Shubhanjali Roy

Background: Employees often remain underserved in healthcare due to demanding work schedules, limited access to services, and socioeconomic constraints. Risk-prone lifestyles further increase their vulnerability to oral potentially malignant disorders (OPMD) and oral cancer. Workplace-based screening represents a feasible and risk-based strategy for early detection and prevention. This review evaluated workplace-based OPMD screening by estimating prevalence and examining its role in early diagnosis and prevention of oral cancer. Methods: The protocol was registered in PROSPERO (CRD42024574036). Comprehensive searches across major databases were performed using predefined eligibility criteria. Data were extracted after de-duplication. Study quality and risk of bias were assessed using Joanna Briggs Institute (JBI), Cochrane Risk of Bias in Non-Randomized studies of Exposure, and GRADEpro. A random-effects meta-analysis estimated pooled prevalence and associated risk factors. Results: Nineteen studies (1988–2024), predominantly cross-sectional, identified 4480 OPMDs among 30,358 screened workers, yielding a pooled prevalence of 17% (95% CI: 0.12–0.23) with substantial heterogeneity (I ² = 99.3%). The pooled point estimates were above 1 for tobacco users and males; however, the 95% confidence intervals included 1, indicating that these associations were not statistically significant. The estimate for age was close to 1 and was also not statistically significant. Most studies showed low (n = 8) to moderate (n = 9) methodological quality (JBI) and low to very low certainty of evidence (Grading of Recommendations, Assessment, Development, and Evaluations), with marked publication bias. Conclusion: Nearly one-fifth of workers had an OPMD, with risks amplified by tobacco, age, and gender. Periodic workplace screening, awareness activities, intersectoral coordination, and a common risk factor approach are essential to strengthen oral cancer prevention.

Background and Aims: Inadequate complementary feeding practices (CFPs) can lead to malnutrition among children and result in poor health outcomes throughout life. This study aimed to explore the spatial patterns and determinants of inadequate complementary feeding indicators (CFIs) among children aged 6–23 months in Bangladesh. Methods: We used data from the latest Bangladesh Demographic and Health Survey (BDHS) 2022. Three CFIs: minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) were the outcome variables. Data from a weighted sample of 2578 children aged 6–23 months were included in this study. Hot spot analysis, ordinary Kriging interpolation, and multilevel binary logistic regression analyses were employed. Results: The overall prevalence of inadequate MDD, MMF, and MAD among children was 62.8%, 34.4%, and 70.4%, respectively. Spatial autocorrelation analysis showed that the distributions of inadequate MDD, MMF, and MAD across Bangladesh were highly clustered. For all three outcomes, a significant hot spot of inadequate feeding practice was noticed in the northeast region (Sylhet) of Bangladesh, while the cold spot was in the Southwest Khulna division. Young children (6–11 months), children of parents having no formal education, mothers with no employment, no media exposure, and belonging to households with low wealth status had higher odds of having inadequate MDD, MMF, and MAD. In contrast, children of mothers who had more frequent antenatal care (ANC) visits were less likely to have inadequate MMF and MAD. Conclusion: Socioeconomic and maternal factors, such as low parental education, lack of maternal employment, limited media exposure, and lower household wealth, were significantly associated with suboptimal CFPs. Monitoring appropriate CFIs nationwide and implementing policies and programs to address geographical and socioeconomic disparities are crucial for ensuring optimal child nutrition.

