Social Determinants of Health and Tobacco Use in Thirteen Low and Middle Income Countries: Evidence from Global Adult Tobacco Survey

BACKGROUND: Tobacco use has been identified as the single biggest cause of inequality in morbidity. The objective of this study is to examine the role of social determinants on current tobacco use in thirteen low-and-middle income countries. METHODOLOGY/PRINCIPAL FINDINGS: We used nationally representative data from the Global Adult Tobacco Survey (GATS) conducted during 2008-2010 in 13 low-and-middle income countries: Bangladesh, China, Egypt, India, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay, and Viet Nam. These surveys provided information on 209,027 respondent's aged 15 years and above and the country datasets were analyzed individually for estimating current tobacco use across various socio-demographic factors (gender, age, place of residence, education, wealth index, and knowledge on harmful effects of smoking). Multiple logistic regression analysis was used to predict the impact of these determinants on current tobacco use status. Current tobacco use was defined as current smoking or use of smokeless tobacco, either daily or occasionally. Former smokers were excluded from the analysis. Adjusted odds ratios for current tobacco use after controlling other cofactors, was significantly higher for males across all countries and for urban areas in eight of the 13 countries. For educational level, the trend was significant in Bangladesh, Egypt, India, Philippines and Thailand demonstrating decreasing prevalence of tobacco use with increasing levels of education. For wealth index, the trend of decreasing prevalence of tobacco use with increasing wealth was significant for Bangladesh, India, Philippines, Thailand, Turkey, Ukraine, Uruguay and Viet Nam. The trend of decreasing prevalence with increasing levels of knowledge on harmful effects of smoking was significant in China, India, Philippines, Poland, Russian Federation, Thailand, Ukraine and Viet Nam. CONCLUSIONS/SIGNIFICANCE: These findings demonstrate a significant but varied role of social determinants on current tobacco use within and across countries

Misidentification of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals in Tripoli, Libya

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial (hospital-acquired) pathogen of exceptional concern. It is responsible for life-threatening infections in both the hospital and the community. Aims: To determine the frequency of MRSA misidentification in hospitals in Tripoli, Libya using current testing methods. Methods: One hundred and seventy S. aureus isolates previously identified as MRSA were obtained from three hospitals in Tripoli. All isolates were reidentified by culturing on mannitol salt agar, API 20 Staph System and retested for resistance to methicillin using the cefoxitin disk diffusion susceptibility test and PBP2a. D-tests and vancomycin E-tests (Van-E-tests) were also performed for vancomycin-resistant isolates. Results: Of the 170 isolates examined, 86 (51%) were confirmed as MRSA (i.e. 49% were misidentified as MRSA). Fifteen (17%) of the confirmed MRSA strains exhibited inducible clindamycin resistance. Of the 86 confirmed MRSA isolates, 13 (15%) were resistant to mupirocin, 53 (62%) were resistant to ciprofloxacin, 41 (48%) were resistant to trimethoprim-sulfamethoxazole, and none were resistant to linezolid. Although disc-diffusion testing indicated that 23 (27%) of the isolates were resistant to vancomycin, none of the isolates were vancomycin-resistant by Van-E-test. Conclusions: Misidentification of nosocomial S. aureus as MRSA is a serious problem in Libyan hospitals. There is an urgent need for the proper training of microbiology laboratory technicians in standard antimicrobial susceptibility procedures and the implementation of quality control programs in microbiology laboratories of Libyan hospitals

Effect of Dried Mealworms (Tenebrio molitor), Larvae andOlive Leaves (Olea europaeaL.) on Growth Performance,Carcass Yield and Some Blood Parameters of Japanese Quail (Coturnix coturnix japonica

peer reviewedThe aim of this study was to investigate the effect ofTenebrio molitormeal (TM) and/or oliveleaf powder (OL) supplementation to quail diet on animal performance, carcass yield and some bloodparameters. One hundred and forty-four 1-day-old Japanese quails (body weight:29.9±0.46 g) weredivided into four groups of 36 chicks, receiving four different diets, i.e., G1: Standard commercial(SCD); G2: SCD + 3% TM; G3: SCD + 3% OL; and G4: SCD + 3% TM + 2% OL. Feed and water wereprovidedad-libitum. The results showed that TM and OL inclusion promoted quail body weight at5 weeks of age;p= 0.001. Feed conversion ratio (FCR) of G3 was significantly (p< 0.01) reducedcompared to the other groups. Overall mortality was not different, at around 6.25%, between groups.Carcass [(71.5–74.3%)], gizzard [(2.5–2.7%)], heart [(1.1–1.2%)] and giblet [(6.8–6.9%)] yields were notinfluenced by the diet. No significant effect of the diet was observed for serum proteins, creatinine,urea and lipids. To conclude, the mixture of an incorporation of TM and OL in quail diet showed noadverse effects on growth performance, carcass constituent yields and serum constituent

