The burden of young-onset pancreatic cancer and its risk factors from 1990 to 2019: A systematic analysis of the global burden of disease study 2019.

OBJECTIVE: To investigate worldwide incidence, deaths, disability-adjusted life years (DALYs) and risk factors for young-onset pancreatic cancer (YOPC) using the Global Burden of Disease Study 2019-20 data. METHODS: We queried the Global Health Data Exchange tool for "pancreatic cancer" and "incidence", "deaths" as the "measure", and "DALYs" as the "cause" for the age group of 15-49 years to determine global, regional, and national trends in the incidence, deaths, and DALYs of YOPC. Sociodemographic index (SDI) was used to evaluate the associations between socioeconomic development and YOPC. Risk factors including smoking, tobacco use, hi2gh body mass index (BMI), and high fasting plasma glucose (FPG) were evaluated, and their attributable burden was estimated. RESULTS: Global incidence, death, and DALY rates of YOPC significantly increased from 1990 to 2019 ((0.30 (p = 0.001), 0.25 (p = 0.001), and 11.18 (p = 0.002), respectively). Regions with the highest and lowest incidence, death, and DALY rates of YOPC were Eastern Europe and Central Sub-Saharan Africa, respectively. Incidence, death, and DALY rates increased with increasing age and SDI. Leading risk factors for YOPC in 2019 were smoking and tobacco use. DALYs attributable to smoking and tobacco use decreased from 1990 to 2019, especially in females, while those attributable to high BMI and FPG increased during the same period. CONCLUSIONS: The global incidence, death and DALY rates of YOPC have significantly increased over 3 decades. Certain regions and nations are witnessing a higher increase in this trend. There is an urgent need for global efforts targeting preventable causes of YOPC.

Experiencing the COVID-19 pandemic as a homeless person in Chennai, India: An interpretative phenomenological analysis.

Persons experiencing homelessness (PEHs) have a higher risk of morbidity and mortality compared to the general population and are highly vulnerable during the coronavirus disease (COVID-19) pandemic. Understanding their experience of the pandemic is important for mitigating the effects of the pandemic. Accordingly, we conducted a qualitative study on their lived experiences during the COVID-19 pandemic. Semi-structured interviews were conducted in nine PEHs from Chennai, India, recruited at food stalls between September 14-25, 2020. Data were analyzed using interpretive phenomenological analysis. The participants shared their experiences of the COVID-19 pandemic, its impact on them, and their coping strategies. All the participants were migrant workers living alone, and were the sole breadwinners of their families. Five group experiential themes emerged relating to the experiences of the participants during the COVID-19 pandemic. Most participants reported significant psychosocial stress, but low suicide risk and robust coping mechanisms. They delayed seeking healthcare for non-COVID-19-related problems. Public hospitals were preferred over private hospitals due to cost constraints and prior experience of discrimination. Upward classism was observed as participants blamed the rich for the spread of COVID-19. Initial assumption that COVID-19 would only affect the rich was also reported. Free government testing and quarantine facilities assuaged their medico-psychosocial needs. Engaging in collective activities was a key stress mitigator. We highlight several important policy implications. Firstly, we underscore the importance of involving social workers to facilitate communication between healthcare providers and patients from vulnerable communities. This engagement can help minimize discrimination and promote equitable access to healthcare. Secondly, we emphasize the need for effective public health communication. Specifically, there is a need to address and alleviate concerns about the transmission of COVID-19 within hospital premises. Lastly, the research suggests that government initiatives aimed at fostering community participation should persist both during and after the pandemic.

Experiencing the COVID-19 pandemic as a healthcare provider in rural Dhanbad, India: An interpretative phenomenological analysis.

BACKGROUND: The COVID-19 pandemic is causing widespread morbidity and mortality. It has led to a myriad of mental health problems, particularly in health care providers (HCPs). To strengthen the fight against COVID-19, it is essential to investigate the mental health challenges being faced by the HCPs, their emotional responses, and coping strategies. OBJECTIVES: We aimed to explore the lived experiences of frontline HCPs in rural India during the peak of the second wave of the COVID-19 pandemic. METHODS: Through purposive heterogenous snowball sampling, five HCPs in rural Dhanbad were recruited and one-on-one double-blind unstructured interviews were conducted. The interviews were transcribed and master themes and subthemes were extracted by interpretative phenomenological analysis. RESULTS: Six master themes and 23 subthemes were identified. Our findings demonstrate that the participants were under mental duress due to heavy workloads, fear of getting infected and transmitting the infection, urban-rural disparities in access to medical supplies and peer support, and negative social perception of HCPs during the pandemic. Most HCPs have not yet processed the psychological effects of being at the frontlines of the COVID-19 pandemic in a resource-poor setting; however, spirituality seems to be an important coping mechanism that helps them get through the day. CONCLUSIONS: This study is unique in the sense that not many studies have been conducted to evaluate the psychological issues of Indian HCPs during this pandemic. Much less is known about the mental health of HCPs in rural settings. Moreover, novel findings such as negative social perception of HCPs during the pandemic and HCPs resorting to spirituality as a coping strategy against stress, open a plethora of research opportunities wherein the results of this qualitative study, along with the existing literature and findings of future quantitative studies, can establish better understanding of the impact of the pandemic on HCPs.

Access Clinic: A student-run clinic model to address gaps in the healthcare needs of the homeless population in Adelaide.

BACKGROUND: The average life expectancy of people who are homeless is approximately 20 years lower than the general population. Lack of access to healthcare is one of the key contributors to the increased morbidity and mortality. OBJECTIVE: The aim of this article is to describe a student-run clinic that was established at a homeless shelter in Adelaide, Australia, to improve healthcare access for individuals who are homeless. DISCUSSION: By enhancing the target population's health literacy, the clinic functioned as a bridge between healthcare services and individuals experiencing homelessness who were disengaged from society. Such clinics, if encouraged, can foster a symbiotic relationship where students learn clinical medicine while gaining experience in providing healthcare to vulnerable individuals, and individuals who are homeless can access much-needed services in an environment they already engage with and feel safe in.