162 results on '"Sathiakumar N"'
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2. Use of biomass fuel and acute respiratory infections in rural Pakistan
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Janjua, N.Z., Mahmood, B., Dharma, V.K., Sathiakumar, N., and Khan, M.I.
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- 2012
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3. Cancer Incidence among Semiconductor and Electronic Storage Device Workers
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Bender, T. J., Beall, C., Cheng, H., Herrick, R. F., Kahn, A. R., Matthews, R., Sathiakumar, N., Schymura, M. J., Stewart, J. H., and Delzell, E.
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- 2007
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4. An Updated Study of Mortality among North American Synthetic Rubber Industry Workers
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Sathiakumar, N., Graff, J., Macaluso, M., Maldonado, G., Matthews, R., and Delzell, E.
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- 2005
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5. A Cross-Sectional Study of Triallate Exposure and Neurological Health among Workers at a Pesticide Manufacturing and Formulating Facility
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Sathiakumar, N., Delzell, E., MacLennan, P. A., Anne, M., Rosenberg, N. L., Cheng, H., and Myers, S. L.
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- 2004
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6. Mortality following bone metastasis and skeletal-related events among men with prostate cancer: a population-based analysis of US Medicare beneficiaries, 1999–2006
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Sathiakumar, N, Delzell, E, Morrisey, M A, Falkson, C, Yong, M, Chia, V, Blackburn, J, Arora, T, and Kilgore, M L
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- 2011
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7. Musculoskeletal pain in four occupational populations in Sri Lanka
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Warnakulasuriya, S. S. P., Peiris-John, R. J., Coggon, D., Ntani, G., Sathiakumar, N., and Wickremasinghe, A. R.
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- 2012
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8. Cross-sectional study of triallate exposure and neurological health among workers at a pesticide manufacturing and formulating facility
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Sathiakumar, N., Delzell, E., and MacLennan, P. A.
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Occupational health and safety -- Cases ,Chemical industry -- Environmental aspects ,Herbicides -- Environmental aspects ,Pesticides industry -- Environmental aspects ,Company legal issue ,Health - Published
- 2004
9. Work-related Musculoskeletal Disorders among mail sorting officers in Sri Lanka: a cross sectional study
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Warnakulasuriya, SSP, primary, Peiris-John, RJ, additional, Sivayogan, S, additional, Sathiakumar, N, additional, Coggan, D, additional, and Wickremasinghe, AR, additional
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- 2012
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10. Air pollution and public health in developing countries: Is Sri Lanka different?
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Nandasena, S, primary, Wickremasinghe, AR, additional, and Sathiakumar, N, additional
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- 2012
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11. Accuracy of Self-Reported Adherence to Tuberculosis Therapy among DOTS patients in Mumbai
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Sathiakumar, N, primary, Bagchi, S, additional, Singh, D, additional, Vijay, PK, additional, and Ambe, G, additional
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- 2011
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12. Musculoskeletal complaints among nurses working at a tertiary care hospital in Karachi, Pakistan
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Kadir, M. M., primary, Khan, A. A., additional, Sathiakumar, N., additional, and Coggon, D., additional
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- 2011
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13. P2-547 Tile: musculoskeletal disorders and associated factors among nurses in Sri Lanka
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Warnakulasuriya, S., primary, Jone, R. P., additional, Wickramasinghe, A. R., additional, and Sathiakumar, N., additional
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- 2011
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14. P2-476 Association between maternal exposure to biomass smoke and birth weight: an analysis of 2005-2006 India demographic health survey data
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Sreeramareddy, C., primary, Shidhaye, R., additional, and Sathiakumar, N., additional
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- 2011
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15. Cancer incidence among semiconductor and electronic storage device workers
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Bender, T J, primary, Beall, C, additional, Cheng, H, additional, Herrick, R F, additional, Kahn, A R, additional, Matthews, R, additional, Sathiakumar, N, additional, Schymura, M J, additional, Stewart, J H, additional, and Delzell, E, additional
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- 2006
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16. Methodologic Issues in Follow-Up Studies of Cancer Incidence Among Occupational Groups in the United States
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BENDER, T, primary, BEALL, C, additional, CHENG, H, additional, HERRICK, R, additional, KAHN, A, additional, MATTHEWS, R, additional, SATHIAKUMAR, N, additional, SCHYMURA, M, additional, STEWART, J, additional, and DELZELL, E, additional
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- 2006
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17. Mortality from cancer and other causes of death among synthetic rubber workers
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Sathiakumar, N., primary, Delzell, E., additional, Hovinga, M., additional, Macaluso, M., additional, Julian, J. A., additional, Larson, R., additional, Cole, P., additional, and Muir, D. C., additional
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- 1998
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18. Exposure to Airborne Asbestos in Jamaican Hospitals.
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Scarlett, H. P., Delzell, E., Sathiakumar, N., Oestenstad, R. K., and Postlethwait, E.
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Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2010
19. Chemical exposures in the synthetic rubber industry and lymphohematopoietic cancer mortality.
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Graff JJ, Sathiakumar N, Macaluso M, Maldonado G, Matthews R, and Delzell E
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OBJECTIVE: This study evaluated the association between exposure to several chemicals and mortality from lymphohematopoietic cancer (LHC) among 16,579 synthetic rubber industry workers who were followed up from 1943 to 1998. METHODS: Poisson regression analyses examined LHC rates in relation to butadiene, styrene, and DMDTC exposure. Models provided maximum likelihood estimates of the relative rate for the contrast between categories of one agent, adjusting for other agents and for additional potential confounders. RESULTS: Cumulative exposure to 1,3-butadiene was associated positively with all leukemia (relative rates of 1.0, 1.4, 1.2, 2.9, and 3.7, respectively, for exposures of 0, >0 to <33.7, 33.7 to <184.7, 184.7 to <425.0, and 425.0+ ppm-years), chronic myelogenous leukemia and to a lesser extent with chronic lymphocytic leukemia. Adjusting for styrene and DMDTC attenuated these associations. After controlling for butadiene, neither styrene nor DMDTC displayed a consistent exposure-response trend with all leukemia, chronic myelogenous leukemia, or chronic lymphocytic leukemia. CONCLUSIONS: This study found a positive association between butadiene and leukemia that was not explained by exposure to other agents examined. [ABSTRACT FROM AUTHOR]
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- 2005
20. An updated mortality study of workers at a dye and resin manufacturing plant.
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Sathiakumar N and Delzell E
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This investigation evaluated the mortality experience of workers at a dye and resin manufacturing plant in New Jersey. The retrospective follow-up study included 3266 workers employed for at least 6 months at the plant. Plant production areas were South Dyes, where anthraquinone dyes and intermediates were produced; North Dyes, where azo dyes and intermediates were produced; and plastics and additives, where various resins and additives for plastics were made. Analyses used standardized mortality ratio (SMRs) to compare the cohort's cause-specific mortality rates during 1952 to 1995 with the rates of the New Jersey population. There were fewer than expected deaths from all causes combined (728 observed vs 810 expected) and similar numbers of observed and expected cancer deaths (225 vs 232). Statistically significant work area-specific cancer excesses were limited to white men and included an excess of lung cancer in Maintenance workers (40 observed vs 26 expected; SMR, 153; 95% confidence interval [CI], 109 to 208) and in South Dyes workers (32 observed vs 19 expected; SMR, 168; CI, 115 to 237) and an excess of stomach cancer (5 observed vs 1.3 expected; SMR, 386; CI, 125 to 901), bladder cancer (4 observed vs 0.8 expected; SMR, 515; CI, 140 to 1318) and central nervous system cancer (5 observed vs 1 expected; SMR, 517; CI, 168 to 1206) in North Dyes workers. None of these increases was concentrated in work area subgroups with long duration of employment and long potential induction time. It was concluded that the excess of bladder cancer probably was due to exposure to carcinogenic arylamines at another facility, where some employees had worked before coming to the study plant. The other cancer increases may be attributable to chance, to uncontrolled confounding by smoking, or to an unidentified occupational exposure. [ABSTRACT FROM AUTHOR]
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- 2000
21. Leukemia and exposure to 1,3-butadiene, styrene and dimethyldithiocarbamate among workers in the synthetic rubber industry
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Delzell, E., Macaluso, M., Sathiakumar, N., and Matthews, R.
