Evaluation of Population-Level Tobacco Control Interventions and Health Outcomes: A Systematic Review and Meta-Analysis.

Importance: Smoking causes considerable noncommunicable diseases, perinatal morbidity, and mortality. Objective: To investigate the associations of population-level tobacco-control policies with health outcomes. Data Sources: PubMed, EMBASE, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and EconLit were searched from inception to March 2021 (updated on 1 March 2022). References were manually searched. Study Selection: Studies reporting on associations of population-level tobacco control policies with health-related outcomes were included. Data were analyzed from May to July 2022. Data Extraction and Synthesis: Data were extracted by 1 investigator and cross-checked by a second investigator. Analyses were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Main Outcomes and Measures: The primary outcomes were respiratory system disease (RSD), cardiovascular disease (CVD), cancer, mortality, hospitalization, and health care utilization. The secondary outcomes were adverse birth outcomes, such as low birth weight and preterm birth. Random-effects meta-analysis was used to estimate pooled odds ratios (ORs) and 95% CIs. Results: Of 4952 records identified, 144 population-level studies were included in the final analysis; 126 studies (87.5%) were of high or moderate quality. The most frequently reported policies were smoke-free legislation (126 studies), followed by tax or price increases (14 studies), multicomponent tobacco control programs (12 studies), and a minimum cigarette purchase age law (1 study). Smoke-free legislation was associated with decreased risk of all CVD events (OR, 0.90; 95% CI, 0.86-0.94), RSD events (OR, 0.83; 95% CI, 0.72-0.96), hospitalization due to CVD or RSD (OR, 0.91; 95% CI, 0.87-0.95), and adverse birth outcomes (OR, 0.94; 95% CI, 0.92-0.96). These associations persisted in all sensitivity and subgroup analyses, except for the country income category, for which a significant reduction was only observed in high-income countries. In meta-analysis, there was no clear association of tax or price increases with adverse health outcomes. However, for the narrative synthesis, all 8 studies reported statistically significant associations between tax increases and decreases in adverse health events. Conclusions and Relevance: In this systematic review and meta-analysis, smoke-free legislation was associated with significant reductions in morbidity and mortality related to CVD, RSD, and perinatal outcomes. These findings support the need to accelerate the implementation of smoke-free laws to protect populations against smoking-related harm.

A Grid Search-Based Multilayer Dynamic Ensemble System to Identify DNA N4-Methylcytosine Using Deep Learning Approach.

DNA (Deoxyribonucleic Acid) N4-methylcytosine (4mC), a kind of epigenetic modification of DNA, is important for modifying gene functions, such as protein interactions, conformation, and stability in DNA, as well as for the control of gene expression throughout cell development and genomic imprinting. This simply plays a crucial role in the restriction-modification system. To further understand the function and regulation mechanism of 4mC, it is essential to precisely locate the 4mC site and detect its chromosomal distribution. This research aims to design an efficient and high-throughput discriminative intelligent computational system using the natural language processing method "word2vec" and a multi-configured 1D convolution neural network (1D CNN) to predict 4mC sites. In this article, we propose a grid search-based multi-layer dynamic ensemble system (GS-MLDS) that can enhance existing knowledge of each level. Each layer uses a grid search-based weight searching approach to find the optimal accuracy while minimizing computation time and additional layers. We have used eight publicly available benchmark datasets collected from different sources to test the proposed model's efficiency. Accuracy results in test operations were obtained as follows: 0.978, 0.954, 0.944, 0.961, 0.950, 0.973, 0.948, 0.952, 0.961, and 0.980. The proposed model has also been compared to 16 distinct models, indicating that it can accurately predict 4mC.

Equity in access to safely managed sanitation and prevalence of diarrheal diseases in Bangladesh: a national and sub-national analysis.

