How Does Tobacco Use Affect the Cognition of Older Adults? A Propensity Score Matching Analysis Based on a Large-Scale Survey.

INTRODUCTION: Tobacco is a well-established risk factor for cancer, but its association with other morbidities needs consideration. The low-income and middle-income countries (LMICs) with unprecedented demographic transformation lack evidence on tobacco use and its impact on cognitive health. AIMS AND METHODS: Using a propensity score matching approach, we utilized data from the Longitudinal Ageing Study of India. Study employed 1:1 nearest neighbor matching with the replacement methodology. We estimated the odds of the poor cognitive score and tobacco use among older adults based on five different models for ever tobacco user, former tobacco user, current tobacco user, current smokers, and current smokeless tobacco users with reference to never tobacco users. RESULTS: The estimated average treatment effect for the treated and the untreated group has shown a higher likelihood of cognitive decline among ever (OR -0.26; 95%CI -0.43 to -0.09), current (OR -0.28; 95%CI -0.45 to -0.10), and former (OR -0.53; 95%CI -0.87 to -0.19) tobacco users compared to never tobacco users. The finding further suggests the odds of lower cognitive scores among older adults who were smokers (OR -0.53; 95%CI -0.87 to -0.19) and smokeless tobacco users (OR -0.22; 95%CI -0.43 to -0.01) as compared to never tobacco users. CONCLUSIONS: Interventions designed to prevent the incidence of cognitive impairment should focus on limiting the use of tobacco. Strategies under the tobacco-free generation initiative should be amplified in order to prevent future generations from productivity loss, premature ageing and to promote healthy aging. IMPLICATIONS: Evidence of a definitive association between tobacco consumption and cognition among older adults is sporadic in LMICs. Though tobacco is a risk factor for various diseases including cancer, the extent of its impact on cognitive health among the older population is limited. This study contributes to the existing literature by highlighting poor cognitive outcomes among older adults who smoke tobacco and/or consume smokeless tobacco as compared to never-tobacco users. Our findings emphasize the need to accelerate programmes related to tobacco-free generation in LMICs to reach a higher quality of life and healthy aging in pursuit of achieving the sustainable development goal of "good health and well-being."

The Extent of Delay in Diagnosis, Treatment and their Associated Factors among Tuberculosis Patients Attending Government Hospitals of Rishikesh, Uttarakhand: A Cross-Sectional Study.

BACKGROUND: "Tuberculosis (TB) remains a major public health problem" worldwide, affecting almost all age groups. "Early diagnosis and prompt treatment are essential to significantly reducing the TB burden." However, a significant proportion of cases remain undiagnosed and untreated, which plays a vital role in the transmission of the disease and severity of the illness in the community in most developing countries. AIMS & OBJECTIVES: This study aimed to assess "the extent of delay in diagnosis and treatment of TB patients" and to identify the major factors associated with such delays (whether patient or health system-related) among TB patients in Rishikesh. METHODS: This descriptive cross-sectional study was conducted in Rishikesh Town, Dehradun District, Uttara khand, India. Total of 130 newly diagnosed TB patients were recruited as study participants who attended the government hospitals of Rishikesh, All India Institute of Medical Sciences, Rishikesh and S P S Government Hospital, Rishikesh. A universal sampling technique was used in this study. RESULTS: The mean age of the study participant was 36.75 (Standard Deviation (SD), 17.6), and the median age was 34 years. Of the patients, 64.6% were men, and 35.4% were women. The extent of various delays, such as patient delay (median 16 days), diagnostic delay (median 78.5 days), treatment delay (median 4 days), health system delay (43 days), and total delay (median 81 days). CONCLUSION: The misconception of any chronic disease may lead to a false diagnosis or long treatment for symptomatic relief; the absence of proper diagnostic tests and doctor shopping could be the reasons for the prolonged diagnostic delay. Therefore, by strengthening the collaboration between private and public practitioners in order to meet the expectations of the Government of India to achieve the goals of the "National Strategic Plan for ending TB" in India by providing good quality care for all patients.

Determinants of initiation, continuation and cessation of smokeless tobacco use among pregnant and lactating women: a qualitative study from low-income communities in urban India.

Smokeless tobacco (SLT) consumption increases the risk of cardiovascular diseases and cancer and leads to adverse reproductive health outcomes among women and newborns. This study examines the factors associated with initiation, continuation and cessation of SLT use among women in the reproductive age so as to formulate and include prevention and cessation interventions from its inception. The study was conducted in urban low-income communities in India. Using snowball and purposive sampling techniques, in-depth interviews were conducted with 20 pregnant and 22 lactating women who currently used SLT products. Data were analysed using thematic analysis with the help of QSR NVivo software. Findings revealed that factors such as people influencing usage change with different life stages including pre-marital and post-marital periods. Perceived health benefits, altered taste preferences during pregnancy and social influences were also studied. Women were found to be more aware of the harmful effects of tobacco during pregnancy than during breastfeeding. Social stigma around women consuming tobacco acted as a major driving factor for cessation. Most of the participants were willing to quit but were not aware of any technique or programme for cessation. The findings of the study highlight the need to develop behavioural change intervention tools, which are culturally and locally appropriate and have a gender-sensitive approach. Different socio-cultural factors associated with initiation/cessation at different life stages should also be taken into consideration while developing these tools.

