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Biomedical subjects

M R Pandey

Publications and source records attributed to M R Pandey.

At least 19 recordsLinked to original sources
PubMed2006

Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study.

BACKGROUND: Tobacco use is one of the major avoidable causes of cardiovascular diseases. We aimed to assess the risks associated with tobacco use (both smoking and non-smoking) and second hand tobacco smoke (SHS) worldwide. METHODS: We did a standardised case-control study of acute myocardial infarction (AMI) with 27,089 participants in 52 countries (12,461 cases, 14,637 controls). We assessed relation between risk of AMI and current or former smoking, type of tobacco, amount smoked, effect of smokeless tobacco, and exposure to SHS. We controlled for confounders such as differences in lifestyles between smokers and non-smokers. FINDINGS: Current smoking was associated with a greater risk of non-fatal AMI (odds ratio [OR] 2.95, 95% CI 2.77-3.14, p<0.0001) compared with never smoking; risk increased by 5.6% for every additional cigarette smoked. The OR associated with former smoking fell to 1.87 (95% CI 1.55-2.24) within 3 years of quitting. A residual excess risk remained 20 or more years after quitting (1.22, 1.09-1.37). Exclusion of individuals exposed to SHS in the never smoker reference group raised the risk in former smokers by about 10%. Smoking beedies alone (indigenous to South Asia) was associated with increased risk (2.89, 2.11-3.96) similar to that associated with cigarette smoking. Chewing tobacco alone was associated with OR 2.23 (1.41-3.52), and smokers who also chewed tobacco had the highest increase in risk (4.09, 2.98-5.61). SHS was associated with a graded increase in risk related to exposure; OR was 1.24 (1.17-1.32) in individuals who were least exposed (1-7 h per week) and 1.62 (1.45-1.81) in people who were most exposed (>21 h per week). Young male current smokers had the highest population attributable risk (58.3%; 95% CI 55.0-61.6) and older women the lowest (6.2%, 4.1-9.2). Population attributable risk for exposure to SHS for more than 1 h per week in never smokers was 15.4% (12.1-19.3). CONCLUSION: Tobacco use is one of the most important causes of AMI globally, especially in men. All forms of tobacco use, including different types of smoking and chewing tobacco and inhalation of SHS, should be discouraged to prevent cardiovascular diseases.

Age Distribution↗
PubMed2005

Imaging the Indian subcontinent beneath the Himalaya.

The rocks of the Indian subcontinent are last seen south of the Ganges before they plunge beneath the Himalaya and the Tibetan plateau. They are next glimpsed in seismic reflection profiles deep beneath southern Tibet, yet the surface seen there has been modified by processes within the Himalaya that have consumed parts of the upper Indian crust and converted them into Himalayan rocks. The geometry of the partly dismantled Indian plate as it passes through the Himalayan process zone has hitherto eluded imaging. Here we report seismic images both of the decollement at the base of the Himalaya and of the Moho (the boundary between crust and mantle) at the base of the Indian crust. A significant finding is that strong seismic anisotropy develops above the decollement in response to shear processes that are taken up as slip in great earthquakes at shallower depths. North of the Himalaya, the lower Indian crust is characterized by a high-velocity region consistent with the formation of eclogite, a high-density material whose presence affects the dynamics of the Tibetan plateau.

Journal Article↗
PubMed2001

Asthma and indoor environment in Nepal.

BACKGROUND: The development of asthma seems to be influenced by the adoption of a Western lifestyle. A study was undertaken to assess the importance of indoor environmental factors in Nepal where the lifestyle and home environment differ from that in the West. METHODS: The home environment of 121 schoolchildren with asthma and 126 controls aged 11-17 years was studied. The homes of all participants were investigated and the children and their mothers were interviewed using a standardised questionnaire. Cases and controls were identified from an ISAAC (International Study of Asthma and Allergy in Childhood) based population study of 2330 schoolchildren in Kathmandu, Nepal. RESULTS: Keeping cattle inside the house during the night was related to a lower risk for having asthma (adjusted odds ratio (OR) 0.2 (95% CI 0.1 to 0.5)) while there was no association between asthma and cattle kept outside. Asthma was associated with cigarette smoking by two or more family members (OR 1.9 (95% CI 1.0 to 3.9)) and with the domestic use of smoky fuels (OR 2.2 (95% CI 1.0 to 4.5)). In analyses stratified by sex, passive smoking and the use of smoky fuels were significantly associated with asthma only in boys. CONCLUSIONS: The risk of asthma in Nepalese children was lower in subjects exposed to cattle kept inside the house and higher in subjects exposed to passive smoking and indoor use of smoky fuels. Childhood exposure to microorganisms or allergens from cattle may protect against the development of atopic disease.

