Socio Demographic and Reproductive Risk Factors for Cervical Cancer - a Large Prospective Cohort Study from Rural India

Thulaseedharan, Jissa V.,Malila, Nea,Hakama, Matti,Esmy, Pulikottil O.,Cheriyan, Mary,Swaminathan, Rajaraman,Muwonge, Richard,Sankaranarayanan, Rengaswami Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.6

Background: India shows some of the highest rates of cervical cancer worldwide, and more than 70% of the population is living in rural villages. Prospective cohort studies to determine the risk factors for cervical cancer are very rare from low and medium resource countries. The aim of this study was to quantify the effect of risk factors related to cervical cancer in a rural setting in South India. Material and methods: Sociodemographic and reproductive potential risk factors for cervical cancer were studied using the data from a cohort of 30,958 women who constituted the unscreened control group in a randomised screening trial in Dindigul district, Tamilnadu, India. The analysis was accomplished with the Cox proportional hazard regression model. Results: Women of increasing age (HR=2.4; 95% CI: 1.6, 3.8 in 50-59 vs 30-39), having many pregnancies (HR=7.1; 1.0, 52 in 4+ vs 0) and no education (HR=0.6; 0.2, 0.7 in high vs none) were found to be at significantly increased risk of cervical cancer. Conclusion: This cohort study gives very strong evidence to say that education is the fundamental factor among the sociodemographic and reproductive determinants of cervical cancer in low resource settings. Public awareness through education and improvements in living standards can play an important role in reducing the high incidence of cervical cancer in India. These findings further stress the importance of formulating public health policies aimed at increasing awareness and implementation of cervical cancer screening programmes.

Effect of Screening on the Risk Estimates of Socio Demographic Factors on Cervical Cancer - A Large Cohort Study from Rural India

Thulaseedharan, Jissa Vinoda,Malila, Nea,Hakama, Matti,Esmy, Pulikottil Okuru,Cherian, Mary,Swaminathan, Rajaraman,Muwonge, Richard,Sankaranarayanan, Rengaswami Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.1

Background: Prospective cohort studies to determine cofactors with oncogenic HPV-infections for cervical cancer are very rare from developing countries and such data are limited to the few screening trials. Large screening trials provide such data as a by product. Some of the cases are prevented by screening and do not surface as invasive cancers at all. Also, pre-invasive lesions are detected almost entirely by screening. Screening causes selection bias if attendance in or effectiveness of screening is correlated with the risk factors. The aim of this study was to quantify the influence of screening on risk factors for cervical cancer. Materials and Methods: Our material stems from a rural cohort of 80,000 women subjected to a randomised screening trial. The effect of screening on the incidence of cervix cancer was estimated with reference to socio-demographic and reproductive risk factors of cervical cancer. We compared these risks with the incidence of cancer in the randomised control population by the same determinants of risk. Results: The results in the screening arm compared to the control arm showed that the women of low SES and young age were benefitting more than those of high SES and old age. The relative risk by age (30-39 vs 50-59) was 0.33 in the control arm and 0.24 in the screening arm. The relative risk by education (not educated vs educated) was 2.8 in the control arm and 1.8 in the screening arm. The previously married women did not benefit (incidence 113 and 115 per 100,000 women years in control vs screening arms) whereas the effect was substantial in those married (86 vs 54). Conclusions: The results in controls were consistent with the general evidence, but results in attenders and nonattenders of the screening arm showed that screening itself and self-selection in attendance and effectiveness can influence the effect estimates of risk factors. The effect of cervical cancer screening programmes on the estimates of incidence of cervical cancer causes bias in the studies on etiology and, therefore, they should be interpreted with caution.

Effect of Screening on Variation in Cervical Cancer Survival by Socioeconomic Determinants - a Study from Rural South India

Thulaseedharan, Jissa Vinoda,Malila, Nea,Swaminathan, Rajaraman,Esmy, Pulikottil Okuru,Cherian, Mary,Hakama, Matti,Muwonge, Richard,Sankaranarayanan, Rengaswamy Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.13

Background: Socioeconomic factors are associated with screening in terms of reducing the risk of cervical cancer. This study aimed to clearly establish the effect of screening on variation in socio-economic factor-specific survival estimates. Materials and Methods: Survival estimates were calculated using the life table method for 165 women from the routine care control arm and 67 from the visual inspection with acetic acid screening arm diagnosed with cervical cancer during 2000-2006 in rural south India. Kaplan-Meier survival curves were plotted to compare the variation in survival by socioeconomic factors. Results: Whereas there was a significant variation in survival estimates of the different categories of age at diagnosis among the screen-detected cancers with women aged<50 years having an improved survival, no significant variation was noted among women diagnosed with cervical cancer from the control arm. Compared to the variation among the cancer cases detected in the unscreened control group, screening widened the variation in survival estimates by age and type of house, and reduced the variation by education. The direction of the magnitude of the survival estimates was reversed within the different categories of occupation, marital status and household income in the screen-detected cancer cases compared to control group cancer cases. Also, women diagnosed with stage 1 disease had a very good survival. Conclusions: Screening changed the pattern of survival by socio-economic factors. We found improved survival rates in screened women aged <50 years, with no formal education, manual workers and married women.