BACKGROUND: In Bangladesh, safely managed sanitation (SMS) coverage is low, and diarrheal disease is a significant health problem. This study estimated the inequality in access to SMS facilities at the national and sub-national levels and assessed the prevalence of diarrheal diseases in connection with these improved facilities. METHODS: Data were extracted from the Bangladesh Demographic and Health Survey, conducted during 2017-2018. SMS was defined as using an improved sanitation facility, which designed to hygienically separate excreta from human contact and include the use of a flush toilet connected to piped sewer system, septic tank, ventilated improved pit latrine, pit latrine with a slab, and composting toilet. The slope index of inequality (SII) and multi-level regression models were used for inequality and risk factors of SMS respectively. RESULTS: The national coverage of SMS was 44.0% (45.3% and 43.5% in urban and rural areas, respectively). At the sub-national level, the lowest and highest coverage of SMS was observed in Mymensingh (32.9%) and Chittagong (54.1%) divisions, respectively. The national level SII indicated that wealthy households had access to higher SMS by 60.8 percentage points than poor households. Additionally, greater inequality was observed in rural areas, which was 71.9 percentage points higher in the richest households than in the poorest households. The coverage gap between the rich and poor was highest in the Sylhet division (85.3 percentage points higher in rich than in poor) and lowest in Dhaka (34.9 percentage points). Old and highly educated household heads and richest households had better access to higher levels of adequate sanitation. After adjusting for confounding variables, the prevalence of diarrheal disease was 14.0% lower in the SMS user group than in their counterparts. CONCLUSION: Substantial inequalities in access to SMS exist at both national and sub-national levels of Bangladesh, with the prevalence of diarrhea being lower among SMS users. These findings may help to prioritize resources for reducing inequality and expanding the coverage of improved sanitation in Bangladesh.

Equity in antenatal care visits among adolescent mothers: An analysis of 54 country levels trend and projection of coverage from 2000 to 2030.

Background: Ensuring utilization of antenatal care (ANC) services by adolescent mothers (ages 10-19) is an enormous challenge in low-and middle-income countries (LMICs). This study provides the first comprehensive analysis of ANC visits among adolescent and adult mothers. Methods: Using all available Demographic and Health Survey and Multiple Indicator Cluster Surveys between 2000 and 2019 in 54 LMICs, we estimated proportion of ANC visits among women. Bayesian hierarchical regression models were used to estimate trend, projection, and determinants of single and four ANC visits (ANC1 and ANC4) independently. Equity analysis were performed to assess the magnitude of wealth-based and urban-rural inequalities in access to ANC visits. Results: Compared to women aged 36-49 years, coverage of ANC1 and ANC4 are expected to increase significantly for adolescent mothers and women aged 20-35 years. This increase was observed at the national level, as well as both urban and rural areas in most countries between 2000 and 2030. By 2030, the coverage of ANC1 is predicted to reach 80% or more in all countries except Angola, Central African Republic and Togo, whereas only 16 countries are predicted to reach 80% or more for ANC4. According to wealth quintile, the lowest inequalities with highest coverage of 80% or more ANC4 will be observed in Armenia, Cambodia, Dominican Republic, Ghana, Maldives, Indonesia, and Sao Tome and Principe in 2030. Determinant analysis found increased odds of receiving ANC visits during pregnancy for adolescent mothers with higher educational levels, frequency of listening/watching mass media, and various household socio-economic status factors. Conclusions: This study calls for advanced, innovative and cost-effective approaches to increase ANC coverage among adolescent mothers, particularly in rural areas and/or in low socioeconomic groups.

Hyponatremia in COVID-19 patients: Experience from Bangladesh.

Background: The purpose of the study was to measure the prevalence of hyponatremia and its association with clinical and laboratory characteristics of hospitalized coronavirus disease 2019 (COVID-19) patients at Dhaka Medical College and Hospital (DMCH). Methods: This retrospective study was conducted in COVID-19 dedicated wards at DMCH from June to August 2020. Demographic, clinical, and laboratory data were collected from patient treatment sheets. Two groups of COVID-19 patients were retrospectively screened on the basis of plasma sodium level at admission: hyponatremic (sodium < 135 mM, n = 84) or normonatremic (sodium ≥ 135 mM, n = 48) patients. Severity was assessed using World Health Organization classification for COVID-19 disease severity. To compare the two groups, Pearson's χ 2 (qualitative variables) and Student's T tests (quantitative variables) were applied. The link between patients' clinical data and outcomes was investigated using logistic regression model. Results: A total of 132 patients were included in the study, with a mean age of 51.41 (±14.13) years. Hyponatremia was found in 84 patients (63.6%) and the remaining 48 patients (36.4%) had normal plasma Na+ values. Among them, 74 (56.06%) presented with severe disease and 53 (40.15%) with moderate disease. At presentation, patients with moderate COVID-19 disease had 2.15 (1.04-4.5) times higher odds of suffering from hyponatremia. Besides, hyponatremia was independently associated with on admission SpO2 (p = 0.038), hemoglobin (p = 0.004), and C-reactive protein (p = 0.001). Conclusions: The authors suggest that patients' serum electrolytes be measured during initial hospital admission and then monitored throughout the hospital stay to predict the probability for referral for invasive ventilation and for better management.