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- 2001
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22. Cerebral palsy in Zaria, northern Nigeria--is it preventable?
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Sathiakumar, N. and Yakubu, A. M.
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- 1987
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23. Prevalence of syphilis among antenatal clinic attendees in Karachi: Imperative to begin universal screening in Pakistan
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Shah, S. A., Kristensen, S., Memon, M. A., Usman, G., Ghazi, A., John, R., Sathiakumar, N., and Sten Vermund
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Adult ,Male ,Substance-Related Disorders ,Article ,Cross-Sectional Studies ,Pregnancy ,Risk Factors ,Prenatal Diagnosis ,Surveys and Questionnaires ,Prevalence ,Urban Health Services ,Humans ,Female ,Pakistan ,Syphilis ,Treponema pallidum ,Pregnancy Complications, Infectious ,Needs Assessment - Abstract
To assess the prevalence and associated risk factors of syphilis among antenatal clinic attendees by a multi-center cross-sectional study in Karachi, Pakistan.We administered a structured questionnaire and obtained a blood sample for syphilis serology (rapid plasma reagin test with Treponema pallidum hemagglutination assay confirmation) from all women giving informed consent over six weeks in 2007. Prevalence was calculated at 95% confidence intervals. Multivariate analysis was adapted to assess risk factors.There were seven (0.9%) confirmed cases of syphilis (95% CI: 0.4, 1.8) in a sample size of 800 women recruited from three urban sites (-1% refusal rate). Women who lived in an area where male drug use is prevalent had 1.5% higher prevalence rates than women from the other two sites 0.5%.We documented higher-than-expected syphilis seroprevalence rates in a low risk population of antenatal clinic attendees in Pakistan. Bridge populations for syphilis may include drug users, who are usually married, and Hijras or their clients. In accordance with our results, the national policy for syphilis control in Pakistan should be modified to include universal syphilis screening in antenatal clinics with subsequent partner notification.
24. Correction: The CUPID (Cultural and Psychosocial Influences on Disability) Study: Methods of Data Collection and Characteristics of Study Sample
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Coggon D, Ntani G, Kt, Palmer, Ve, Felli, Harari R, Lh, Barrero, Sa, Felknor, Gimeno D, Cattrell A, Serra C, Bonzini M, Solidaki E, Merisalu E, Rr, Habib, Sadeghian F, Kadir M, Ssp, Warnakulasuriya, Matsudaira K, Nyantumbu B, Sim MR, Harcombe H, Cox K, Mh, Marziale, Lm, Sarquis, Harari F, Freire R, Harari N, Mv, Monroy, La, Quintana, Rojas M, Ej, Salazar Vega, Ec, Harris, Sergio Vargas-Prada, Jm, Martinez, Delclos G, Fg, Benavides, Carugno M, Mm, Ferrario, Ac, Pesatori, Chatzi L, Bitsios P, Kogevinas M, Oha K, Sirk T, Sadeghian A, Rj, Peiris-John, Sathiakumar N, Ar, Wickremasinghe, Yoshimura N, Kielkowski D, Hl, Kelsall, Vcw, Hoe, Dm, Urquhart, Derrett S, McBride D, and Gray A
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Multidisciplinary ,Science ,lcsh:R ,Medicine ,Correction ,lcsh:Medicine ,lcsh:Q ,lcsh:Science
25. Pulmonary tuberculosis in Mumbai, India: Factors responsible for patient and treatment delays
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Ashutosh Tamhane, Ambe G, Sh, Vermund, Cl, Kohler, Karande A, and Sathiakumar N
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treatment delay ,lcsh:R ,India ,lcsh:Medicine ,Original Article ,pulmonary tuberculosis ,Patient delay - Abstract
Purpose: To determine the factors responsible for patient delay and treatment delay in newly diagnosed sputum smear-positive pulmonary tuberculosis (TB) patients. Methods: Study subjects (N = 150) were randomly selected from municipal health centers in Mumbai, India. Duration of symptoms, treatment, and reason for delay were assessed using interviews and medical records. We defined patient delay as presentation to a health care provider (HCP) >20 days of the onset of TB-related symptoms and treatment delay as therapy initiated more than 14 days after the first consultation (for TB-related symptoms) with an HCP. Results: Of the 150 subjects, 29% had patient delays and 81% had treatment delays. In multivariable analysis, patient delay was significantly associated with the self-perception that initial symptoms were due to TB [odds ratio (OR) = 3.8, 95% confidence interval (CI) = 1.1-12.6] and perceived inability to pay for care (OR = 2.9, 95% CI = 1.2-7.1). Treatment delay was significantly associated with consulting a non-allopathic provider (OR = 12.3, 95% CI = 1.4-105) and consulting >3 providers (OR = 5.0, 95% CI = 1.4-17.4). Patient interval was half the treatment interval (median days: 15 vs. 31). Women were slightly more likely to experience patient and treatment delays than men. For two-thirds of the patients, another TB patient was a source of TB-related knowledge, while health education material (16%) and television (10%) played a smaller role. Conclusion: Treatment delay, primarily due to diagnosis delay, was a greater problem than patient delay. Expanding public-public and public-private partnerships and regular training sessions for HCPs might decrease treatment delay. Media coverage and cured TB patients as peer advocates may help to reinforce TB-related health education messages.
26. Heteropagus: a case report
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Sathiakumar, N., primary, Ifere, O.A.S., additional, Salawu, S.A.I., additional, and Mbamali, E.I., additional
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- 1988
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27. Association between biomass fuel use and maternal report of child size at birth - an analysis of 2005-06 India Demographic Health Survey data
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Sathiakumar Nalini, Shidhaye Rahul R, and Sreeramareddy Chandrashekhar T
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Public aspects of medicine ,RA1-1270 - Abstract
Background Observational epidemiological studies and a systematic review have consistently shown an association between maternal exposure to biomass smoke and reduced birth weight. Our aim was to further test this hypothesis. Methods We analysed the data from 47,139 most recent singleton births during preceding five years of 2005-06 India Demographic Health Survey (DHS). Information about birth weight from child health card and/or mothers' recall) was analysed. Since birth weight was not recorded for nearly 60% of the reported births, maternal self-report of child's size at birth was used as a proxy. Fuel type was classified as high pollution fuels (wood, straw, animal dung, and crop residues kerosene, coal and charcoal), and low pollution fuels (electricity, liquid petroleum gas (LPG), natural gas and biogas). Univariate and multivariable logistic regression models were developed using SURVEYLOGISTIC procedure in SAS system. We used three logistic regression models in which child factors, maternal factors and demographic factors were added step-by-step to the main exposure variable. Adjusted Odds Ratios (AORs) and their 95% CI were calculated. A p-value less than 0.05 was considered as significant. Results Child's birth weight was available for only 19,270 (41%) births; 3113 from health card and 16,157 from mothers' recall. For available data, mean birth weight was 2846.5 grams (SD = 684.6). Children born in households using high pollution fuels were 73 grams lighter than those born in households using low pollution fuels (mean birth weight 2883.8 grams versus 2810.7 grams, p < 0.001). Use of biomass fuels was associated with size at birth. Unadjusted OR was 1.41 (95% CI, 1.27 1.55). Adjusted OR after controlling for child factors was 1.41 (95% CI 1.29, 1.57). AOR after controlling for both child and maternal factors was 1.21 (95% CI 1.06, 1.32). In final model AOR was 1.07 (95% 0.94, 1.22) after controlling for child, maternal and demographic factors. Gender, birth order, mother's BMI, haemoglobin level and education were significant in all three models. Conclusions Use of biomass fuels is associated with child size at birth. Future studies should investigate this association using more direct methods for measurement of exposure to smoke emitted from biomass fuels and birth weight.