Adolescent↗
PubMed1999

Tobacco smoking and hypertension.

Coronary artery diseases is rapidly increasing in our part of the world. The South Asian ethnic groups are especially vulnerable to coronary artery disease. The two most striking features of coronary artery disease in the South Asian population are extreme prematurity and severity of the disease, both resulting from the malignant atherosclerosis that begins at an earlier age than in other population. Triple vessel disease and complicated lesions are not common even in young people and follow a malignant course. The most important aspect of prevention is to identify individuals with high risk of coronary artery disease at an early age and aggressive modification of risk factors. Tobacco smoking and hypertension are the two most important risk factors for coronary heart disease and stroke. Both of these risk factors have very high prevalence in India, Nepal and other countries of this region. There is a synergistic interaction of tobacco smoking with hypertension and high blood cholesterol which greatly increase coronary heart disease risk as well as sudden death and stroke.

Cardiovascular Diseases↗
PubMed1992

Childhood mortality after a high dose of vitamin A in a high risk population.

OBJECTIVES: To determine whether a single high dose of vitamin A given to all children in communities with high mortality and malnutrition could affect mortality and to assess whether periodic community wide supplementation could be readily incorporated into an ongoing primary health programme. DESIGN: Opportunistic controlled trial. SETTING: Jumla district, Nepal. SUBJECTS: All children aged under 5 years; 3786 in eight subdistricts given single dose of vitamin A and 3411 in remaining eight subdistricts given no supplementation. MAIN OUTCOME MEASURES: Mortality and cause of death in the five months after supplementation. RESULTS: Risk of death for children aged 1-59 months in supplemented communities was 26% lower (relative risk 0.74, 95% confidence interval 0.55 to 0.99) than in unsupplemented communities. The reduction in mortality was greatest among children aged 6-11 months: death rate (deaths/1000 child years at risk) was 133.8 in supplemented children and 260.8 in unsupplemented children (relative risk 0.51, 0.30 to 0.89). The death rate from diarrhoea was also reduced (63.5 supplemented v 97.5 unsupplemented; relative risk 0.65, 0.44 to 0.95). The extra cost per death averted was about $11. CONCLUSION: The results support a role for Vitamin A in increasing child survival. The supplementation programme was readily integrated with the ongoing community health programme at little extra cost.

Child Health Services↗
PubMed1991

Reduction in total under-five mortality in western Nepal through community-based antimicrobial treatment of pneumonia.

Pneumonia is a leading cause of death among children world wide but those at highest risk in developing countries have limited access to clinical services; effective and low-cost alternatives are a global public health priority. We have done a controlled intervention trial among 13,404 children under five in Jumla, Nepal, which relied exclusively on indigenous community health workers to detect and treat pneumonia according to the World Health Organisation decision strategy, with a five-day home-treatment course of oral co-trimoxazole. No other health services were provided, and referral of children to hospital was not practicable. During the three-year study, 2101 deaths were recorded. The programme led to a 28% reduction in the risk of death from all causes by the third year of services (relative risk 0.72, 95% confidence interval 0.63-0.82), with a significant trend (p less than 0.02) of lower mortality with greater duration of the programme. The greatest benefit was among infants. In addition to reduction in deaths due to pneumonia, there was a significant reduction in deaths due to diarrhoea and measles, indicating that reduction in pneumonia morbidity had considerable carry-over effect. Our findings show that indigenous community workers can effectively detect and treat pneumonia, and reduce overall child mortality, even without other primary care activities.

Administration, Oral↗
PubMed1991

Efficacy of vitamin A in reducing preschool child mortality in Nepal.

