Search

The health impacts of global climate change mitigation will affect local populations differently. However, most co-benefits analyses have been done at a global level, with relatively few studies providing local level results. We aimed to quantify the local health impacts due to fine particles (PM 2.5 ) under the governance arrangements embedded in the Shared Socioeconomic Pathways (SSPs1-5) under two greenhouse gas concentration scenarios (Representative Concentration Pathways (RCPs) 2.6 and 8.5) in local populations of Mozambique, India, and Spain. We simulated the SSP-RCP scenarios using the Global Change Analysis Model, which was linked to the TM5-FASST model to estimate PM 2.5 levels. PM 2.5 levels were calibrated with local measurements. We used comparative risk assessment methods to estimate attributable premature deaths due to PM 2.5 linking local population and mortality data with PM 2.5 -mortality relationships from the literature, and incorporating population projections under the SSPs. PM 2.5 attributable burdens in 2050 differed across SSP-RCP scenarios, and sensitivity of results across scenarios varied across populations. Future attributable mortality burden of PM 2.5 was highly sensitive to assumptions about how populations will change according to SSP. SSPs reflecting high challenges for adaptation (SSPs 3 and 4) consistently resulted in the highest PM 2.5 attributable burdens mid-century. Our analysis of local PM 2.5 attributable premature deaths under SSP-RCP scenarios in three local populations highlights the importance of both socioeconomic development and climate policy in reducing the health burden from air pollution. Sensitivity of future PM 2.5 mortality burden to SSPs was particularly evident in low- and middle- income country settings due either to high air pollution levels or dynamic populations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Exposure to high and low ambient temperatures is associated with morbidity and mortality across the globe. Most of these studies assessing the effects of non-optimum temperatures on health and have been conducted in the developed world, whereas in India, the limited evidence on ambient temperature and health risks and has focused mostly on the effects of heat waves. Here we quantify short term association between all temperatures and mortality in urban Pune, India., Methods: We applied a time series regression model to derive temperature-mortality associations based on daily mean temperature and all-cause mortality records of Pune city from year January 2004 to December 2012. We estimated high and low temperature-mortality relationships by using standard time series quasi-Poisson regression in conjunction with a distributed lag non-linear model (DLNM). We calculated temperature attributable mortality fractions for total heat and total cold., Findings: The analysis provides estimates of the total mortality burden attributable to ambient temperature. Overall, 6∙5% [95%CI 1.76-11∙43] of deaths registered in the observational period were attributed to non-optimal temperatures, cold effect was greater 5.72% [95%CI 0∙70-10∙06] than heat 0∙84% [0∙35-1∙34]. The gender stratified analysis revealed that the highest burden among men both for heat and cold., Conclusion: Non-optimal temperatures are associated with a substantial mortality burden. Our findings could benefit national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately due to climate change., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Studies reporting outcomes of salvage surgery in locally advanced head and neck squamous cell carcinoma (LAHNSCC) have inherent biases like biological and temporal selection. Our study considered all patients deemed fit for salvage surgery and compared to those who underwent surgery versus those who refused it thus throwing light on the real world benefit of salvage surgery., Methods: This was a post hoc analysis of a phase 3 randomized trial conducted between 2012 and 2018. Out of 536 LAHNSCC patients randomised in the study, 113 patients had residual disease or recurrent disease and were planned for salvage surgery in a multidisciplinary clinic. Patients were divided into 2 cohorts for comparison, willing for salvage surgery (n = 91) and unwilling for salvage surgery(n = 22). The primary endpoint was overall survival., Results: The median follow up was 28.7 months (95%CI 23.9-33.5 months). Out of the 91 patients who were willing for salvage surgery, 78 underwent same. The median survival in cohort of patients willing for salvage surgery was 22.0 months (95%CI 10.1-33.9) while it was 9.7 months (95%CI 6.6-12.8) in patients who were unwilling for salvage surgery (HR = 0.262 95%CI HR 0.147-0.469, p = 0.000)., Conclusion: Salvage surgery leads to a substantial improvement in outcomes in head and neck cancers and should be the de facto standard of care in patients who are eligible for the same., Competing Interests: Declaration of competing interest None of the other authors have anything to declare that maybe considered as potential competing interests., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Cabazitaxel has shown activity in squamous cancer cell lines and in taxane