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- 2011
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28. Air pollution and health in Sri Lanka: a review of epidemiologic studies
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Sathiakumar Nalini, Wickremasinghe Ananda R, and Nandasena Yatagama
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Air pollution is increasingly documented as a threat to public health in most developing countries. Evaluation of current air quality levels, regulatory standards and scientific literature on outdoor and indoor air pollution, and health effects are important to identify the burden, develop and implement interventions and to fill knowledge gaps in Sri Lanka. Methods PUBMED and Medline databases, local journals and conference proceedings were searched for epidemiologic studies pertaining to air pollution and health effects in Sri Lanka. All the studies pertaining to air pollution and health effects were considered. Results Sixteen studies investigated the association between exposure to ambient or indoor air pollution (IAP) and various health outcomes ranging from respiratory symptoms, low birth weight and lung cancers. Of the sixteen, three used a case control design. Half of the studies collected exposure data only through questionnaires. There were positive associations between air pollution and adverse health effects in all studies. Methodological limitations in most of the studies resulted in poor quantification of risk estimates. Conclusion A limited number of epidemiological studies in Sri Lanka have investigated the health effects of air pollution. Based on findings of studies and reported air quality levels, air pollution may be considered a neglected public health problem in Sri Lanka.
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- 2010
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29. Effect of sunlight exposure on cognitive function among depressed and non-depressed participants: a REGARDS cross-sectional study
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Wadley Virginia G, Arnett Donna K, Crosson William L, McClure Leslie A, Kent Shia T, and Sathiakumar Nalini
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Industrial medicine. Industrial hygiene ,RC963-969 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Possible physiological causes for the effect of sunlight on mood are through the suprachiasmatic nuclei and evidenced by serotonin and melatonin regulation and its associations with depression. Cognitive function involved in these same pathways may potentially be affected by sunlight exposure. We evaluated whether the amount of sunlight exposure (i.e. insolation) affects cognitive function and examined the effect of season on this relationship. Methods We obtained insolation data for residential regions of 16,800 participants from a national cohort study of blacks and whites, aged 45+. Cognitive impairment was assessed using a validated six-item screener questionnaire and depression status was assessed using the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to find whether same-day or two-week average sunlight exposure was related to cognitive function and whether this relationship differed by depression status. Results Among depressed participants, a dose-response relationship was found between sunlight exposure and cognitive function, with lower levels of sunlight associated with impaired cognitive status (odds ratio = 2.58; 95% CI 1.43–6.69). While both season and sunlight were correlated with cognitive function, a significant relation remained between each of them and cognitive impairment after controlling for their joint effects. Conclusion The study found an association between decreased exposure to sunlight and increased probability of cognitive impairment using a novel data source. We are the first to examine the effects of two-week exposure to sunlight on cognition, as well as the first to look at sunlight's effects on cognition in a large cohort study.
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- 2009
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30. Acute health effects of the Tasman Spirit oil spill on residents of Karachi, Pakistan
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Najam-ul-Hassan, Khuwaja Urooj, Farooqui Sadia, Nawaz Haq, Kasi Pashtoon, Janjua Naveed, Jafri Syed, Lutfi Shahid, Kadir Muhammad, and Sathiakumar Nalini
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background On July 27 2003, a ship carrying crude oil run aground near Karachi and after two weeks released 37,000 tons of its cargo into the sea. Oil on the coastal areas and fumes in air raised health concerns among people. We assessed the immediate health impact of oil spill from the tanker Tasman Spirit on residents of the affected coastline in Karachi, Pakistan. Methods We conducted a study consisting of an exposed group including adults living in houses on the affected shoreline and two control groups (A and B) who lived at the distance of 2 km and 20 km away from the sea, respectively. We selected households through systematic sampling and interviewed an adult male and female in each household about symptoms relating to eyes, respiratory tract, skin and nervous system, smoking, allergies, beliefs about the effect on their health and anxiety about the health effects. We used logistic regression procedures to model each symptom as an outcome and the exposure status as an independent variable while adjusting for confounders. We also used linear regression procedure to assess the relationship exposure status with symptoms score; calculated by summation of all symptoms. Results Overall 400 subjects were interviewed (exposed, n = 216; group A, n = 83; and group B, n = 101). The exposed group reported a higher occurrence of one or more symptoms compared to either of the control groups (exposed, 96% vs. group A, 70%, group B 85%; P < 0.001). Mean summary symptom scores were higher among the exposed group (14.5) than control group A (4.5) and control group B (3.8, P < 0.001). Logistic regression models indicated that there were statistically significant, moderate-to-strong associations (Prevalence ORs (POR) ranging from 2.3 to 37.0) between the exposed group and the symptoms. There was a trend of decreasing symptom-specific PORs with increase in distance from the spill site. Multiple linear regression model revealed strong relationship of exposure status with the symptoms score (β = 8.24, 95% CI: 6.37 – 10.12). Conclusion Results suggest that the occurrence of increased symptoms among the exposed group is more likely to be due to exposure to the crude oil spill.
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- 2006
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31. Clinicopathological Features of Childhood Nephrotic Syndrome in Northern Nigeria
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ABDURRAHMAN, M. B., AIKHIONBARE, H. A., BABAOYE, F. A., SATHIAKUMAR, N., and NARAYANA, P. T.
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The clinicopathological features of childhood nephrotic syndrome in northern Nigeria were studied in 100 consecutive patients. The patients presented with gross anasarca and very low serum albumin, which was <15 g/1 in 30 patients. The three most frequent histological diagnoses in 98 renal biopsies were membranoproliferative glomerulonephritis (25), quartan malarial nephropathy (20), and proliferative glomerulonephritis (19): together they accounted for 65 per cent of all biopsies. Only nine patients had minimal change nephropathy. Antigens were detected by immunofluorescence in the glomeruli of 70 of 76 biopsies (92 per cent): Plasmodium malariae was detected in 25 per cent and hepatitis B surface antigen in 24 per cent. The disease was characterized by progressive deterioration in renal function and a high mortality rate of 13 per cent. Nine of the 13 deaths occurred within one year of diagnosis.
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- 1990
32. Implementation of a non-randomized controlled trial of yoga-based intervention to reduce behavioural issues in early adolescent school-going children in Sri Lanka.
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Sivashankar JT, Surenthirakumaran R, Doherty S, and Sathiakumar N
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- Adolescent, Child, Humans, Schools, Sri Lanka, Meditation, Problem Behavior, Yoga psychology
- Abstract
Background: Adolescence can be difficult to navigate and the post-conflict environment in Jaffna Province, Sri Lanka compounds existing issues for adolescents. Conduct problems, hyperactivity along with emotional problems are challenges faced by adolescents, particularly in fragile, post-conflict settings. This study was a non-randomized controlled trial carried out in 4 educational zones over 6 months. The study implemented a yoga-based intervention package: two types of slow breathing for 5-6 min, Surya-namaskaram for 6-8 min, and mindfulness meditation for 5-6 min. Pre/post quantitative assessments were conducted with intervention and control groups. A focus group was conducted with the intervention group. The aim was to evaluate. Effectiveness of implementing a yoga-based intervention package in grade 8 school children (early adolescents) to address behavioural problems., Results: Paired t-test and independent t-tests were completed for both arms using statistical product and service solutions (SPSS21). Parents' assessments of emotional issues reduced for the intervention group (n = 584) [t(584) = 11.41, p = 0.001] along with reduction of the total difficulty score [t(584) = 28.12, p = 0.001]. Teachers' assessments indicated prosocial scores improved in the intervention group [t(584) = - 28.5, p = 0.001]. Students' self-assessments in the intervention group indicate a reduction in emotional problems [t(584) = 6.4, p = 0.001], and reduction in problems with peers [t(584) = 14.4, p = 0.001]. Within the control group (n = 499), teachers' assessments indicated emotional problems increased [t(499) = - 9.5, p = 0.001] and prosocial scores reduced [t(499) = 13.5, p = 0.001]. Students' self-assessments in the control group indicated emotional problems increased [t(499) = - 27.1, p = 0.001]. A comparison of post-test scores revealed a statistically significant difference between groups. Focus group results indicate students felt the intervention had an overall positive effect on school achievements, family dynamics and individual health., Conclusions: This yoga-based intervention package appeared to be effective in reducing both externalizing and internalizing symptoms in adolescents. Practicing Surya-namaskaram, breathing control techniques and mindfulness meditation significantly reduced both externalizing symptoms (conduct problems and hyperactivity) as well as internalizing symptom (emotional problem and peer problems). It is recommended this intervention be scaled up across Sri Lanka and other similar post-conflict regions., (© 2022. The Author(s).)