Association of sleep duration and sleep quality with overweight/obesity among adolescents of Bangladesh: a multilevel analysis.

BACKGROUND: Sleep deprivation is widely recognized as a potential contributor to childhood obesity. However, few studies have addressed this issue in low-income settings. The aim of this study was to determine the association of both sleep duration and sleep quality with overweight/obesity among adolescents of Bangladesh. METHODS: A cross-sectional study was conducted in four randomly selected schools in Gazipur, Bangladesh, from May to August 2019. Using a self-administered semi-structured questionnaire, data on sleep duration and sleep quality were collected from 1,044 adolescents between 13 and 17 years of age. The body mass indices of the study participants were evaluated using their objectively-assessed anthropometric measurements (weight and height). Multilevel logistic regression was used for data analysis. RESULTS: The prevalence of underweight, overweight and obesity in adolescents in this study were 14.9, 18 and 7.1%, respectively. More than 15% of the students reported sleep disturbance and poor sleep quality. After adjusting for confounders, reduced (<7 h/day) total sleep duration (OR=1.73, 95% CI=1.21-2.47), weekend sleep duration (OR=1.46, 95% CI=1.00-2.12), and night sleep duration (OR=1.55, 95% CI=1.06-2.28) were found to be significantly associated with overweight or obesity in Bangladeshi adolescents. Similarly, significant positive associations were evident between short duration of total sleep (OR=0.33, 95% CI=0.20-0.54), weekday sleep (OR=0.55, 95% CI=0.35-0.84), weekend sleep (OR=0.53, 95% CI=0.31-0.89), and night sleep (OR=0.56, 95% CI=0.36-0.87), and underweight in study participants. Adolescents with short sleep duration were found less likely to be underweight and more likely to be overweight/obese. CONCLUSIONS: Study findings denoted short sleep duration to be associated with overweight/obesity and underweight among adolescents of Bangladesh. Adequate sleep may therefore serve as an effective obesity prevention strategy in the growing stages.

Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis.

BACKGROUND: Ensuring access to health services for all is the main goal of universal health coverage (UHC) plan. Out-of-pocket (OOP) payment still remains the main source of funding for healthcare in Bangladesh. The association between barriers to accessing healthcare and over-reliance on OOP payments has not been explored in Bangladesh using nationally representative household survey data. This study is a novel attempt to examine the burden of OOP payment and forgone healthcare in Bangladesh, and further explores the inequalities in catastrophic health expenditures (CHE) and forgone healthcare at the national and sub-national levels. METHODS: This study used data from the most recent nationally representative cross-sectional survey, Bangladesh Household Income and Expenditure Survey, conducted in 2016-17 (N = 39,124). In order to identify potential determinants of CHE and forgone healthcare, multilevel Poisson regression was used. Inequalities in CHE and forgone healthcare were measured using the slope index of inequality. RESULTS: Around 25% of individuals incurred CHE and 14% of the population had forgone healthcare for any reasons. The most common reasons for forgone healthcare were treatment cost (17%), followed by none to accompany or need for permission (5%), and distance to health facility (3%). Multilevel analysis indicated that financial burden and forgone care was higher among households with older populations or chronic illness, and those who utilize either public or private health facilities. Household consumption quintile had a linear negative association with forgone care and positive association with CHE. CONCLUSION: This study calls for incorporation of social safety net in health financing system, increase health facility, and gives priority to the disadvantaged population to ensure access to health services for all.

Persistence of sleep disturbance among post-COVID patients: Findings from a 2-month follow-up study in a Bangladeshi cohort.