Effects of sanitation and hygiene perceptions on international travelers' health, travel plans and trip experiences in India.

Background: International travelers often experience travelers' diarrhea. However, there is paucity of data on whether self-reported gastrointestinal symptoms influence travelers' perceptions of adequacy of sanitation and hygiene services encountered during travel, and to what degree their travel plans, and overall trip experience are impacted. Methods: A cross-sectional face-to-face survey was conducted amongst international travelers in India. Data collected included socio-demographics, travel characteristics, self-reported occurrence and frequency/severity of gastrointestinal symptoms, perceptions of sanitation and hygiene encountered, and adverse effects of symptoms on travel plans and trip experiences. Chi-square tests and logistic regression were performed to describe differences and associations between categorical variables. Results: Of the 300 international travelers surveyed, 46.3% experienced diarrhea. At least two thirds of travelers perceived the quality of sanitation (67.0%) and hygiene (70.0%) encountered to be inadequate. Perceptions of inadequate sanitation (adjusted OR = 3.0; 95% CI 1.7-5.5) and poor hygiene (adjusted OR = 7.7; 95% CI 4.1-15.5) were higher among travelers who experienced diarrhea. Additionally, both higher likelihood of travel plans being affected (adjusted OR = 10.7; 95% CI 5.1-23.6) and adverse impacts on overall trip experience (adjusted OR = 2.8; 95% CI 1.4-5.8) were reported among those who experienced diarrhea. Conclusions: More than two thirds of travelers surveyed in India experienced inadequate sanitation and hygiene services, with perceptions influenced by occurrence and frequency of diarrhea. Self-reported diarrhea was also associated with adverse effects on travel plans and overall trip experience. While these results may seem intuitive, they have important implications and suggest that improving sanitation and hygiene standards in India could potentially enhance tourism.

Psychological distress and well-being assessment among Indian people during COVID-19 pandemic.

Background: A rapid spread of the COVID-19 pandemic restricted millions of people in their homes and affected them with anxiety, stress, and psychological distress. This online study was conducted to assess the psychological distress among the Indian population. Method: This is a cross-sectional study, data collected via an online self-reported questionnaire using a snowball sampling technique. COVID-19 psychological stress was measured through the COVID-19 peritraumatic distress index (CPDI). This questionnaire was open-access and adapted from the Shanghai Mental Health Centre. Data were extracted to Microsoft Excel and analyzed in SPSS 23 version. Ordinal logistic regression was used to calculate the odds ratio for predicting variables. Results: A total of 625 responses were received. The mean age of the respondents was 26.41 years (standard deviation [SD] = 9.35; range = 17-79 years) with 320 (51.2%) males and the majority (68.8%) of the respondents were students. Youth with age group between 21 and 25 years were observed to be having peritraumatic distress 2.42 times more than the other groups (P = 0.001). Females were found to be more nervous and anxious (χ2 = 5.12; P = 0.02), more sluggish reaction due to anxiety (χ2 = 9.46; P = 0.002) as compared to males. Unmarried respondents were observed to be more sluggish due to anxiety (χ2 = 7.2; P = 0.007), felt more tired and exhausted (χ2 = 6.12; P = 0.013) in comparison to married. Conclusion: COVID-19 pandemic crisis significantly affected a major segment of society. The psychological distress level was observed to be high among youth, females, and a group of people in quarantine or isolation.

The Association of Problematic Online Gaming Behavior With Mental Well-Being and Depressive Symptoms Among Students of Professional Colleges in Rishikesh.

Background and objective Excessive online gaming is becoming a behavior pattern, and it has been recently classified as a medical illness and added to the International Classification of Diseases-11 (ICD-11), termed as "gaming disorder". This condition can be severe enough to result in significant impairment in psychological health. In light of this, we conducted this study to analyze the relationship between problematic online gaming and mental well-being among students of professional colleges in Rishikesh. Methods A cross-sectional study was conducted among professional college students in Rishikesh on problematic online gaming behavior (POGB). The Problematic Online Gaming Questionnaire-Short Form (POGQ-SF) was used to assess POGB among the participants. The five-item World Health Organization Well-Being Index (WHO-5) and Patient Health Questionnaire-9 (PHQ-9) were used to assess mental well-being and depressive symptoms respectively. Results The prevalence of POGB was 27.4% among our cohort, and its association with mental well-being as well as depressive symptoms was statistically significant. The study participants with poor mental well-being and mild or moderate to moderately severe depressive symptoms had higher odds of developing POGB. Conclusion POGB has been recently identified as a behavioral addiction and it is often neglected. A significant proportion of the study participants exhibited problematic gaming behavior.

India Fighting COVID-19: Experiences and Lessons Learned From the Successful Kerala and Bhilwara Models.

The COVID-19 pandemic marks its emergence in China in December 2019. India reported its first case on January 30th 2020 which happened to be epidemiologically linked to China. On March 24, India went into nationwide lockdown. The number of cases increased in the country and a few hotspots were identified. Cluster containment strategy seemed to be effective in containing the disease and breaking the chain of transmission. Two models (Kerala and Bhilwara) emerged as a lesson for other states. Kerala government implemented a "triple-lock containment strategy" and Bhilwara district administration followed "all down curfew" with massive sample testing. The experiences from these successful field models can be implemented in other districts and states to flatten the COVID-19 curve.