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- 2022
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33. 1,3-Butadiene, styrene and lymphohaematopoietic cancers among North American synthetic rubber polymer workers: exposure-response analyses.
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Sathiakumar N, Bolaji BE, Brill I, Chen L, Tipre M, Leader M, Arora T, and Delzell E
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- Cohort Studies, Elastomers, Female, Humans, Lymphoma, B-Cell epidemiology, Lymphoma, Non-Hodgkin epidemiology, Male, Multiple Myeloma epidemiology, North America epidemiology, Regression Analysis, Butadienes adverse effects, Leukemia epidemiology, Occupational Exposure adverse effects, Styrene adverse effects
- Abstract
Objective: To evaluate exposure-response between 1,3-butadiene, styrene and lymphohaematopoietic cancers in an updated cohort of workers at six North American plants that made synthetic rubber polymers., Methods: Employees were followed from 1943 through 2009 to determine mortality outcomes. Cox regression analyses estimated rate ratios (RRs) and 95% CIs by quartile of cumulative exposure to butadiene or styrene, measured in parts per million-years (ppm-years), and exposure-response trends for all leukaemia, lymphoid leukaemia, myeloid leukaemia, acute myeloid leukaemia, non-Hodgkin's lymphoma (NHL), multiple myeloma and all B-cell malignancies., Results: Among 21 087 workers, adjusted RRs for butadiene and all leukaemia (132 deaths) rose with increasing exposure, with an RR of 2.53 (95% CI 1.37 to 4.67) in the highest exposure quartile (≥363.64 ppm-years), and the exposure-response trend was statistically significant for all leukaemia (p=0.014) and for lymphoid leukaemia (52 deaths, p=0.007). Styrene exposure-response trends for all leukaemia and lymphoid leukaemia were less consistent than those for butadiene. Cumulative exposures to butadiene and styrene were not associated consistently with myeloid leukaemias or the B-cell malignancies, NHL and multiple myeloma., Conclusions: We confirmed a positive exposure-response relationship between butadiene and all leukaemia among workers, most of whom had coexposure to styrene. Results supported an association between butadiene and lymphoid leukaemia, but not myeloid leukaemia, and provided little evidence of any association of butadiene or styrene exposures with major subtypes of B-cell malignancies other than lymphoid leukaemia, including NHL and multiple myeloma., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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34. 1,3-Butadiene, styrene and selected outcomes among synthetic rubber polymer workers: Updated exposure-response analyses.
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Sathiakumar N, Bolaji B, Brill I, Chen L, Tipre M, Leader M, Arora T, and Delzell E
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- Aged, Canada, Chemical Industry statistics & numerical data, Cohort Studies, Female, Humans, Lung Neoplasms etiology, Lung Neoplasms mortality, Male, Middle Aged, Occupational Diseases mortality, Proportional Hazards Models, Pulmonary Disease, Chronic Obstructive etiology, Pulmonary Disease, Chronic Obstructive mortality, Sex Factors, United States, Urinary Bladder Neoplasms etiology, Urinary Bladder Neoplasms mortality, Butadienes toxicity, Carcinogens toxicity, Elastomers, Occupational Diseases etiology, Occupational Exposure adverse effects, Styrene toxicity
- Abstract
Objective: - To evaluate exposure-response relationships between 1,3-butadiene and styrene and selected diseases among synthetic rubber polymer workers., Methods: - 21,087 workers (16,579 men; 4508 women) were followed from 1943 through 2009 to determine mortality outcomes. Cox regression models estimated rate ratios (RRs) and 95% confidence intervals (CIs) by quartile of cumulative exposure to butadiene or styrene and exposure-response trends for cancers of the bladder, lung, kidney, esophagus and pancreas, and for all nonmalignant respiratory disease (NMRD), chronic obstructive pulmonary disease (COPD) and pneumonia., Results: - Bladder cancer RRs were 2.13 (95% CI = 1.03 to 4.41) and 1.64 (95% CI = 0.76 to 3.54) in the highest quartiles of cumulative exposure to butadiene and styrene, respectively, and exposure-response trends were positive for both monomers (butadiene, trend p = 0.001; styrene, trend p = 0.004). Further analyses indicated that the exposure-response effect of each monomer on bladder cancer was demonstrated clearly only in the subgroup with high cumulative exposure (at or above the median) to the other monomer. Lung cancer was not associated with either monomer among men. Among women, lung cancer RRs were above 1.0 in each quartile of cumulative exposure to each monomer, but exposure-response was not seen for either monomer. Male workers had COPD RRs slightly above 1.0 in each quartile of cumulative exposure to each monomer, but there was no evidence of exposure-response among the exposed. Monomer exposure was not consistently associated with COPD in women or with the other cancer outcomes., Conclusions: - This study found a positive exposure-response relationship between monomer exposures and bladder cancer. The independent effects of butadiene and styrene on this cancer could not be delineated. In some analyses, monomer exposure was associated with lung cancer in women and with COPD in men, but inconsistent exposure-response trends and divergent results by sex do not support a causal interpretation of the isolated positive associations., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2021
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35. Effects of indoor air pollution due to solid fuel combustion on physical growth of children under 5 in Sri Lanka: A descriptive cross sectional study.
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Ranathunga N, Perera P, Nandasena S, Sathiakumar N, Kasturiratne A, and Wickremasinghe AR
- Subjects
- Child, Preschool, Cross-Sectional Studies, Humans, Infant, Infant, Newborn, Particulate Matter, Prevalence, Air Pollution, Indoor
- Abstract
Solid fuel combustion is an important risk factor of morbidity. This study was conducted to determine the effect of indoor air pollution (IAP) due to solid fuel combustion on physical growth in 262 Sri Lankan children under five. Exposure was defined by the type of fuel used for cooking. Pollutant levels were measured in a subsample of households. "High" exposure group (households using biomass fuel/kerosene oil for cooking) comprised 60% of the study population; the prevalence of wasting was 19.7% and underweight was 20.4% in the entire population where 68% were from the high exposure group. Children from the "high" exposure group had significantly lower mean z-scores for weight-for-height (p = 0.047), height-for-age (p = 0.004) and weight-for-age (p = 0.001) as compared to the "low" exposure group (children of households using liquefied petroleum gas and/or electricity) after adjusting for confounders. Z-scores of weight-for-age, height-for-age and weight-for-height were negatively correlated with CO (p = 0.001, 0.018, 0.020, respectively) and PM2.5 concentrations (p<0.001,p = 0.024 p = 0.008, respectively). IAP due to combustion of biomass fuel leads to poor physical growth., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2021
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36. The Changing Aspects of Motherhood in Face of the COVID-19 Pandemic in Low- and Middle-Income Countries.
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Kingsley JP, Vijay PK, Kumaresan J, and Sathiakumar N
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- Adult, Female, Humans, Maternal Health Services statistics & numerical data, Mothers statistics & numerical data, Pandemics, Poverty statistics & numerical data, Pregnancy, SARS-CoV-2, COVID-19 epidemiology, COVID-19 mortality, Developing Countries statistics & numerical data, Maternal Health Services organization & administration, Mothers psychology, Pregnancy Outcome, Pregnant Women psychology
- Abstract
Purpose: To advocate perspectives to strengthen existing healthcare systems to prioritize maternal health services amidst and beyond the COVID-19 pandemic in low- and middle income countries., Description: COVID-19 directly affects pregnant women causing more severe disease and adverse pregnancy outcomes. The indirect effects due to the monumental COVID-19 response are much worse, increasing maternal and neonatal mortality., Assessment: Amidst COVID-19, governments must balance effective COVID-19 response measures while continuing delivery of essential health services. Using the World Health Organization's operational guidelines as a base, countries must conduct contextualized analyses to tailor their operations. Evidence based information on different services and comparative cost-benefits will help decisions on trade-offs. Situational analyses identifying extent and reasons for service disruptions and estimates of impacts using modelling techniques will guide prioritization of services. Ensuring adequate supplies, maintaining core interventions, expanding non-physician workforce and deploying telehealth are some adaptive measures to optimize care. Beyond the COVID-19 pandemic, governments must reinvest in maternal and child health by building more resilient maternal health services supported by political commitment and multisectoral engagement, and with assistance from international partners., Conclusions: Multi-sectoral investments providing high-quality care that ensures continuity and available to all segments of the population are needed. A robust primary healthcare system linked to specialist care and accessible to all segments of the population including marginalized subgroups is of paramount importance. Systematic approaches to digital health care solutions to bridge gaps in service is imperative. Future pandemic preparedness programs must include action plans for resilient maternal health services.
