Editorial: Public health, suicide, and substance addiction

Suicide remains a critical public health concern, intricately entwined with factors ranging from mental health vulnerabilities to societal pressures. Research on “Public health, suicide, and substance addiction” offers a wealth of information about the complex interplay between these three problems. Suicide is a hidden epidemic that is quiet and has many underlying factors. Scholars have traditionally placed a high value on investigating and evaluating various causative factors. In this editorial, we navigate through the key themes and notable findings across a diverse array of studies, each shedding light on distinct facets of this complex landscape

Obesity and metabolic evaluation of 24 hour urinary analysis of adult stone formers, a case control study

Background: Urinary tract stone (Urolithiasis) is a common problem nowadays. Frequencies of urolithiasis vary from region to region: 1-5% in Asia, 5-9% in Europe, 13% in North America. Urolithiasis is believed to be due to imbalance & crystallisation of minerals inside urine, which act as the focus for more sedimentation and finally the formation of a stone within the urinary tract. The comorbidities associated with urinary stones includes: renal colic, urinary tract infection, hydronephrosis, obstruction of the collecting system, renal parenchymal damage which ultimately leads to renal failure and even death. The aim of this study was to assess the relationship between obesity and the metabolic evaluation of 24 hour urinary analysis of stone formers.Methods: A case-control study was carried out on 70 patients aged ≥20 years with urolithiasis that were without any comorbidities treated between January 2014 to January 2015. We performed 24 hour urinary analysis on urolithiasis patients and classified them as being of low weight (body mass index; BMI: <18.5, 8 men, 5 women), normal weight (BMI: 18.5-24.9, 19 men, 7 women), overweight (BMI: 25-29.9, 30 men, 12 women) or obese (BMI≥30, 12 men, 7 women).140 healthy normal weight sex and age-matched controls were also included in the study in the ratio of 1:2.Results: There was a statistically significant difference in the prevalence of obesity between the urolithiasis group and the control group (p<0.05).The correlation analysis revealed a significant positive relationship between BMI and the serum calcium, uric acid, urinary calcium, uric acid and citrate, and there was an inverse relationship between BMI and urinary pH (p<0.05). The frequency of urinary stone risk factors was increased with BMI (p<0.05).Conclusions: The positive relationship between Obesity and the risk factors for urolithiasis was evident from this study. To understand the mechanism of urolithiasis in obese patient’s further research is required

Role of serum procalcitonin level in early diagnosis of bacterial pneumonia in children, a hospital based study

Background: Procalcitonin (PCT) is a precursor of hormone calcitonin. It is composed of 116 amino acids and is produced by para follicular C cells of the thyroid and by neuroendocrine cells of lungs and intestine. The level of Procalcitonin in healthy individuals is below the limit of detection (0.01µg/L).These levels may rise from extra thyroid tissues especially in response to inflammatory stimulus of bacterial origin. PCT has the greatest sensitivity and Specificity for differentiating patients with sepsis from those with systemic inflammatory response syndrome. And the objective of the study is to discuss the method for early diagnosis and use of antibiotic therapy in patients of bacterial pneumonia.Methods: A hospital based study was conducted in our hospital from January 2015 to June 2015. Eighty six children with severe pneumonia were enrolled from Department of Paediatrics and were divided into two groups according to bacteriological detection; bacterial pneumonia group consisting of 44 children patients and non-bacterial pneumonia group of 42 children patients. Meanwhile, 45 healthy children were also enrolled and grouped into normal control group. Chest X-ray and Peripheral venous blood of all children was collected to detect complete blood count, CRP and procalcitonin (PCT).Results: Serum PCT level of patients with bacterial pneumonia was significantly higher than that in the non-bacterial pneumonia patients and normal controls ; serum PCT level of patients with bacterial pneumonia, before and after treatment had statistical significance ; Serum PCT level of patients with non-bacterial pneumonia had no statistical significance before and after treatment .Conclusions: Serum PCT is an important biomarker for prompt diagnosis of bacterial infection and a sensitive indicator to distinguish bacterial from non-bacterial pneumonia. Evaluating serum PCT levels helps in early use of antibiotic therapy and prognosis of underlying disease.