To evaluate the persistence and factors associated with sleep disturbances among COVID-19 patients with a history of sleep disturbances 2 months after discharge from the hospital. A total of 400 patients admitted at Dhaka Medical College Hospital during July and August were diagnosed as suffering from sleep disturbances during their hospital stay using a standardized scale. They were followed up 2 months later through telephone, and a total of 322 participants were interviewed (excluding 63 nonresponders and five deceased) regarding the persistence of disturbances in sleep through a structured questionnaire. Patient demographic, clinical, and epidemiological data including history regarding in-hospital sleep disturbance were retrieved from hospital treatment sheets. Results revealed, 35% of study participants (n = 113) were still experiencing symptoms of sleep disturbances during the interview by telephone. Age (p = 0.015), diabetes mellitus (relative risk [RR]: 1.21; confidence interval [CI]: 1.02-1.42, p = 0.022), on admission SPO2 (p = 0.009), C-reactive protein (CRP) (p = 0.025), serum ferritin (p = 0.014), and d-dimer (p = 0.030) were independently associated with sleep disturbances among participants (p < 0.05). Binary and fitting logistic regression through repeated K folds cross-validation revealed 1.65 (CI: 1.02-2.66), 1.07 (CI: 1.01-1.14), and 1.07 (CI: 1.00-1.15) times higher odds of persistence of sleep disturbances among patients with diabetes mellitus, increased neutrophil, and lymphocyte percentages, respectively. Findings of this study need to be validated and patients should be further followed up with more in-depth studies conducted 6 or 12 months after initial infection, possibly with the help of higher sample size and in-person interview.

A 2-month post-COVID-19 follow-up study on patients with dyspnea.

BACKGROUND AND AIMS: Dyspnea is one of the most common symptoms associated with the COVID-19 caused by novel coronavirus SARS-CoV-2. This study aimed to assess the prevalence of dyspnea, observe co-variables, and find predictors of dyspnea after 2 months of recovery from COVID-19. METHODS: A total of 377 patients were included in the study based on their responses and clinical findings during initial admission to the hospital with COVID-19. After excluding five deceased patients, a total of 327 patients were interviewed through telephone using a 12-point dyspnea scale and using relevant questions to gauge the patient clinically. Interviews were carried out by trained physicians, and responses were recorded and stored. All analyses were carried out using the statistical programming language R. RESULTS: Of the total 327 participants in the study, 34% had stated that they were suffering from respiratory symptoms even after 2 months of COVID-19. The study demonstrated that patient oxygen saturation level SpO2 (P = .03), D-dimer (P = .001), serum ferritin (P = .006), and the presence and severity of dyspnea are significantly correlated. In addition to that, patient smoking history (P = .012) and comorbidities such as chronic obstructive pulmonary disease (COPD) (P = .021) were found to be statistically significant among groups. CONCLUSION: These findings of this study can be useful for predicting and managing long-term complications of COVID-19.

Distribution of ß-Thalassemia and Other Hemoglobinopathies in Bangladeshi University Students and Ready-Made Garment Workers.

BACKGROUND: The inheritable thalassemia and other structural hemoglobinopathies are prevalent globally. In Bangladesh, there is a scarcity of studies concerning thalassemia and other structural hemoglobinopathies. Hence, the present study investigated the prevalence and distribution of ß-thalassemia and other hemoglobinopathies among the university students and ready-made garment (RMG) workers. METHODS: A cross-sectional study was conducted, whereas a total of 989 subjects were selected randomly from 10 garments industries (n=495) and five universities (n=494) for diagnosis and counseling from April 2018 to August 2018. Basic information related to the study and venous blood was collected and subjected to capillary Hb-electrophoresis for each participant. RESULTS: The present study identified thalassemia carriers and other hemoglobinopathies among 13.6% of the participants (14.1% university students and 13.2% RMG workers). The most common form of hemoglobin formation disorder was the Hb-E trait (10.5%), considering both participants' groups. Other forms of hemoglobin formation disorders observed were a ß-thalassemia trait, Hb-D trait, Hb-E disease, and ß-thalassemia major. The hemoglobinopathies were significantly associated with the individuals who had a family history of thalassemia and were not vaccinated against hepatitis B in the total sample. Although not statistically suggestive, the most considerable portion (87.3%) of the carriers was unmarried in the present findings. CONCLUSION: The present study findings are anticipated to help the public health authorities by providing novel data (of a neglected cohort, ie, RGM workers), facilitating the upcoming comprehensive national thalassemia prevention programs.