- Published
- 2021
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37. Mortality Among Men and Women in the North American Synthetic Rubber Industry, 1943 to 2009.
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Sathiakumar N, Tipre M, Leader M, Brill I, and Delzell E
- Subjects
- Aged, Aged, 80 and over, Butadienes adverse effects, Canada epidemiology, Female, Humans, Leukemia mortality, Lung Neoplasms mortality, Lymphoma, Non-Hodgkin mortality, Male, Middle Aged, Mortality, Occupational Exposure adverse effects, Proportional Hazards Models, Styrene adverse effects, Time Factors, United States epidemiology, Urinary Bladder Neoplasms mortality, Manufacturing Industry statistics & numerical data, Neoplasms mortality, Occupational Exposure statistics & numerical data, Rubber
- Abstract
Objective: To evaluate 1943 to 2009 mortality among 22,785 synthetic rubber industry employees., Methods: Standardized mortality ratio (SMR) and internal Cox regression analyses., Results: Among hourly employees with more than or equal to 10 years worked and more than or equal to 20 years since hire, SMRs were elevated for leukemia (SMR = 139, 95% confidence interval [CI] = 106 to 179), non-Hodgkin lymphoma (NHL) (SMR = 136, CI = 102 to 177), bladder cancer (SMR = 148, CI = 110 to 195) and, for women only, lung cancer (SMR = 225, CI = 103 to 427). Butadiene and styrene exposure-response trends were positive for leukemia and bladder cancer but not for NHL or for lung cancer among women., Conclusions: Results support a causal relationship between butadiene and leukemia. Interpretation of results for lung cancer among women and for bladder cancer is uncertain because of inability to control for smoking and inadequate or inconsistent support from other studies for an association between butadiene or styrene and the latter cancers.
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- 2019
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38. Effect of household air pollution due to solid fuel combustion on childhood respiratory diseases in a semi urban population in Sri Lanka.
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Ranathunga N, Perera P, Nandasena S, Sathiakumar N, Kasturiratne A, and Wickremasinghe R
- Subjects
- Asthma epidemiology, Asthma etiology, Child, Preschool, Educational Status, Electricity, Female, Follow-Up Studies, Humans, Infant, Kerosene toxicity, Lunch, Male, Petroleum toxicity, Prospective Studies, Respiratory Tract Infections complications, Respiratory Tract Infections epidemiology, Sri Lanka, Air Pollution, Indoor adverse effects, Cooking methods, Fossil Fuels toxicity, Respiration Disorders etiology, Suburban Population
- Abstract
Background: Household air pollution from combustion of solid fuels for cooking and space heating is one of the most important risk factors of the global burden of disease. This study was aimed to determine the association between household air pollution due to combustion of biomass fuel in Sri Lankan households and self-reported respiratory symptoms in children under 5 years., Methods: A prospective study was conducted in the Ragama Medical Officer of Health area in Sri Lanka. Children under 5 years were followed up for 12 months. Data on respiratory symptoms were extracted from a symptom diary. Socioeconomic data and the main fuel type used for cooking were recorded. Air quality measurements were taken during the preparation of the lunch meal over a 2-h period in a subsample of households., Results: Two hundred and sixty two children were followed up. The incidence of infection induced asthma (RR = 1.77, 95%CI;1.098-2.949) was significantly higher among children resident in households using biomass fuel and kerosene (considered as the high exposure group) as compared to children resident in households using Liquefied Petroleum Gas (LPG) or electricity for cooking (considered as the low exposure group), after adjusting for confounders. Maternal education was significantly associated with the incidence of infection induced asthma after controlling for other factors including exposure status. The incidence of asthma among male children was significantly higher than in female children (RR = 1.17; 95% CI 1.01-1.37). Having an industry causing air pollution near the home and cooking inside the living area were significant risk factors of rhinitis (RR = 1.39 and 2.67, respectively) while spending less time on cooking was a protective factor (RR = 0.81). Houses which used biomass fuel had significantly higher concentrations of carbon monoxide (CO) (mean 2.77 ppm vs 1.44 ppm) and particulate matter
2.5 (PM2.5 ) (mean 1.09 mg/m3 vs 0.30 mg/m3 ) as compared to houses using LPG or electricity for cooking., Conclusion: The CO and PM2.5 concentrations were significantly higher in households using biomass fuel for cooking. There was a 1.6 times higher risk of infection induced asthma (IIA) among children of the high exposure group as compared to children of the low exposure group, after controlling for other factors. Maternal education was significantly associated with the incidence of IIA after controlling for exposure status and other variables.- Published
- 2019
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39. Building global partnerships through shared curricula for an MPH programme in India and Sri Lanka.
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Sathiakumar N, Tipre M, Wickremasinghe R, Bhat V, Kadir MM, Coggon D, Pathemeswaran A, Kamath R, Arunkumar G, Fatmi Z, Smith TL, Pattanshetty SM, and Delzell E
- Subjects
- Humans, India, Program Development, Sri Lanka, Curriculum, Education, Graduate organization & administration, Education, Public Health Professional organization & administration, International Cooperation
- Abstract
Objective: To design and implement a locally relevant competency- based MPH programme., Methods: The demand for trained public health professionals in South Asia is enormous and growing, which created a unique opportunity for a Fogarty International Center-funded University of Alabama at Birmingham-South Asia [Aga Khan University, Pakistan; Manipal Academy of Higher Education, India; and University of Kelaniya, Sri Lanka] international research training in environmental and occupational health (ITREOH) programme. In 2009, a Master of Public Health (MPH) degree programme was designed using a combination of competencies developed by the Association of School of Public Health, the World Health Organization and the Centers for Disease Control and Prevention., Results: A competency- based curriculum was developed with two specialty tracks in applied epidemiology and environmental and occupational health, emphasising applied practice and research., Conclusions: This is the most comprehensive skill-based MPH programme in the region, which positions each institution as a regional leader in public health training. The success of the programme has been amply demonstrated by placements of graduated MPH students in leadership roles in public, private and academic sectors within their countries.
- Published
- 2019
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40. Accuracy of Medicare Claim-based Algorithm to Detect Breast, Prostate, or Lung Cancer Bone Metastases.
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Sathiakumar N, Delzell E, Yun H, Jooste R, Godby K, Falkson C, Yong M, and Kilgore ML
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- Aged, Aged, 80 and over, Early Detection of Cancer statistics & numerical data, Female, Humans, Insurance Claim Review, Male, United States, Algorithms, Breast Neoplasms diagnosis, Lung Neoplasms diagnosis, Medicare organization & administration, Prostatic Neoplasms diagnosis
- Abstract
Background: We had previously developed an algorithm for Medicare claims data to detect bone metastases associated with breast, prostate, or lung cancer. This study was conducted to examine whether this algorithm accurately documents bone metastases on the basis of diagnosis codes in Medicare claims data., Methods: We obtained data from Medicare claims and electronic medical records of patients 65 years or older with a breast, prostate, or lung cancer diagnosis at a teaching hospital and/or affiliated clinics during 2005 or 2006. We calculated the sensitivity and positive predictive value (PPV) of our algorithm using medical records as the "gold standard." The κ statistic was used to measure agreement between claims and medical record data., Results: The agreement between claims and medical record data for bone metastases among breast, prostate, and lung cancer patients was 0.93, 0.90, and 0.69, respectively. The sensitivities of our algorithm for bone metastasis in patients with breast, prostate, and lung were 96.8% [95% confidence interval (CI)=83.8% to 99.4%], 91.7% (95% CI=78.2% to 97.1%), and 74.1% (95% CI=55.3% to 86.8%), respectively; and the PPVs were 90.9% (95% CI=76.4% to 96.9%), 91.7% (95% CI=78.2% to 97.1%), and 71.4% (95% CI=52.9% to 84.8%), respectively., Conclusions: The algorithm for detecting bone metastases in claims data had high sensitivity and PPV for breast and prostate cancer patients. Sensitivity and PPV were lower but still moderate for lung cancer patients.
