SEX-SELECTIVE ABORTIONS IN INDIA: A BEHAVIOURAL EPIDEMIC

Sex- selective abortions have been known to be a problem in India. A study titled “Trends in selective abortions of girls in India: analysis of nationally representative birth histories from 1990 to 2005 and census data from 1991 to 2011” by Jha P et al was published in Lancet in May 2011 presented the first nationally representative analysis of trends in sex-selective abortions in India. It came as an aftermath of the provisional 2011 census release which showed a fall in 0-6 year sex ratio from 927 in 2001 to 914 in 20111. 56 percent of Indian districts have child sex-ratio of less than 9152, spreading to areas where the sex-selective abortions were known to be negligible. This was in contrast to the fact that overall sex-ratio increased from 933 to 9401,3.Such findings necessitate a more specific approach to this problem by looking at the trends in child sex-ratio unlike the crude analysis of overall sex-ratios adopted earlier. Also this study provides an estimate of sex-selective abortions from 1980 to 2010 ranging from 4.2-12.1 million

Time trend and predictors of lab positivity among suspected cases in the post pandemic phase of H1N1

BackgroundWHO declared Influenza A H1N1  to have entered the post pandemic phase on August 10, 2010. Continued surveillance activities are recommended in the post pandemic phase to watch over the trend, severity and impact of Influenza like illnesses (ILI).AimsThis study aimed to document the epidemiological profile of lab positive H1N1 cases in post pandemic period from August 2010-December 2014 in nodal H1N1 surveillance centre of Puducherry.MethodsThe study analysed secondary data collected during the period August 10, 2010 to Dec 2014 from ILI suspects attending a tertiary care hospital, for the Integrated Disease Surveillance Project (IDSP).  Demographic details, lab positivity based on Real time –PCR technique for H1N1, clinical symptoms and outcomes were extracted. Data were analysed using STATA version 11.0. Independent predictors of lab positivity rate were identified using logistic regression analysis.  Time trend of frequency of suspected cases and lab positivity rate were performed using time series plots.ResultsA total of 2065 suspected cases were reported, of whom 197 cases were positive for H1N1 (lab positivity rate 9.5%).  Being an adult (OR: 1.6; 95% CI:1.1 - 2.3; p=0.02), management in in-patient settings (OR: 2.5; 95% CI:1.3-4.7; p=0.001), history of contact (OR: 2.7; 95% CI1.5 - 4.5; p=0.0001) and history of travel (OR: 2.3; 95% CI: 1.2 to 4.3; p=0.01) were the independent predictors for lab positivity. Death rate among lab confirmed cases was found to be 9.6 %. After 2012, the trend of laboratory confirmed H1N1 cases became a plateau. One needs to screen 35 suspected cases to capture one lab confirmed case of H1N1 in 2014.ConclusionLab positivity was seen among 9.5% of cases and the independent predictors were severe cases, adult patients, positive history of contact and travel. The number needed to screen to get one lab positive H1N1 case is 35 suspected cases

Increasing the accessibility, acceptability and use of the IUD in Gujarat, India

The USAID-funded FRONTIERS Program of the Population Council, in collaboration with the Department of Health & Family Welfare, Government of Gujarat, and the Center for Operations Research and Training, Vadodara, conducted an operations research study in India to test the hypothesis that by improving the demand for the IUD and simultaneously strengthening the technical competencies and counseling skills of the providers, use of the IUD use would increase. The findings show that demand-generation activities and provision of good-quality IUD services, together with a supportive programmatic environment, when carried out simultaneously showed increased acceptance of the IUD. The intervention could be easily integrated into the existing system. A sustained and coherent IEC campaign is required to remove myths; the IEC and counseling aids developed for the study have been well accepted by healthcare providers, clients, and national and state government officials

Estimation of the cardiovascular risk using World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in a rural population of South India

Background: World Health Organization/International Society of Hypertension (WHO/ISH) charts have been employed to predict the risk of cardiovascular outcome in heterogeneous settings. The aim of this research is to assess the prevalence of Cardiovascular Disease (CVD) risk factors and to estimate the cardiovascular risk among adults aged >40 years, utilizing the risk charts alone, and by the addition of other parameters. Methods: A cross-sectional study was performed in two of the villages availing health services of a medical college. Overall 570 subjects completed the assessment. The desired information was obtained using a pre- tested questionnaire and participants were also subjected to anthropometric measurements and laboratory investigations. The WHO/ISH risk prediction charts for the South-East Asian region was used to assess the cardiovascular risk among the study participants. Results: The study covered 570 adults aged above 40 years. The mean age of the subjects was 54.2 (±11.1) years and 53.3% subjects were women. Seventeen percent of the participants had moderate to high risk for the occurrence of cardiovascular events by using WHO/ISH risk prediction charts. In addition, CVD risk factors like smoking, alcohol, low High-Density Lipoprotein (HDL) cholesterol were found in 32%, 53%, 56.3%, and 61.5% study participants, respectively. Conclusion: Categorizing people as low (20%) risk is one of the crucial steps to mitigate the magnitude of cardiovascular fatal/non-fatal outcome. This cross-sectional study indicates that there is a high burden of CVD risk in the rural Pondicherry as assessed by WHO/ISH risk prediction charts. Use of WHO/ISH charts is easy and inexpensive screening tool in predicting the cardiovascular event

Contact tracing for COVID-19 in a healthcare institution: Our experience and lessons learned

During the initial phases of the COVID-19 pandemic contact tracing was used to control spread of the disease. It played a key role in health care institute which continued to work even during lockdown. In this piece of work, we share the lessons learnt from the contact tracing activity done in the health care institution during April to July 2020. The training needs of persons involved in contact tracing, the follow of activities, use of technology, methods to fill the missing gaps were the key lessons learnt. Its documentation supports in setting up contact tracing activity for any emerging infectious disease outbreaks in future

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

IS 30 THE MAGIC NUMBER? ISSUES IN SAMPLE SIZE ESTIMATION

ABSTRACT Research has become mandatory for career advancement of medical graduates. Researchers are often confounded by issues related to calculation of the required sample size. Various factors like level of significance, power of the study, effect size, precision and variability affect sample size. Also design issues like sampling technique and loss to follow up need to be considered before calculating sample size. Once these are understood, the researcher can estimate the required sample size using softwares like Open Epi. Correct estimation of sample size is important for the internal validity of the study and also prevents unnecessary wastage of resources