Tackling the silent epidemic of Type-I Diabetes Mellitus (Type-1 DM) through National Health Programmes- A narrative review of available evidence

Type 1 diabetes mellitus (T1DM) is an autoimmune ?-cell destruction, usually leading to absolute insulin deficiency, insulin resistance, or by a combination of both. Both the incidence and prevalence of diabetes T1DM is suspected to be high in India, but in the absence of nation-wide registry, the possibility of exact numbers is unsure. Till date, studies done among the population have seen prevalence more than the incidence of the disease, which has led to late screening and diagnosis of the disease within the community settings. India is already suffering from the burden of type 2 DM, in the process of screening those, patients with T1DM are somewhat getting ignored. Furthermore, cost associated with the treatment expenditure and social status of the people suffering from the disease too have a role to consider which has been totally side-lined in national programmes like National Program for Control of Diabetes, Cardiovascular disease, and Stroke (NPCDCS). There is also scarcity of data on the incidence of T1DM which could aid in formulating better policy avenues for the patients suffering from the disease.  Reports on trends in T1DM are more commonly available from countries with better established public health surveillance systems and diabetes research infrastructure. From India, due to scarcity of data on T1DM, we had to rely on published literature of some major centers across the country. Results from the Indian Council of Medical Research (ICMR) first phase, till July 2011 which included 5546 patients found T1DM among 63.9% cases and predominately among children; at registration 11.1% had already developed chronic complication of T1DM. As India is already suffering from the burden of type 2 DM, during current management and treatment, the problem lies at various levels which needs to be addressed. We propose a setting based, life course approach for T1DM where every age group will have access to the health care system either directly or indirectly from intra-natal life till elderly age group through health approach based on scientific methods delivered through health system. In this regard a central registry having enumeration and provisioning of mandatory Insulin to all through a national policy being implemented by NPCDCS is what policy makers must take up at urgent bases if we want to bend the curve of rising T1DM and prevalence of overall diabetes in India

Islam, Ethics and Modern Medicine: From Theory to Medical Practice

Islam arose from the same Semitic soil that gave rise to Judaism and Christianity. As stated in the Declaration of Faith, its most fundamental idea is monotheism. For Muslims, holy law is an all-encompassing entity that concerns every aspect of human life. Many Ulema has concluded that the concept of a “consensus decree” is preferable in the circumstances needing specialist understanding. These consensus panels for medical choices often include a broad and diversified representation. The decision-making process is frequently transparent, allowing members of the greater community to scrutinize the arguments presented. Before providing culturally sensitive treatment, a fundamental level of cultural awareness is essential. We simplified and highlighted key themes in Islamic medical ethics in this study. Despite the fact that this is a preliminary study, we believe the findings will assist physicians in better understanding their Muslim patients

THE RISING SCOURGE OF MENTAL ILLNESS AND INFODEMIC: AN OUTCOME OF SOCIAL MEDIA AND COVID-19

COVID-19 was accompanied with the increasing broadcast of fake news, misinformation and excessive information via social media platforms. This phenomenon has been termed “infodemic”, to describe an overwhelming amount of mostly fake, false or inaccurate information which spreads rapidly and impacts negatively on achieving a solution. It would therefore be desirable to use a cautious approach which utilizes culturally sensitive and country specific measures to deal with this occurrence. We aim to raise awareness, likewise draw the attention of global scientific community on this topic of public and mental health concern and it calls for further comments on this issue

Non-communicable disease surveillance in India using Geographical Information System-An experience from Punjab

"Geographic information system (GIS) collects various kinds of data based on the geographic relationship across space." Data in GIS is stored to visualize, analyze, and interpret geographic data to learn about an area, an ongoing project, site planning, business, health economics and health-related surveys and information. GIS has evolved from ancient disease maps to 3D digital maps and continues to grow even today. The visual-spatial mapping of the data has given us an insight into different diseases ranging from diarrhea, pneumonia to non-communicable diseases like diabetes mellitus, hypertension, cardiovascular diseases, or risk factors like obesity, being overweight, etc. All in a while, this information has highlighted health-related issues and knowledge about these in a contemporary manner worldwide. Researchers, scientists, and administrators use GIS for research project planning, execution, and disease management. Cases of diseases in a specific area or region, the number of hospitals, roads, waterways, and health catchment areas are examples of spatially referenced data that can be captured and easily presented using GIS. Currently, we are facing an epidemic of non-communicable diseases, and a powerful tool like GIS can be used efficiently in such a situation. GIS can provide a powerful and robust framework for effectively monitoring and identifying the leading cause behind such diseases.  GIS, which provides a spatial viewpoint regarding the disease spectrum, pattern, and distribution, is of particular importance in this area and helps better understand disease transmission dynamics and spatial determinants. The use of GIS in public health will be a practical approach for surveillance, monitoring, planning, optimization, and service delivery of health resources to the people at large. The GIS platform can link environmental and spatial information with the disease itself, which makes it an asset in disease control progression all over the globe

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019