Background: Colorectal cancer is a leading cause of cancer mortality and morbidity worldwide. To guide strategies for reducing disease burden, we analysed colorectal cancer incidence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2023 at global, regional, and national levels—including the impact of selected risk factors—and forecasted trends through 2050. Methods: Colorectal cancer estimates were generated using Global Burden of Disease Study (GBD) 2023 methods, employing data from vital registration systems, population-based cancer registries, and verbal autopsies. Mortality was estimated using ensemble models, and incidence using mortality-to-incidence ratios. Years of life lost (YLLs) were generated based on death counts and GBD standard life expectancy at the age of death, and years lived with disability (YLDs) by multiplying prevalence and disability weights. YLLs and YLDs were summed to yield DALYs. Decomposition analysis was used to estimate the contributions of population growth, population ageing, colorectal cancer risk factors, and changes in rates to temporal changes in colorectal cancer DALYs. For risk factors with evidentiary links to colorectal cancer, risk-attributable DALYs were estimated based on the GBD 2023 comparative risk assessment framework. Forecasts used GBD forecasting methods and were aligned with GBD 2023 estimates. Findings: In 2023, colorectal cancer was the second-leading cause of cancer deaths (1.11 million [95% uncertainty interval, 0.997–1.21] deaths), with 2.31 million (2.03–2.58) incident cases, representing increases from 1990 of 90.4% (75.4–106.9) and 145.0% (114.3–183.1), respectively. Globally, 2023 rates of age-standardised incidence (ASIRs) and mortality (ASMRs) were 25.4 cases (22.2–28.3) and 12.3 deaths (11.0–13.4) per 100 000 population, respectively, with relatively stable global ASIR (percentage change: 3.2% [–9.5 to 18.3]) and a decrease of 21.9% (15.2–27.6) in ASMR between 1990 and 2023. In 2023, over three-fourths of global colorectal cancer cases and deaths occurred in World Bank high- and upper-middle income groups, which also experienced higher ASIRs than low- and lower-middle income groups. Notably, however, ASIRs increased between 1990 and 2023 for all groups except for high-income, where ASIR remained stable. ASMRs increased substantially in low- and lower-middle income groups, yet decreased in high- and upper-middle-income groups. In 2023, modifiable risk factors accounted for 55.7% (41.4–67.3) of the 26.2 million (23.8–28.6) global colorectal cancer DALYs, with dietary risks the leading contributor (37.2% [18.1–53.5]). Global DALYs increased by 76.4% (62.3–94.5) between 1990 and 2023, with population growth and ageing driving increases, partly offset by decreases related to risk-deleted DALY rates and risk factors. In 2050, global ASIRs and ASMRs are forecasted to be 24.6 (17.1–32.6) and 12.0 (8.9–16.4), respectively, per 100 000, while global incident cases and deaths are forecasted to rise to 4.21 million (2.76–5.81) and 2.21 million (1.50–3.20), respectively. Interpretation: Colorectal cancer is a major global health concern, with rising numbers of cases and deaths globally. While most colorectal cancer cases and deaths occurred in high- and upper-middle income countries, ASIRs and ASMRs increased in lower-middle- and low-income countries. Over half of the disease burden is linked to modifiable risk factors, most notably dietary risks. Strengthening prevention, early detection, and access to care across the resource spectrum is essential to limit future burden.

The rapid growth of India's elderly population necessitates understanding the determinants of cognitive health. Objective: This study examined the prevalence of cognitive impairment and its association with socio-demographic, health, and behavioural factors among community-dwelling older adults in urban Delhi. Methods: A community-based cross-sectional study was conducted from January to June 2023 among 290 adults aged ≥60 years in South-West Delhi, selected through multistage sampling. Data on socio-demographics, health status, and lifestyle were collected via structured interviews. Cognitive function was assessed using the Brief Interview for Mental Status (BIMS) and classified as intact, mild to moderate, or severe impairment. Principal Component Analysis (PCA) identified explanatory dimensions; multivariable ordinal logistic regression examined associations; and K-means clustering grouped participants by cognitive profiles. Results: Overall, 52.8% had intact cognition, 37.2% mild to moderate impairment, and 10% severe impairment. Severe impairment was most prevalent among those aged ≥81 years (61.5%) and with no formal education (55.2%), while intact cognition was highest among skilled workers (26.6%) and those with high school or higher education (43.8%). Significant factors included age, education, body mass index (BMI), physical activity, smoking, alcohol use, dietary intake, sleep quality, mental activity, and social engagement (all p<0.001). PCA yielded eight principal components capturing behavioral, health, and socio-demographic domains. K-means clustering identified two distinct cognitive profiles based on performance and associated factors. Conclusion: Cognitive status in older urban adults is shaped by modifiable health and lifestyle factors. Community-based interventions promoting physical activity, social participation, and healthy behaviors may help preserve cognition in aging populations.