Case Report: Tracheal infiltration with wheezing revealing Hodgkin's disease [version 2; peer review: 2 approved]

Hodgkin's disease with an initial tracheobronchial involvement is not common. The symptoms might be misleading, resulting in a diagnosis delay. We report the case of a 38-year-old woman with a one-month history of wheezing associated with a dry cough. The physical examination revealed a good general state of health, bilateral wheezing and supra-clavicular lymphadenopathy. The adenopathy biopsy's histopathology revealed Hodgkin lymphoma. The whole body FDG-PET scan was an important tool to assess the diagnosis as well as for the staging. The patient was treated with chemotherapy. Another unusual aspect is the tracheobronchial metastasis confirmed by a bronchial biopsy. Thus, our patient was put on a second-line chemotherapy. She died one year after the initial diagnosis. To conclude, it is an atypical clinical presentation of an Hodgkin lymphoma with a tracheobronchial relapse. It should be considered in the differential diagnosis of asthma or a tracheal tumor

The Economics of Tobacco and Tobacco Control

This monograph, a joint effort of the U.S. National Cancer Institute and World Health Organization, examines economic issues in tobacco and tobacco control, including the supply and demand of tobacco products. This first chapter frames the issues addressed in the monograph and describes its organization around key topic areas. Each monograph chapter focuses on the global evidence on these issues, particularly the evidence from low- and middle-income countries (LMICs). The closing sections of this chapter present chapter conclusions and major overall conclusions generated by the work presented here. Experts in economics, tobacco control, public policy, public health, and other related fields from every region in the world, including high-income countries and LMICs, were assembled to provide the research and analyses presented within these pages. It is hoped that this monograph will help inform the implementation of global tobacco control efforts in the 21st century.Additional co-authors: Dongbo Fu, C.K. Gajalakshmi, Vendhan Gajalakshmi, Mark Goodchild, Emmanuel Guindon, Prakash Gupta, Reviva Hasson, Luminita S Hayes, Sara Hitchman, Kinh Hoang-Van, Jidong Huang, Andrew Hyland, Nathan Jones, John Keyser, Pierre Kopp, Harry Lando, David Levy, James Lightwood, Christine Logel, Benn McGrady, Yumiko Mochizuki-Kobayashi, Mario Monsour, Nigar Nargis, Richard J. O’Connor, Maizurah Omar, Zeynep Önder, William Onzivu, Anne-Marie Perucic, Armando Peruga, Vinayak M. Prasad, Martin Raw, Cecily S. Ray, Lyn Reed, Bung-on Ritthiphakdee, Hana Ross, Jennifer Ruger, Henry Saffer, Genevieve Sansone, Natalie Sansone, Fatwa Sari Tetra Dewi, Kerstin Schotte, Omar Shafey, Yoon-Jeong Shin, Giorgio Sincovich, John Tauras, Mark Travers, Édouard Tursan d’Espaignet, Marco Vargas, Mandeep K. Virk-Baker, Corné van Walbeek, Charles W. Warren, Marzenna Anna Weresa, Xin Xu, Eduard Zaloshnja, Lei Zhang, Ping Zhan

Evaluation of the use of Global Youth Tobacco Survey (GYTS) data for developing evidence-based tobacco control policies in Turkey

Introduction The tobacco control effort in Turkey has made significant progress in recent years. Turkey initiated its tobacco control effort with the passing of Law 4207 (The Prevention of Harmful Effects of Tobacco Products) in 1996 and ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in 2004. It is important to base policy decisions on valid and reliable evidence from population-based, representative studies that are periodically repeated to enable policy makers to monitor the results of their interventions and to appropriately tailor anti-tobacco activities towards future needs. Methods The Global Youth Tobacco Survey (GYTS) was developed to track tobacco use among young people and enhance the capacity of countries to design, implement, and evaluate tobacco control and prevention programs. Turkey conducted the GYTS in 2003 and data from this survey can be used as baseline measures for evaluation of the tobacco control programs implemented by the Ministry of Health (MOH) of the Turkish government. Results The GYTS was conducted in 2003 on a representative sample of students aged 13 to 15 years. It indicated that almost 3 in 10 students in Turkey had ever smoked cigarettes, with significantly higher rates among boys. Current cigarette smoking rates were lower, at 9% for boys and 4% for girls. The prevalence of current use of other tobacco products was about half these figures for each gender. About 80% were exposed to secondhand smoke. Exposure to pro-smoking media messages was not rare. Almost half of the smokers 'usually' bought their tobacco from a store, despite the law prohibiting this. Exposure to teaching against smoking in schools was not universal. Conclusion Findings from the GYTS, with periodic repeats of the survey, can be used to monitor the impact of enforcing various provisions of the present law (No: 4207), the progress made in achieving the goals of the WHO FCTC, and the effectiveness of various preventive interventions against smoking. Such data would inform and help in the development of public health strategy.PubMedWoSScopu