- Published
- 2017
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41. Post-Deepwater Horizon Oil Spill Exposure Patterns Among Children in Mobile County, Alabama.
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Tipre M, Turner-Henson A, Tiwari HK, Gohlke J, Chen L, Leader M, and Sathiakumar N
- Subjects
- Adult, Aged, Aged, 80 and over, Alabama epidemiology, Child, Child, Preschool, Environmental Exposure adverse effects, Female, Gulf of Mexico, Humans, Male, Middle Aged, Petroleum Pollution adverse effects, Young Adult, Environmental Exposure statistics & numerical data, Petroleum Pollution statistics & numerical data, Water Pollutants, Chemical adverse effects
- Abstract
Objective: The aim of this study was to characterize environmental exposure from Deepwater Horizon oil spill among pre-K to fourth-grade children from six schools in Mobile County, Alabama., Methods: A mail-in survey administered 11 months post-oil spill to children's parents/caregivers elicited information on exposure-related activities. Descriptive and multivariable analyses were performed., Results: Overall, 180 children (coastal schools, 90; inland schools, 90) completed the survey. During the post-oil spill period, children in coastal schools were less likely to reduce their exposure-related activities, including fishing; eating and selling caught fish; visiting beaches; and parental participation in cleanup activities, than children in inland schools. Particularly, fishing and eating caught fish were significantly associated with the coastal group (odds ratio = 2.28; 95% confidence interval = 1.54 to 3.36)., Conclusion: Proximity to the shoreline may serve as an indicator for potential exposure in oil spills among vulnerable populations including children.
- Published
- 2017
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42. Epidemiological Differences Between Localized and Nonlocalized Low Back Pain.
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Coggon D, Ntani G, Walker-Bone K, Palmer KT, Felli VE, Harari R, Barrero LH, Felknor SA, Gimeno D, Cattrell A, Vargas-Prada S, Bonzini M, Solidaki E, Merisalu E, Habib RR, Sadeghian F, Kadir MM, Warnakulasuriya SS, Matsudaira K, Nyantumbu B, Sim MR, Harcombe H, Cox K, Sarquis LMM, Marziale MH, Harari F, Freire R, Harari N, Monroy MV, Quintana LA, Rojas M, Harris EC, Serra C, Martinez JM, Delclos G, Benavides FG, Carugno M, Ferrario MM, Pesatori AC, Chatzi L, Bitsios P, Kogevinas M, Oha K, Freimann T, Sadeghian A, Peiris-John RJ, Sathiakumar N, Wickremasinghe AR, Yoshimura N, Kelsall HL, Hoe VCW, Urquhart DM, Derrett S, McBride D, Herbison P, Gray A, and Salazar Vega EJ
- Subjects
- Adult, Age Distribution, Cohort Studies, Cross-Sectional Studies, Female, Humans, Incidence, Low Back Pain diagnosis, Male, Middle Aged, Occupational Diseases diagnosis, Occupational Diseases epidemiology, Prevalence, Risk Factors, Sex Characteristics, Surveys and Questionnaires, Low Back Pain epidemiology
- Abstract
Study Design: A cross-sectional survey with a longitudinal follow-up., Objectives: The aim of this study was to test the hypothesis that pain, which is localized to the low back, differs epidemiologically from that which occurs simultaneously or close in time to pain at other anatomical sites SUMMARY OF BACKGROUND DATA.: Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain., Methods: We analyzed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability, and potential risk factors, in 47 occupational groups (office workers, nurses, and others) from 18 countries., Results: Among 12,197 subjects at baseline, 609 (4.9%) reported localized LBP in the past month, and 3820 (31.3%) nonlocalized LBP. Nonlocalized LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, nonlocalized LBP was differentially associated with risk factors, particularly female sex, older age, and somatizing tendency. There were also marked differences in the relative prevalence of localized and nonlocalized LBP by occupational group., Conclusion: Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP that occurs in association with pain at other anatomical locations., Level of Evidence: 2.
- Published
- 2017
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43. Post-deepwater horizon blowout seafood consumption patterns and community-specific levels of concern for selected chemicals among children in Mobile County, Alabama.
- Author
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Sathiakumar N, Tipre M, Turner-Henson A, Chen L, Leader M, and Gohlke J
- Subjects
- Alabama, Animals, Arsenic analysis, Child, Child, Preschool, Crustacea, Dioctyl Sulfosuccinic Acid analysis, Environmental Monitoring, Female, Fishes, Food Safety, Gulf of Mexico, Humans, Male, Metals, Heavy analysis, Methylmercury Compounds analysis, Nutrition Surveys, Petroleum, Polycyclic Aromatic Hydrocarbons analysis, Risk Assessment, Food Contamination analysis, Petroleum Pollution, Seafood analysis, Water Pollutants, Chemical analysis
- Abstract
Purpose: The goal of the study was to characterize risk pertaining to seafood consumption patterns following the Deepwater Horizon oil spill, among school children (K to 4th grade) residing in close proximity to the Gulf of Mexico in Mobile County, Alabama., Methods: Responses on seafood consumption pattern including the type of seafood and intake rate during the pre and post oil spill periods, from parents of 55 school children from three schools located <20mile radius from the Gulf of Mexico shoreline (coastal group) were compared with those from parents of 55 children from three schools located ≥20miles away from the shoreline (inland group). We also estimated levels of concern (LOCs) in seafood for selected chemicals found in crude oil including heavy metals, and polycyclic aromatic hydrocarbons (PAH), and dioctyl sodium sulfosuccinate (DOSS), the primary compound in dispersants., Results: The coastal group ate more seafood consisting primarily of crustaceans (62% vs. 42%, p=0.04) and fin fish (78% vs. 58%, p=0.02) from the Gulf of Mexico compared to the inland group, while the inland group ate more fin fish not found in the Gulf of Mexico (62% vs. 33%, p<0.01). In the post-oil spill time period, both groups substantially reduced their consumption of sea food. On average, the coastal group ate ≥2 seafood meals per week, while the inland group ate ≤1 meal per week; these frequency patterns persisted in the post oil-spill period. Comparison of the estimated LOCs with contaminant levels detected in the seafood tested by the Food and Drug Administration and National Oceanic and Atmospheric Administration, post-oil spill, found that the levels of PAHs, arsenic, and DOSS in seafood were 1-2 orders of magnitude below the LOCs calculated in our study. Levels of methyl mercury (MeHg) in the seafood tested pre- and post- oil spill were higher than the estimated LOCs suggesting presence of higher levels of MeHg in seafood independent of the oil spill., Conclusion: In sum, the study found higher than average seafood consumption among children along the Mobile coastal area when compared to the inland children and the National Health and Nutrition Examination Survey (NHANES) estimates. Risk characterization based on the LOCs indicated no increase in risk of exposure despite higher seafood consumption rates among the study population compared to the general population., (Copyright © 2016. Published by Elsevier GmbH.)
- Published
- 2017
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44. Melioidosis in Malaysia: A Review of Case Reports.
