The overall survey response rate was 73% (743/1018). In the 24 hours preceding ED arrival, the median (IQR) maximal pain score rated by children and caregivers was 8/10 (4) and 5/10 (2), respectively, and 30.4% (226/743) of caregivers offered analgesia. In the ED, children reported a median (IQR) pain score of 8/10 (2) and 54.9% (408/743) were offered analgesia. When offered in the ED, analgesia was accepted by 91% (373/408). Overall, 55.7% (414/743) of children received some form of analgesia.
Most caregivers/children accept analgesia when offered by ED personnel, suggesting refusal is not a major barrier to optimal management of children’s pain and highlighting the importance of ED personnel in encouraging adequate analgesia. A large proportion of children in pain are not offered analgesia by caregivers or ED personnel. Educational strategies for recognizing and treating pain should be directed at children, caregivers, and ED personnel.
Many women experience both vasomotor menopausal symptoms (VMS) and depressed mood at midlife, but little is known regarding the prospective bi-directional relationships between VMS and depressed mood and the role of sleep difficulties in both directions.
A pooled analysis was conducted using data from 21 312 women (median: 50 years, interquartile range 49−51) in eight studies from the InterLACE consortium. The degree of VMS, sleep difficulties, and depressed mood was self-reported and categorised as never, rarely, sometimes, and often (if reporting frequency) or never, mild, moderate, and severe (if reporting severity). Multivariable logistic regression models were used to examine the bi-directional associations adjusted for within-study correlation.
At baseline, the prevalence of VMS (40%, range 13–62%) and depressed mood (26%, 8–41%) varied substantially across studies, and a strong dose-dependent association between VMS and likelihood of depressed mood was found. Over 3 years of follow-up, women with often/severe VMS at baseline were more likely to have subsequent depressed mood compared with those without VMS (odds ratios (OR) 1.56, 1.27–1.92). Women with often/severe depressed mood at baseline were also more likely to have subsequent VMS than those without depressed mood (OR 1.89, 1.47–2.44). With further adjustment for the degree of sleep difficulties at baseline, the OR of having a subsequent depressed mood associated with often/severe VMS was attenuated and no longer significant (OR 1.13, 0.90–1.40). Conversely, often/severe depressed mood remained significantly associated with subsequent VMS (OR 1.80, 1.38–2.34).
Difficulty in sleeping largely explained the relationship between VMS and subsequent depressed mood, but it had little impact on the relationship between depressed mood and subsequent VMS.
Coronal Mass Ejections (CMEs) contribute to the perturbation of solar wind in the heliosphere. Thus, depending on the different phases of the solar cycle and the rate of CME occurrence, contribution of CMEs to solar wind parameters near the Earth changes. In the present study, we examine the long term occurrence rate of CMEs, their speeds, angular widths and masses. We attempt to find correlation between near sun parameters of the CMEs with near the Earth measurements. Importantly, we attempt to find what fraction of the averaged solar wind mass near the Earth is provided by the CMEs during different phases of the solar cycles.
We have used the Coronagraphic and Heliospheric Imaging data from Solar TErrestrial RElations Observatory (STEREO) to observe a prominence which is erupted on June 7th 2011. This prominence is subjected to the morphological evolution of MRT instability from the lower solar corona upto the inter-planetary space. The unstable structures are converted into the bunch of localized plasma spikes due to the turbulent mixing, and propagate in the inter-planetary space upto 1 A.U.
Active sun is characterized by compelling short-lived flash of solar eruption like solar flare, coronal mass ejections (CMEs), high-speed solar winds and solar energetic particles along with colossal release of energy and mass. This paper proposes a new method to evaluate solar wind parameters and geomagnetic indices based on wavelet analysis during the solar flares. The crucial role of IMF-Bz (interplanetary magnetic field) is examined for the two solar flares events. The key result obtained from our study is substantial dependence of solar flare intensity on IMF-Bz together with solar wind velocity. We also observed the duration of solar flares and their effect on ionospheric and ground based parameters.
It has been established that Coronal Mass Ejections (CMEs) may have significant impact on terrestrial magnetic field and lead to space weather events. In the present study, we selected several CMEs which are associated with filament eruptions on the Sun. We attempt to identify the presence of filament material within ICME at 1AU. We discuss how different ICMEs associated with filaments lead to moderate or major geomagnetic activity on their arrival at the Earth. Our study also highlights the difficulties in identifying the filament material at 1AU within isolated and in interacting CMEs.
The Sun is an active star and its magnetic field fluctuates from a fraction of a second to a long period of time. The solar wind, CME, solar prominence, solar flares, solar particle and solar filament are the direct result of solar magnetic activity effects on the interplanetary space, Earth’s magnetosphere and ionosphere. The intensity of irruption of these phenomena from the Sun’s surface depends upon its phases. The extreme events affect technology both in space and on the ground.The data obtained from series of observations can help to predict solar activities and safekeeping to the space technology. In this study the cross correlations between IMF Bz, solar wind velocity(Vsw) and interplanetary electric field(Ey) with AE and SYM-H are studied. The results reveal that strong geomagnetic disturbances have high impact on the components of space weather than weak disturbances have.
Using data from India’s National Family Health Survey, 2005–06 (NFHS-3), this article examines the patterns of relationship between birth order and infant mortality. The analysis controls for a number of variables, including mother’s characteristics such as age at the time of survey, current place of residence (urban/rural), years of schooling, religion, caste, and child’s sex and birth weight. A modest J-shaped relationship between birth order of children and their risk of dying in the neonatal period is found, suggesting that although both first- and last-born children are at a significantly greater risk of dying compared with those in the middle, last-borns (i.e. fourth and higher order births) are at the worst risk. However, in the post-neonatal period first-borns are not as vulnerable, but the risk increases steadily with the addition of successive births and last-borns are at much greater risk, even worse than those in the neonatal period. Although the strength of relationship between birth order and mortality is attenuated after the potential confounders are taken into account, the relationship between the two variables remains curvilinear in the neonatal period and direct in the post-neonatal period. There are marked differences in these patterns by the child’s sex. While female children are less prone to the risk of dying in the neonatal period in comparison with male children, the converse is true in the post-neonatal period. Female children not only run higher risks of dying in the post-neonatal period, but also become progressively more vulnerable with an increase in birth order.