The COVID-19 pandemic has had a profound and far-reaching impact on global health, resulting in significant morbidity and mortality across populations. Long term post COVID-19 conditions can include neurological symptoms, chronic fatigue, and mental health disorders, which collectively contribute to a deterioration in health-related quality of life. This study aims assess long-term HRQoL using EuroQol (EQ 5D 5L) among COVID-19 patients in community settings. This study conducted a multicentric, community-based cross-sectional design to assess the long-term HRQoL among patients who have recovered from COVID-19. The study included participants aged above 18 years from two cities Delhi and Bhubaneswar. Descriptive statistics of categorical variables were presented in frequency and percentage, while continuous variables were presented in mean ± SD. The censored regression analysis has been performed by reporting beta coefficients and significance by (p < 0.05). The EQ-5D-5L index scores indicated a mean of 0.89 (95% CI 0.87, 0.91) for Delhi, compared to a lower mean score of 0.66 (95% CI 0.62, 0.71) for Bhubaneswar. Age was negatively correlated with health states, showing a crude coefficient of − 0.003 (95% CI − 0.005, 0.001) with a significant p value of 0.002, although the adjusted coefficient was − 0.002 (95% CI − 0.005, 0.001), indicating a loss of significance when controlling for other factors. The emphasizes the health-related quality of life of the COVID-19 recovered patients and challenges in their daily living. The study descriptively highlighting the quality-of-life and in association with age, educational status, marital status, health insurance availability, and treatment setting.

Background COVID-19's emergence created a worldwide disaster, hitting nations of all income levels and causing catastrophic health and socioeconomic destruction. Due to differences in healthcare systems, demography, and containment measures, low and lower-middle-income nations (LMICs) had distinct problems in coping with the epidemic. Objectives This review synthesizes the existing evidence on the cost of treating COVID-19 in low and middle-income countries, including direct and indirect expenses and the methods employed in cost assessment. Methodology The review includes studies published after 2019, concentrating on COVID-19 patients in low and lower middle-income countries. Four studies complied to the inclusion criteria, demonstrating various methodological approaches, perspectives, cost components and regional variation across the healthcare system. Results Four studies from Iran, Kenya, Ghana and Ethiopia were included. Average direct medical costs per inpatient ranged from $321 to $3,755, with ICU care consistently 2–4 times more expensive than general ward care. Key cost drivers included ICU services (up to 41%), staffing (up to 46%), medications (up to 35%), and PPE (up to 79%). Indirect costs, where reported, added substantially to the total burden. Conclusion COVID-19 imposed a significant economic burden in low- and lower-middle-income countries, with costs escalating sharply in severe and critical cases. ICU care, staffing, medications, and PPE are the primary cost drivers. These findings emphasized the need for cost-efficient strategies—such as early detection, home-based care, and targeted ICU use—to optimize resource allocation and reduce financial strain on health systems.

Globally, 1.7 billion cases of childhood diarrheal disease occur every year. The Government of India initiated the Intensive Diarrhea Control Fortnight (IDCF) program in 2015 aimed to reduce childhood diarrheal deaths to zero. We aimed to ascertain the association between WASH practices and the prevalence of diarrhea in India's children under three years of age. We analyzed the data from the NFHS-5 survey conducted between 2019 and 2021. We extracted data on household and individual levels. The association between WASH practice in the household and diarrheal episodes in children <3 years old were presented by unadjusted and adjusted prevalence ratio (PR) with a 95% confidence interval (CI). We used STATA v 16 for analysis. We included 132,198 children, 8.4% (n = 11,060) had diarrhea in the 2 weeks preceding the survey. The majority of the children were residing in rural areas (79.8%) and using unprotected water (90%) sources. Diarrhea was associated with using shared toilet facilities (adj. PR: 1.28, 95% CI: 1.17, 1.34), improper disposal of child's stools (adj. PR: 1.12, 95% CI: 1.05, 1.20) and having no separate kitchen (adj. PR: 1.16, 95% CI: 1.08, 1.23). Household WASH practices continue to be independent predictors of diarrhea among <3 children.