Enhancement of Mechanical and Thermal Properties of Polycaprolactone/Chitosan Blend by Calcium Carbonate Nanoparticles

This study investigates the effects of calcium carbonate (CaCO3) nanoparticles on the mechanical and thermal properties and surface morphology of polycaprolactone (PCL)/chitosan nanocomposites. The nanocomposites of PCL/chitosan/CaCO3 were prepared using a melt blending technique. Transmission electron microscopy (TEM) results indicate the average size of nanoparticles to be approximately 62 nm. Tensile measurement results show an increase in the tensile modulus with CaCO3 nanoparticle loading. Tensile strength and elongation at break show gradual improvement with the addition of up to 1 wt% of nano-sized CaCO3. Decreasing performance of these properties is observed for loading of more than 1 wt% of nano-sized CaCO3. The thermal stability was best enhanced at 1 wt% of CaCO3 nanoparticle loading. The fractured surface morphology of the PCL/chitosan blend becomes more stretched and homogeneous in PCL/chitosan/CaCO3 nanocomposite. TEM micrograph displays good dispersion of CaCO3 at lower nanoparticle loading within the matrix

Thiol-reducing agents abate cholestasis-induced lung inflammation, oxidative stress, and histopathological alterations

Cholestasis is not only influences the hepatic function but also damages many other organs. Lung injury is a critical secondary organ damage associated with cholestasis/cirrhosis. Pulmonary histopathological alterations, respiratory distress, and hypoxia are related to cholestasis/cirrhosis-induced lung injury. It has been found that oxidative stress plays a crucial role in this complication. The current study was designed to investigate the effect of N-acetyl cysteine (NAC) and dithiothreitol (DTT) as thiol-reducing and antioxidant agents against cholestasis-induced lung injury. Bile duct ligated (BDL) rats were monitored for the presence of inflammatory cells, TNF-α, and IgG levels in their broncho-alveolar fluid (BALF) at scheduled time intervals (3, 7, 14, and 28 days post-BDL surgery). These markers reached their highest level in the BALF of BDL rats on day 28 after the surgery. Therefore, in another set of experiments, the BDL animals were treated with NAC (100 and 300 mg/kg/day, i.p, for 28 consecutive days) and DTT (10 and 20 mg/kg/day, i.p, for 28 consecutive days). Meanwhile, a significant increase in the levels of TNF-α and IgG was detected in the BALF of BDL rats. The BALF level of neutrophils, monocytes, and lymphocytes was also significantly increased in cholestatic animals. A significant increase in lung tissue biomarkers of oxidative stress was detected in the BDL rats. It was found that NAC and DTT could significantly blunt pulmonary damage induced by cholestasis. The effects of these agents on oxidative stress biomarkers and inflammatory response seem to play a pivotal role in their mechanisms of protective properties

Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak:insights from the ECLB-COVID19 multicentre study

Although recognised as effective measures to curb the spread of the COVID-19 outbreak, social distancing and self-isolation have been suggested to generate a burden throughout the population. To provide scientific data to help identify risk factors for the psychosocial strain during the COVID-19 outbreak, an international cross-disciplinary online survey was circulated in April 2020. This report outlines the mental, emotional and behavioural consequences of COVID-19 home confinement. The ECLB-COVID19 electronic survey was designed by a steering group of multidisciplinary scientists, following a structured review of the literature. The survey was uploaded and shared on the Google online survey platform and was promoted by thirty-five research organizations from Europe, North Africa, Western Asia and the Americas. Questions were presented in a differential format with questions related to responses “before” and “during” the confinement period. 1047 replies (54% women) from Western Asia (36%), North Africa (40%), Europe (21%) and other continents (3%) were analysed. The COVID-19 home confinement evoked a negative effect on mental wellbeing and emotional status (P < 0.001; 0.43 ≤ d ≤ 0.65) with a greater proportion of individuals experiencing psychosocial and emotional disorders (+10% to +16.5%). These psychosocial tolls were associated with unhealthy lifestyle behaviours with a greater proportion of individuals experiencing (i) physical (+15.2%) and social (+71.2%) inactivity, (ii) poor sleep quality (+12.8%), (iii) unhealthy diet behaviours (+10%), and (iv) unemployment (6%). Conversely, participants demonstrated a greater use (+15%) of technology during the confinement period. These findings elucidate the risk of psychosocial strain during the COVID-19 home confinement period and provide a clear remit for the urgent implementation of technology-based intervention to foster an Active and Healthy Confinement Lifestyle AHCL)