Community trials of the efficacy of vitamin A supplementation in reducing preschool childhood mortality have produced conflicting results. To resolve the question, a randomised, double-masked, placebo-controlled community trial of 28,630 children aged 6-72 months was carried out in rural Nepal, an area representative of the Gangetic flood plain of South Asia. Randomisation was carried out by administrative ward; the vitamin-A-supplemented children received 60,000 retinol equivalents every 4 months and placebo-treated children received identical capsules containing 300 retinol equivalents. After 12 months, the relative risk of death in the vitamin-A-supplemented compared with the control group was 0.70 (95% confidence interval 0.56-0.88), equivalent to a 30% reduction in mortality. The trial, which had been planned to last 2 years, was discontinued. The reduction in mortality was present in both sexes (relative risk for boys 0.77; for girls 0.65), at all ages (range of relative risks 0.83-0.50), and throughout the year (0.76-0.67). The reduction in mortality risk was not affected by acute nutritional status, as measured by arm circumference. Thus, periodic vitamin A delivery in the community can greatly reduce child mortality in developing countries.

Adult↗
PubMed1990

Indoor air pollution in developing countries.

Of the four principal categories of indoor pollution (combustion products, chemicals, radon and biologicals), research in developing countries has focused on combustion-generated pollutants, and principally those from solid-fuel-fired cooking and heating stoves. Such stoves are used in more than half the world's households and have been shown in many locations to produce high indoor concentrations of particulates, carbon monoxide and other combustion-related pollutants. Although the proportion of all such household stoves that are used in poorly ventilated situations is uncertain, the total population exposed to excessive concentrations is potentially high, probably several hundred million. A number of studies were carried out in the 1980s to discover the health effects of such stove exposures. The majority of such studies were done in South Asia in homes burning biomass fuels or in China with coal-burning homes, although a sprinkling of studies examining biomass-burning have been done in Oceania, Latin America and Africa. Of the health effects that might be expected from such exposures, little, if any, work seems to have been done on low birthweight and eye problems, although there are anecdotal accounts making the connection. Decreased lung function has been noted in Nepali women reporting more time spent near the stove as it has for Chinese women using coal stoves as compared to those using gas stoves. Respiratory distress symptoms have been associated with use of smoky fuels in West India, Ladakh and in several Chinese studies among different age groups, some with large population samples. Acute respiratory infection in children, one of the chief causes of infant and childhood mortality, has been associated with Nepali household-smoke exposures. Studies of chronic disease endpoints are difficult because of the need to construct exposure histories over long periods. Nevertheless, chronic obstructive lung disease has been associated with the daily time spent near the stove for Nepali women and found to be elevated among coal-stove users compared to gas-stove users in Shanghai. In contrast to early reports, there seems to be little or no risk of nasopharyngeal cancer from cookstove smoke. Several studies in China, however, have found smoke to be a strong risk factor for lung cancer among non-smoking women. In addition, severe fluorosis has been observed in several parts of China where coal fluoride levels are high.(ABSTRACT TRUNCATED AT 250 WORDS)

Air Pollutants↗
PubMed1989

Impact of a pilot acute respiratory infection (ARI) control programme in a rural community of the hill region of Nepal.

A prospective study was conducted to determine the magnitude of morbidity and mortality caused by acute respiratory infections (ARI) among children under 5 years of age and to assess the feasibility of reducing mortality owing to ARI by the use of community health workers. Villages selected for this study were situated on the south-west edge of Kathmandu Valley, about 24 km from the city centre. The study group consisted of 1019 children under the age of 5 years at the beginning of the study and followed for 3 years. During the 1st year, baseline information was collected. During the 2nd and 3rd years, intervention measures (health education, immunization and antibiotics for children with signs suggesting pneumonia) were taken and their effect assessed. There was a 59% reduction in the ARI-specific death rate among study children between surveillance year and intervention year I and a further 25% reduction in the ARI-specific death rate between intervention years I and II. Despite a substantial reduction in ARI mortality with the interventions, there was still an unacceptably high mortality from chronic diarrhoea, malnutrition and other factors. This implies that the programme to control ARI, diarrhoea, malnutrition and immunizable diseases should be integrated into one, within the framework of a primary health care strategy.

Child, Preschool↗
PubMed1988

Epidemiological study of tobacco smoking behaviour among adults in a rural community of the hill region of Nepal with special reference to attitude and beliefs.