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Kingsley PV, Leader M, Nagodawithana NS, Tipre M, and Sathiakumar N
- Subjects
- Adult, Bacteremia epidemiology, Child, Diabetes Mellitus, Female, Humans, Infant, Newborn, Malaysia epidemiology, Male, Melioidosis complications, Melioidosis mortality, Risk Factors, Young Adult, Burkholderia pseudomallei isolation & purification, Melioidosis epidemiology, Melioidosis microbiology
- Abstract
Background: Melioidosis is a tropical infectious disease associated with significant mortality due to early onset of sepsis., Objective: We sought to review case reports of melioidosis from Malaysia., Methods: We conducted a computerized search of literature resources including PubMed, OVID, Scopus, MEDLINE and the COCHRANE database to identify published case reports from 1975 to 2015. We abstracted information on clinical characteristics, exposure history, comorbid conditions, management and outcome., Results: Overall, 67 cases were reported with 29 (43%) deaths; the median age was 44 years, and a male preponderance (84%) was noted. Forty-one cases (61%) were bacteremic, and fatal septic shock occurred in 13 (19%) within 24-48 hours of admission; nine of the 13 cases were not specifically treated for melioidosis as confirmatory evidence was available only after death. Diabetes mellitus (n = 36, 54%) was the most common risk factor. Twenty-six cases (39%) had a history of exposure to contaminated soil/water or employment in high-risk occupations. Pneumonia (n = 24, 36%) was the most common primary clinical presentation followed by soft tissue abscess (n = 22, 33%). Other types of clinical presentations were less common-genitourinary (n = 5), neurological (n = 5), osteomyelitis/septic arthritis (n = 4) and skin (n = 2); five cases had no evidence of a focus of infection. With regard to internal foci of infection, abscesses of the subcutaneous tissue (n = 14, 21%) was the most common followed by liver (18%); abscesses of the spleen and lung were the third most common (12% each). Seven of 56 males were reported to have prostatic abscesses. Mycotic pseudoaneurysm occurred in five cases. Only one case of parotid abscess was reported in an adult. Of the 67 cases, 13 were children (≤ 18 years of age) with seven deaths; five of the 13 were neonates presenting primarily with bronchopneumonia, four of whom died. Older children had a similar presentation as adults; no case of parotid abscess was reported among children., Conclusions: The clinical patterns of cases reported from Malaysia are consistent for the most part from previous case reports from South and Southeast Asia with regard to common primary presentations of pneumonia and soft tissue abscesses, and diabetes as a major risk factor. Bacteremic melioidosis carried a poor prognosis and septic shock was strong predictor of mortality. Differences included the occurrence of: primary neurological infection was higher in Malaysia compared to reports outside Malaysia; internal foci of infection such as abscesses of the liver, spleen, prostate, and mycotic pseudoaneurysms were higher than previously reported in the region. No parotid abscess was reported among children. Early recognition of the disease is the cornerstone of management. In clinical situations of community-acquired sepsis and/or pneumonia, where laboratory bacteriological confirmation is not possible, empirical treatment with antimicrobials for B. pseudomallei is recommended., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2016
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45. Quest to identify geochemical risk factors associated with chronic kidney disease of unknown etiology (CKDu) in an endemic region of Sri Lanka-a multimedia laboratory analysis of biological, food, and environmental samples.
- Author
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Levine KE, Redmon JH, Elledge MF, Wanigasuriya KP, Smith K, Munoz B, Waduge VA, Periris-John RJ, Sathiakumar N, Harrington JM, Womack DS, and Wickremasinghe R
- Subjects
- Adult, Animals, Drinking Water analysis, Environmental Monitoring, Fishes, Food Contamination analysis, Hair chemistry, Humans, Male, Metals, Heavy analysis, Metals, Heavy blood, Middle Aged, Oryza chemistry, Renal Insufficiency, Chronic chemically induced, Risk Factors, Soil Pollutants blood, Soil Pollutants metabolism, Sri Lanka epidemiology, Trace Elements analysis, Trace Elements blood, Water Pollutants, Chemical blood, Water Pollutants, Chemical metabolism, Environmental Exposure, Renal Insufficiency, Chronic epidemiology, Soil Pollutants analysis, Water Pollutants, Chemical analysis
- Abstract
The emergence of a new form of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka's North Central Province (NCP) has become a catastrophic health crisis. CKDu is characterized as slowly progressing, irreversible, and asymptomatic until late stages and, importantly, not attributed to diabetes, hypertension, or other known risk factors. It is postulated that the etiology of CKDu is multifactorial, involving genetic predisposition, nutritional and dehydration status, exposure to one or more environmental nephrotoxins, and lifestyle factors. The objective of this limited geochemical laboratory analysis was to determine the concentration of a suite of heavy metals and trace element nutrients in biological samples (human whole blood and hair) and environmental samples (drinking water, rice, soil, and freshwater fish) collected from two towns within the endemic NCP region in 2012 and 2013. This broad panel, metallomics/mineralomics approach was used to shed light on potential geochemical risk factors associated with CKDu. Based on prior literature documentation of potential nephrotoxins that may play a role in the genesis and progression of CKDu, heavy metals and fluoride were selected for analysis. The geochemical concentrations in biological and environmental media areas were quantified. Basic statistical measurements were subsequently used to compare media against applicable benchmark values, such as US soil screening levels. Cadmium, lead, and mercury were detected at concentrations exceeding US reference values in many of the biological samples, suggesting that study participants are subjected to chronic, low-level exposure to these elements. Within the limited number of environmental media samples, arsenic was determined to exceed initial risk screening and background concentration values in soil, while data collected from drinking water samples reflected the unique hydrogeochemistry of the region, including the prevalence of hard or very hard water, and fluoride, iron, manganese, sodium, and lead exceeding applicable drinking water standards in some instances. Current literature suggests that the etiology of CKDu is likely multifactorial, with no single biological or hydrogeochemical parameter directly related to disease genesis and progression. This preliminary screening identified that specific constituents may be present above levels of concern, but does not compare results against specific kidney toxicity values or cumulative risk related to a multifactorial disease process. The data collected from this limited investigation are intended to be used in the subsequent study design of a comprehensive and multifactorial etiological study of CKDu risk factors that includes sample collection, individual surveys, and laboratory analyses to more fully evaluate the potential environmental, behavioral, genetic, and lifestyle risk factors associated with CKDu.
- Published
- 2016
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46. Pitfalls and optimal approaches to diagnose melioidosis.
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Kingsley PV, Arunkumar G, Tipre M, Leader M, and Sathiakumar N
- Abstract
Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia with dissemination of infection to multiple organs characterized by abscesses. Pneumonia is the most common clinical presentation. Because of the wide range of clinical presentations, physicians may often misdiagnose and mistreat the disease for tuberculosis, pneumonia or other pyogenic infections. The purpose of this paper is to present common pitfalls in diagnosis and provide optimal approaches to enable early diagnosis and prompt treatment of melioidosis. Melioidosis may occur beyond the boundaries of endemic areas. There is no pathognomonic feature specific to a diagnosis of melioidosis. In endemic areas, physicians need to expand the diagnostic work-up to include melioidosis when confronted with clinical scenarios of pyrexia of unknown origin, progressive pneumonia or sepsis. Radiological imaging is an integral part of the diagnostic workup. Knowledge of the modes of transmission and risk factors will add support in clinically suspected cases to initiate therapy. In situations of clinically highly probable or possible cases where laboratory bacteriological confirmation is not possible, applying evidence-based criteria and empirical treatment with antimicrobials is recommended. It is of prime importance that patients undergo the full course of antimicrobial therapy to avoid relapse and recurrence. Early diagnosis and appropriate management is crucial in reducing serious complications leading to high mortality, and in preventing recurrences of the disease. Thus, there is a crucial need for promoting awareness among physicians at all levels and for improved diagnostic microbiology services. Further, the need for making the disease notifiable and/or initiating melioidosis registries in endemic countries appears to be compelling., (Copyright © 2016 Hainan Medical College. Production and hosting by Elsevier B.V. All rights reserved.)
- Published
- 2016
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47. Classification of neck/shoulder pain in epidemiological research: a comparison of personal and occupational characteristics, disability, and prognosis among 12,195 workers from 18 countries.
