Global burden of disease due to smokeless tobacco consumption in adults : analysis of data from 113 countries

BACKGROUND: Smokeless tobacco is consumed in most countries in the world. In view of its widespread use and increasing awareness of the associated risks, there is a need for a detailed assessment of its impact on health. We present the first global estimates of the burden of disease due to consumption of smokeless tobacco by adults. METHODS: The burden attributable to smokeless tobacco use in adults was estimated as a proportion of the disability-adjusted life-years (DALYs) lost and deaths reported in the 2010 Global Burden of Disease study. We used the comparative risk assessment method, which evaluates changes in population health that result from modifying a population's exposure to a risk factor. Population exposure was extrapolated from country-specific prevalence of smokeless tobacco consumption, and changes in population health were estimated using disease-specific risk estimates (relative risks/odds ratios) associated with it. Country-specific prevalence estimates were obtained through systematically searching for all relevant studies. Disease-specific risks were estimated by conducting systematic reviews and meta-analyses based on epidemiological studies. RESULTS: We found adult smokeless tobacco consumption figures for 115 countries and estimated burden of disease figures for 113 of these countries. Our estimates indicate that in 2010, smokeless tobacco use led to 1.7 million DALYs lost and 62,283 deaths due to cancers of mouth, pharynx and oesophagus and, based on data from the benchmark 52 country INTERHEART study, 4.7 million DALYs lost and 204,309 deaths from ischaemic heart disease. Over 85 % of this burden was in South-East Asia. CONCLUSIONS: Smokeless tobacco results in considerable, potentially preventable, global morbidity and mortality from cancer; estimates in relation to ischaemic heart disease need to be interpreted with more caution, but nonetheless suggest that the likely burden of disease is also substantial. The World Health Organization needs to consider incorporating regulation of smokeless tobacco into its Framework Convention for Tobacco Control

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Measuring and assessing patient satisfaction with sexual health services

There is a high prevalence of sexual transmitted infections (STIs) within Organisation for Economic Co-operation and Development (OECD) settings particularly among ethnic minorities and marginalized groups which contributes significantly to the overall burden of disease. STIs have direct cost implications and impact on the overall wellbeing of patients, in part due to the strong stigma associated with contracting a STI. The thesis aimed to highlight the various aspects of sexual health services considered most important by patients while accessing care to inform healthcare decision-making for evaluation and planning (designing or re-designing) of services to ensure they are patient centred. A systematic review, qualitative synthesis and meta-ethnography, and primary research (qualitative) were conducted to establish themes pertaining to various aspects of services considered most important by patients and potential clients. This was further substantiated by generating an evidence-based discussion (based on existing theories in health economics and patient reported outcome measure (PROM) development processes) to justify the need for the development of a preference-based PROM specifically for sexual health services. Analysis of existing theories in health economics suggested that an Extra-Welfarist approach (expanding the evaluative space within quality adjusted life year (QALY) measurement) as more appropriate for measuring and valuing outcomes in this area. The findings of the systematic review highlighted important structural and methodological limitations in the existing assessment tools whereas the qualitative synthesis and meta-ethnography reported that patients had expectations which were far more than being tested and treated for STIs and receiving advice on contraception. Nine main themes were identified in the primary qualitative research: involvement in decision-making; clear and comprehensive diagnosis and treatment; being seen and getting results quickly; having a choice of appointment type; feeling respected and put at ease; non-judgemental and friendly staff; feeling reassured about confidentiality; having support with partner notification & being able to find & get to services. The findings of the thesis suggest that a standalone or de-novo sexual health services specific preference-based measure would better allow particular focus on the dimensions which are important to patients, with increased ability to detect meaningful changes in the status of patient

Oscillation Criteria of Singular Initial-Value Problem for Second Order Nonlinear Dynamic Equation on Time Scales

By using of generalized Opial’s type inequality on time scales, a new oscillation criterion is given for a singular initial-value problem of second-order dynamic equation on time scales. Some oscillatory results of its generalizations are also presented. Example with various time scales is given to illustrate the analytical findings

Economic evaluations of tobacco control interventions in low‐ and middle‐income countries: a systematic review

Background and Aims: Tobacco consumption and its associated adverse outcomes remain major public health issues, particularly in low- and middle-income countries. This systematic review aimed to identify and critically assess full economic evaluations for tobacco control interventions in low- and middle-income countries. Methods: Electronic databases, including EMBASE, MEDLINE and PsycINFO and the grey literature, were searched using terms such as ‘tobacco’, ‘economic evaluation’ and ‘smoking’ from 1994 to 2020. Study quality was assessed using the Consensus Health Economic Criteria and the Philips checklist. Studies were included which were full economic evaluations of tobacco control interventions in low- and middle-income settings. Reviews, commentaries, conference proceedings and abstracts were excluded. Study selection and quality assessment were conducted by two reviewers independently. A narrative synthesis was conducted to synthesize the findings of the studies. Results: This review identified 20 studies for inclusion. The studies evaluated a wide range of interventions, including tax increase, nicotine replacement therapy (nicotine patch/gum) and financial incentives. Overall, 12 interventions were reported to be cost-effective, especially tax increases for tobacco consumption and cessation counselling. There were considerable limitations regarding data sources (e.g. using cost data from other countries or assumptions due to the lack of local data) and the model structure; sensitivity analyses were inadequately described in many studies; and there were issues around the transferability of results to other settings. Additionally, the affordability of the interventions was only discussed in two studies. Conclusions: There are few high-quality studies of the cost-effectiveness of tobacco use control interventions in low- and middle-income countries. The methodological limitations of the existing literatures could affect the generalizability of the findings

Community Knowledge about Tuberculosis and Perception about Tuberculosis-Associated Stigma in Pakistan

Tuberculosis- (TB) associated stigma is a well-documented phenomenon with various factors, both individual and societal, manifesting its role in shaping health-seeking behavior and contributing to suboptimal TB care in Pakistan. The objective of this study was to assess TB-related knowledge and perceived stigma among community members. This was a cross-sectional survey using a convenience sample of 183 individuals recruited between October and December 2017. A validated stigma measurement tool developed by Van Rie et al. was adapted. Data was analyzed using SPSS version 20.0. A clear majority was aware that TB is curable disease and that it is transmitted by coughing. However, respondents also thought that TB spread through contaminated food, sharing meals, sharing utensils, and by having sexual intercourse with a TB patient. In addition, females, unemployed, and persons having less than six years of education were also more likely to associate stigma with TB. We found an association between the lack of knowledge about TB and perceived stigma. This study highlights the need for improved TB-related education among communities