This study, designed to examine adult smoking behaviour, attitudes and norms was carried out in the hill villages of Alapot and Bhadrabas, Nepal, using the WHO standardized survey questionnaire. Some 1506 adults were interviewed. The overall prevalence of daily smokers is 73.7%. The majority of people, though aware of hazards of smoking, are not concerned with its possible effects on their own or other people's health. More males than females endorse public action against smoking. Both the endorsement of public action against smoking and awareness of social norms discouraging smoking increase with educational attainment. The motives for not smoking and endorsement of public actions against smoking have been ranked. Based on these findings strategies for a national smoking control programme have been recommended.

Adult↗
PubMed1985

Domestic smoke pollution and respiratory function in rural Nepal.

A study was conducted to see the effect of domestic smoke pollution on respiratory function by using vitalograph Model 20.400 S-type dry portable spirometer in 150 randomly selected female subjects aged 30-44 years from a rural area situated in the outskirts of Kathmandu valley at an altitude of 4,800 ft. above sea level. The area is totally free from industrial and atmospheric pollution. Women spend considerable time near the fireplace, which serves both cooking and heating purposes and emits smoke from wood and other biomass fuel. Domestic smoke pollution is considerable because dwellings are ill-ventilated and without chimnies. The selected sample comprised of 6 groups-25 subjects each of 3 exposure levels to domestic smoke pollution amongst smokers and non-smokers. All the spirometric tests (FVO, FEV1 and FMEF 25-75) were performed in a standard way as recommended by American Thoracic Society in Snowbird Meeting in 1979. Variation of age, height, arm-span and weight between the three different levels of exposure to domestic smoke in both the smokers and non-smokers were compared and results revealed no significant variation in all the variables mentioned above. There was a fall of mean FVC, FEV1 and FMEF 25-75 as duration of exposure increased. This decline was found to be statistically significant amongst the smokers but not amongst the non-smokers. Similar results was found even after adjusting for age & height.

Adult↗
PubMed1984

Prevalence of chronic bronchitis in a rural community of the Hill Region of Nepal.

A house to house survey of everyone aged 20 years and above living in a rural community in the Hill Region of Nepal, situated about 16 km outside Kathmandu city, was conducted to determine the prevalence of chronic bronchitis and cor pulmonale. Of the total eligible population, 2826 (95.5%) were interviewed. Chronic bronchitis was diagnosed according to the British Medical Research Council criteria, and emphysema and cor pulmonale according to the World Health Organisation expert committee criteria. The crude prevalence of chronic bronchitis was found to be 18.3%. The prevalence rate of chronic bronchitis was similar in men and women, whereas in most parts of the world much lower rates have been recorded in women. Study of a random sample of 85 individuals with chronic bronchitis showed that 57.4% had evidence of airways obstruction, whereas 15.8% of a representative sample (n = 111) of the surveyed population (excluding those with chronic bronchitis) showed evidence of airway obstruction. Of 516 subjects diagnosed as having chronic bronchitis, 382 were subsequently investigated in hospital, 134 having declined further investigation. The diagnosis was confirmed in most of the patients (93.2%) who were investigated. Other diseases played an insignificant part in the production of the observed high prevalence rates of chronic bronchitis. Of the 382 patients studied in hospital, 87 had emphysema and 42 had cor pulmonale, yielding overall prevalence rates for these two conditions of at least 3.1% and at least 1.5% respectively.

Adult↗
PubMed1984

Domestic smoke pollution and chronic bronchitis in a rural community of the Hill Region of Nepal.

An earlier study of chronic bronchitis in a rural community of the Hill Region of Nepal using Medical Research Council criteria showed a high prevalence rate that was more or less equal in the two sexes. Most of the women in the study population are exposed to domestic smoke caused by wood and straw fires used for cooking and heating purposes in the ill ventilated houses without chimneys. Data from 1375 individuals were analysed to determine whether there was any relationship between domestic smoke pollution and chronic bronchitis. Exposure to domestic smoke was assessed according to the average time per day spent near the fireplace. The association between chronic bronchitis and cigarette smoking was confirmed. In female nonsmokers and smokers and past smokers of both sexes crude and age adjusted prevalence rates for chronic bronchitis were significantly associated with increasing exposure to domestic smoke. In the living conditions existing in the rural Hill Region of Nepal domestic smoke pollution is an important contributing factor in the development of chronic bronchitis.

Adult↗