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Sarquis LMM, Coggon D, Ntani G, Walker-Bone K, Palmer KT, Felli VE, Harari R, Barrero LH, Felknor SA, Gimeno D, Cattrell A, Vargas-Prada S, Bonzini M, Solidaki E, Merisalu E, Habib RR, Sadeghian F, Kadir MM, Warnakulasuriya SSP, Matsudaira K, Nyantumbu B, Sim MR, Harcombe H, Cox K, Marziale MH, Harari F, Freire R, Harari N, Monroy MV, Quintana LA, Rojas M, Harris EC, Serra C, Martinez JM, Delclos G, Benavides FG, Carugno M, Ferrario MM, Pesatori AC, Chatzi L, Bitsios P, Kogevinas M, Oha K, Freimann T, Sadeghian A, Peiris-John RJ, Sathiakumar N, Wickremasinghe AR, Yoshimura N, Kelsall HL, Hoe VCW, Urquhart DM, Derrett S, McBride D, Herbison P, Gray A, and Salazar Vega EJ
- Subjects
- Adult, Age Distribution, Age Factors, Epidemiologic Studies, Female, Follow-Up Studies, Humans, International Cooperation, Male, Mental Health, Middle Aged, Prevalence, Risk Factors, Surveys and Questionnaires, Young Adult, Disabled Persons, Neck Pain complications, Neck Pain epidemiology, Neck Pain psychology, Occupational Diseases epidemiology, Shoulder Pain complications, Shoulder Pain epidemiology, Shoulder Pain pathology
- Abstract
To inform case definition for neck/shoulder pain in epidemiological research, we compared levels of disability, patterns of association, and prognosis for pain that was limited to the neck or shoulders (LNSP) and more generalised musculoskeletal pain that involved the neck or shoulder(s) (GPNS). Baseline data on musculoskeletal pain, disability, and potential correlates were collected by questionnaire from 12,195 workers in 47 occupational groups (mostly office workers, nurses, and manual workers) in 18 countries (response rate = 70%). Continuing pain after a mean interval of 14 months was ascertained through a follow-up questionnaire in 9150 workers from 45 occupational groups. Associations with personal and occupational factors were assessed by Poisson regression and summarised by prevalence rate ratios (PRRs). The 1-month prevalence of GPNS at baseline was much greater than that of LNSP (35.1% vs 5.6%), and it tended to be more troublesome and disabling. Unlike LNSP, the prevalence of GPNS increased with age. Moreover, it showed significantly stronger associations with somatising tendency (PRR 1.6 vs 1.3) and poor mental health (PRR 1.3 vs 1.1); greater variation between the occupational groups studied (prevalence ranging from 0% to 67.6%) that correlated poorly with the variation in LNSP; and was more persistent at follow-up (72.1% vs 61.7%). Our findings highlight important epidemiological distinctions between subcategories of neck/shoulder pain. In future epidemiological research that bases case definitions on symptoms, it would be useful to distinguish pain that is localised to the neck or shoulder from more generalised pain that happens to involve the neck/shoulder region.
- Published
- 2016
- Full Text
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48. Chronic Bronchitis and Chronic Obstructive Pulmonary Disease (COPD) Among Textile Workers in Karachi, Pakistan.
- Author
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Nafees AA, Fatmi Z, Kadir MM, and Sathiakumar N
- Subjects
- Adult, Age Distribution, Aged, Bronchitis, Chronic physiopathology, Cross-Sectional Studies, Forced Expiratory Volume, Humans, Male, Middle Aged, Occupations statistics & numerical data, Pakistan epidemiology, Prevalence, Pulmonary Disease, Chronic Obstructive physiopathology, Risk Factors, Smoking adverse effects, Spirometry, Surveys and Questionnaires, Vital Capacity, Bronchitis, Chronic epidemiology, Occupational Diseases etiology, Occupational Exposure adverse effects, Pulmonary Disease, Chronic Obstructive epidemiology, Textile Industry statistics & numerical data
- Abstract
Objective: To determine the frequency and predictors of chronic bronchitis and COPD among textile workers in Karachi, Pakistan., Study Design: Cross-sectional survey., Place and Duration of Study: Karachi, Pakistan, from October to December 2009., Methodology: Male textile workers from 15 mills of Karachi were inducted. Data was collected using American Thoracic Society respiratory questionnaire (ATS-DLD-78-a) and spirometry., Results: Out of 372 participants, 29 (7.8%) workers had chronic bronchitis (4, 9.1% aged ≥40 years) and 25 (6.7%) had COPD (12, 27.2% aged ≥40 years). Workers with chronic bronchitis had significantly decreased lung function compared to the healthy workers. Those reporting severe self-perceived dust exposure at work, ≥ 10 pack years of smoking, uneducated, longer duration of work (≥11 years), and ever smokers were more likely to have chronic bronchitis or COPD. In the multivariate analyses, severe self-perceived dust exposure at work (AOR = 7.4; 95% CI: 1.9, 28.0), family history of respiratory illness/symptoms (AOR = 4.8; 95% CI: 1.1, 20.9) and lack of education (AOR = 4.2; 95% CI: 1.1, 16.9) were significant predictors of chronic bronchitis. Duration of work ≥11 years (AOR = 5.5; 95% CI: 1.5, 19.7) and pack years of smoking ≥10 years (AOR = 3.5; 95% CI: 1.1, 11.7) were strong predictors for COPD., Conclusion: There is a high frequency of chronic bronchitis and COPD among textile workers. Multiple important predictors for prevention are identified.
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- 2016
- Full Text
- View/download PDF
49. Descriptive Epidemiology of Somatising Tendency: Findings from the CUPID Study.
- Author
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Vargas-Prada S, Coggon D, Ntani G, Walker-Bone K, Palmer KT, Felli VE, Harari R, Barrero LH, Felknor SA, Gimeno D, Cattrell A, Bonzini M, Solidaki E, Merisalu E, Habib RR, Sadeghian F, Kadir MM, Warnakulasuriya SS, Matsudaira K, Nyantumbu B, Sim MR, Harcombe H, Cox K, Sarquis LM, Marziale MH, Harari F, Freire R, Harari N, Monroy MV, Quintana LA, Rojas M, Harris EC, Serra C, Martinez JM, Delclos G, Benavides FG, Carugno M, Ferrario MM, Pesatori AC, Chatzi L, Bitsios P, Kogevinas M, Oha K, Freimann T, Sadeghian A, Peiris-John RJ, Sathiakumar N, Wickremasinghe AR, Yoshimura N, Kelsall HL, Hoe VC, Urquhart DM, Derrett S, McBride D, Herbison P, Gray A, and Vega EJ
- Subjects
- Adult, Attitude to Health, Central America, Female, Humans, Longitudinal Studies, Male, Middle Aged, Musculoskeletal Pain epidemiology, Occupational Diseases epidemiology, Occupations, Odds Ratio, Prevalence, South America, Surveys and Questionnaires, Young Adult, Medically Unexplained Symptoms, Somatoform Disorders epidemiology
- Abstract
Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait.
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- 2016
- Full Text
- View/download PDF
50. Seroprevalence of Burkholderia pseudomallei among Adults in Coastal Areas in Southwestern India.
- Author
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Vandana KE, Mukhopadhyay C, Tellapragada C, Kamath A, Tipre M, Bhat V, and Sathiakumar N
- Subjects
- Adolescent, Adult, Aged, Cross-Sectional Studies, Female, Hemagglutination Tests, Humans, India epidemiology, Male, Middle Aged, Risk Factors, Seroepidemiologic Studies, Sex Factors, Young Adult, Antibodies, Bacterial blood, Burkholderia pseudomallei immunology, Melioidosis epidemiology
- Abstract
Background: Although melioidosis, is an important disease in many Southeast Asian countries and Australia, there is limited data on its prevalence and disease burden in India. However, an increase in case reports of melioidosis in recent years indicates its endemicity in India., Aims and Methods: A population-based cross-sectional seroprevalence study was undertaken to determine the seroprevalence of B. pseudomallei by indirect haemagglutination assay and to investigate the associated risk determinants. Subjects were 711 adults aged 18 to 65 years residing in Udupi district, located in south-western coast of India., Key Results: Overall, 29% of the study subjects were seropositive (titer ≥20). Females were twice as likely to be seropositive compared to males. Rates of seroprevalence were similar in farmers and non-farmers. Besides gardening, other factors including socio-demographic, occupational and environmental factors did not show any relationship with seropositive status., Major Conclusions: There is a serological evidence of exposure to B. pseudomallei among adults in India. While the bacterium inhabits soil, exposure to the agent is not limited to farmers. Non-occupational exposure might play an important role in eliciting antibody response to the bacterium and may also be an important factor in disease causation.
- Published
- 2016
- Full Text
- View/download PDF
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