resistant cell lines. Hence we planned a phase 2 study to evaluate the efficacy of cabazitaxel against Docetaxel in recurrent head and neck cancer, post first line treatment., Methods: This was a phase 2, investigator initiated, randomized controlled trial of Docetaxel (75 mg/m 2 ) versus Cabazitaxel (20 mg/m 2 ), in patients with head and neck cancer with ECOG performance status 0-2 who have been exposed to at least one line of chemotherapy, involving a sample size of 92 (46 per group)(CTRI/2015/06/005848). Disease control rate at 6 weeks was assessed and compared using the chi-square test., Results: The disease control rate at 6 weeks was better in the Docetaxel arm over the cabazitaxel arm (52.3% versus 13.6%, p = 0.017). The median progression free survival was 21 days (95% CI 5.28 to 36.72 days) in the cabazitaxel arm versus 61 days (95% CI 21.39 to 100.60 days) in the Docetaxel arm (HR-1.455, 95% CI 0.919-2.304, p = 0.100). The median overall survival was 115 days (95% CI 74.04 to 155.95 days) in the cabazitaxel arm versus 155 days (95% CI 148.6 to 161.40 days) in the Docetaxel arm (HR-1.464, 95% CI 0.849-2.523, p = 0.170)., Conclusion: Docetaxel had a superior disease control rate at 6 weeks compared to cabazitaxel., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: An estimated 700 million people suffer from mosquito-borne diseases worldwide. Various types of mosquito repellents are widely used to prevent mosquito bites. The objectives of this study were (1) to measure the indoor levels of particulate matter < 2.5 μm in mean aerodynamic diameter (PM2.5) and carbon monoxide (CO) during the burning of mosquito coils (MCs) and study the impact of indoor ventilation patterns; and (2) to study and compare the prevalence of respiratory ailments in homes using different types of mosquito repellents., Methods: Indoor PM2.5 and CO levels were measured inside a bedroom during the burning of MCs keeping the window and/or door open/closed over a 6-h duration. A cross-sectional survey was conducted in three villages where 465 individuals were administered a questionnaire that captured demographic details, type and duration of mosquito repellents used, and prevalence of respiratory symptoms and diseases., Results: Fifty-three percent of the subjects burned MCs on most days of the week, and 63% did so with their doors and windows closed. Burning of MCs produced very high levels of PM2.5 (1,031 μg/m(3) mean, 1,613 μg/m(3) peak) and CO (6.50 parts per million (ppm) mean, 10.27 ppm peak) when both the door and window were closed. These levels reduced by around 50% when the window was opened and > 95% when both the window and the door were opened. The prevalence rates of respiratory symptoms and diseases were higher in subjects using MCs, although not statistically significant. Those living in smaller homes and using MCs had significantly greater morbidity., Conclusions: Burning of MCs produces indoor levels of PM2.5 and CO that are higher than those reported during the burning of biomass fuels for cooking purposes and may be associated with respiratory morbidity., (Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Background: Cetuximab based treatment is the recommended chemotherapy for head and neck squamous cell cancers in the palliative setting. However, due to financial constraints, intravenous (IV) chemotherapy without cetuximab is commonly used in lesser developed countries. We believe that oral metronomic chemotherapy may be safer and more effective in this setting., Methods: We conducted an open label, superiority, parallel design, randomized phase II trial comparing oral MCT [daily celecoxib (200mg twice daily) and weekly methotrexate (15mg/m(2))] to intravenous single agent cisplatin (IP) (75mg/m(2)) given 3 weekly. Eligible patients had head and neck cancers requiring palliative chemotherapy with ECOG PS 0-2 and adequate organ functions who could not afford cetuximab. The primary end point was progression-free survival., Results: 110 Patients were recruited between July 2011 to May 2013, 57 randomized to the MCT arm and 53 to the IP arm. Patients in the MCT arm had significantly longer PFS (median 101 days, 95% CI: 58.2-143.7 days) compared to the IP arm (median 66 days, 95% CI; 55.8-76.1 days) (p=0.014). The overall survival (OS) was also increased significantly in the MCT arm (median 249 days, 95% CI: 222.5-275.5 days) compared to the IP arm (median 152 days, 95% CI: 104.2-199.8 days) (p=0.02). There were fewer grade 3/4 adverse effects with MCT, which was not significant. (18.9% vs. 31.4%, P=0.14)., Conclusion: Oral metronomic chemotherapy has significantly better PFS and OS than single agent platinum in the palliative setting., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: The median survival of technically unresectable oral-cavity cancers (T4a and T4b) with non surgical therapy is 2-12 months. We hypothesized that neoadjuvant chemotherapy (NACT) could reduce the tumour size and result in successful resection and ultimately improved outcomes. We present a retrospective analysis of consecutive patients who received NACT at our centre between January 2008 and August 2012., Patients and Methods: All patients with technically unresectable