Anomalous Variations in Atmospheric Carbon Monoxide Associated with the Tsunami

Retnamayi, Anjali,Ganapathy, Mohan Kumar,Santha, Sreekanth Thulaseedharan Korean Society for Atmospheric Environment 2011 Asian Journal of Atmospheric Environment (AJAE) Vol.5 No.1

Variations in ambient atmospheric carbon monoxide(CO) observed at an inland mining site in the Indo-Gangetic plains, Jaduguda ($22^{\circ}38'N$, $86^{\circ}21'E$, 122m MSL, ~75 km away from the coast of the Bay of Bengal) during the Tsunami of 26 December 2004 were monitored. CO mixing ratio over this site was measured using a non-dispersive infrared analyzer (Monitor Europe Model 9830 B). Back trajectory analysis data obtained using NOAA Hybrid Single Particle Lagrangian Integrated Trajectory (HYSPLIT) Model was also used for this study. Variations in CO mixing ratio at a coastal site, Thiruvananthapuram ($8^{\circ}29'N$, $76^{\circ}57'E$, located ~2 km from the Arabian Sea coast) have also been investigated using CO data retrieved from the Measurement Of Pollution In The Troposphere (MOPITT) instrument. Ground-based measurements indicated abnormal variations in CO mixing ratio at Jaduguda from 25 December 2004 evening (previous day of the Tsunami). MOPITT CO data showed an enhancement in CO mixing ratio over Thiruvananthapuram on the Tsunami day. Back trajectory analyses over Thiruvananthapuram and Jaduguda for a period of 10 days from $21^{st}$ to $30^{th}$ December 2004 depicted that there were unusual vertical movements of air from high altitudes from 25 December 2004 evening. CO as well as the back trajectory analyses data showed that the variations in the wind regimes and consequently wind driven transport are the most probable reasons for the enhancement in CO observed at Jaduguda and Thiruvananthapuram during the Tsunami.

Anomalous Variations in Atmospheric Carbon Monoxide Associated with the Tsunami

Anjali Retnamayi,Mohan Kumar Ganapathy,Sreekanth Thulaseedharan Santha 한국대기환경학회 2011 Asian Journal of Atmospheric Environment (AJAE) Vol.5 No.1

Variations in ambient atmospheric carbon monoxide (CO) observed at an inland mining site in the Indo-Gangetic plains, Jaduguda (22^ㅇ38′ N, 86^ㅇ21′ E, 122m MSL, ~75 km away from the coast of the Bay of Bengal) during the Tsunami of 26 December 2004were monitored. CO mixing ratio over this site was measured using a non-dispersive infrared analyzer (Monitor Europe Model 9830 B). Back trajectory analysis data obtained using NOAA Hybrid Single Particle Lagrangian Integrated Trajectory (HYSPLIT)Model was also used for this study. Variations in CO mixing ratio at a coastal site, Thiruvananthapuram (8^ㅇ29′ N, 76^ㅇ57′ E, located ~2 km from the Arabian Sea coast) have also been investigated using CO data retrieved from the Measurement Of Pollution In The Troposphere (MOPITT) instrument. Ground-based measurements indicated abnormal variations in CO mixing ratio at Jaduguda from 25 December 2004evening (previous day of the Tsunami). MOPITT CO data showed an enhancement in CO mixing ratio over Thiruvananthapuram on the Tsunami day. Back trajectory analyses over Thiruvananthapuram and Jaduguda for a period of 10 days from 21^st to 30^th December 2004 depicted that there were unusual vertical movements of air from high altitudes from 25 December 2004 evening. CO as well as the back trajectory analyses data showed that the variations in the wind regimes and consequently wind driven transport are the most probable reasons for the enhancement in CO observed at Jaduguda and Thiruvananthapuram during the Tsunami.

Asymptomatic Hearing Impairment Frequently Occurs in Early-Onset Parkinson’s Disease

Kuldeep Shetty,Syam Krishnan,Jissa Vinoda Thulaseedharan,Manju Mohan,Asha Kishore 대한파킨슨병및이상운동질환학회 2019 Journal Of Movement Disorders Vol.12 No.2

Recent reports of hearing impairment in Parkinson’s disease (PD) have suggested that auditory dysfunction could be a non-motor manifestation of PD. These reports were based on observations of elderly patients for whom presbycusis may, to some extent, have contributed to hearing dysfunction. Therefore, we aimed to explore the auditory functions in younger patients with PD. MethodsWe conducted a case-control study in a relatively younger (< 55 years of age at study time) population of PD patients and healthy volunteers to test whether auditory dysfunction is a significant non-motor dysfunction in PD. Pure tone audiometry (PTA) and brainstem evoked response audiometry (BERA) were performed in all participants. ResultsNone of the patients or controls reported hearing deficits. Fifty-one patients with PD and 50 healthy volunteers who were age- and gender-matched to the patients participated. PTA-detected hearing impairment was found in 64.7% of patients and 28% of controls (p < 0.001) for both low-mid and/or high frequencies. Hearing impairment was more frequent in the younger subgroups of patients than age-matched controls, while the frequency of hearing impairment was similar in older groups of subjects. BERA was not different between patients and controls. ConclusionAsymptomatic auditory dysfunction is a common non-motor manifestation of early-onset PD and more frequent in younger patients, indicating that it may be independent of aging. The mechanism underlying this dysfunction appears to be peripheral, although a central dysfunction cannot be ruled out based on the findings of this study.