oral cancers were assessed in a multidisciplinary clinic and received 2 cycles of NACT. After 2 cycles, patients were reassessed and planned for either surgery with subsequent CTRT or nonsurgical therapy including CT-RT, RT or palliation. SPSS version 16 was used for analysis of locoregional control and overall survival (OS). Univariate and multivariate analysis was done for factors affecting the OS., Results: 721 patients with stage IV oral-cavity cancer received NACT. 310 patients (43%) had sufficient reduction in tumour size and underwent surgical resection. Of the remaining patients, 167 received chemoradiation, 3 radical radiation and 241 palliative treatment alone The locoregional control rate at 24 months was 20.6% for the overall cohort, 32% in patients undergoing surgery and 15% in patients undergoing non surgical treatment (p=0.0001). The median estimated OS in patients undergoing surgery was 19.6 months (95% CI, 9.59-25.21 months) and 8.16 months (95%, CI 7.57-8.76) in patients treated with non surgical treatment (p=0.0001)., Conclusion: In our analysis, NACT led to successful resection and improved overall survival in a significant proportion of technically unresectable oral-cancer patients., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Rotavirus is the most common cause of severe dehydrating gastroenteritis in developing countries. Safe, effective, and affordable rotavirus vaccines are needed in these countries. We aimed to assess the efficacy and tolerability of a monovalent human-bovine rotavirus vaccine for severe rotavirus gastroenteritis in low-resource urban and rural settings in India., Methods: We did a randomised double-blind, placebo-controlled, multicentre trial at three sites in Delhi (urban), Pune (rural), and Vellore (urban and rural) between March 11, 2011, and Nov 5, 2012. Infants aged 6-7 weeks were randomly assigned (2:1), via a central interactive voice or web response system with a block size of 12, to receive either three doses of oral human-bovine natural reassortant vaccine (116E) or placebo at ages 6-7 weeks, 10 weeks, and 14 weeks. Infants' families, study investigators, paediatricians in referral hospitals, laboratory staff, and committee members were all masked to treatment allocation. The primary outcome was incidence of severe rotavirus gastroenteritis (≥11 on the Vesikari scale). Efficacy outcomes and adverse events were ascertained through active surveillance. Analysis was by intention to treat and per protocol. The trial is registered with Clinical Trial Registry-India (CTRI/2010/091/000102) and ClinicalTrials.gov (NCT01305109)., Findings: 4532 infants were assigned to receive the 116E vaccine and 2267 to receive placebo, of whom 4354 (96%) and 2187 (96%) infants, respectively, were included in the primary per-protocol efficacy analysis. 71 events of severe rotavirus gastroenteritis were reported in 4752 person-years in infants in the vaccine group compared with 76 events in 2360 person-years in those in the placebo group; vaccine efficacy against severe rotavirus gastroenteritis was 53·6% (95% CI 35·0-66·9; p=0·0013) and 56·4% (36·6-70·1; p<0·0001) in the first year of life. The number of infants needed to be immunised to prevent one severe rotavirus gastroenteritis episode was 55 (95% CI 37-97). The incidence of severe rotavirus gastroenteritis per 100 person-years was 1·5 in the vaccine group and 3·2 in the placebo group, with an incidence rate ratio of 0·46 (95% CI 0·33-0·65). Prevalence of immediate, solicited, and serious adverse events was similar in both groups. One case of urticaria in the vaccine group and one each of acute gastroenteritis and suspected sepsis in the placebo group were regarded as related to the study product. We recorded six cases of intussusception in the vaccine group and two in the placebo group, all of which happened after the third dose. 25 (<1%) infants in the vaccine group and 17 (<1%) in the placebo group died; no death was regarded as related to the study product., Interpretation: Monovalent human-bovine (116E) rotavirus vaccine is effective and well tolerated in Indian infants., Funding: Department of Biotechnology and the Biotechnology Industry Research Assistance Council, Government of India; Bill & Melinda Gates Foundation to PATH, USA; Research Council of Norway; UK Department for International Development; National Institutes of Health, Bethesda, USA; and Bharat Biotech International, Hyderabad, India., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

We compared prevalence estimates of self-rated health (SRH) derived indirectly using four different small area estimation methods for the Vadu (small) area from the national Study on Global AGEing (SAGE) survey with estimates derived directly from the Vadu SAGE survey. The indirect synthetic estimate for Vadu was 24% whereas the model based estimates were 45.6% and 45.7% with smaller prediction errors and comparable to the direct survey estimate of 50%. The model based techniques were better suited to estimate the prevalence of SRH than the indirect synthetic method. We conclude that a simplified mixed effects regression model can produce valid small area estimates of SRH., (© 2013 Published by Elsevier Ltd.)