Background: Cancer of unknown primary (CUP) origin is cancer in which malignant cancer cells are ... more Background: Cancer of unknown primary (CUP) origin is cancer in which malignant cancer cells are in the body but the site of cancer where it began is unknown. Detailed incidence and time trends of these cancers, specific to various regions in India is needed. This paper aims to summarize and report the incidence of other and unknown (O&U) cancers across India in 27 population-based cancer registries (PBCRs) and to study the trends among these cancers using joinpoint regression analysis. Methods: Data on the incidence of CUP were obtained from the published reports on 27 PBCRs of the National Cancer Registry Programme (NCRP) of the Indian Council of Medical Research (ICMR). A joinpoint regression model was used to analyze the long-term trends of incidence related to CUP based on published data from PBCRs between 1986 and 2014. Annual Percent Change (APC) in incidence rate was estimated for various registries. Results: The northeast region had the highest age-adjusted rate (AAR) for both men (1.76-29.7) and women (1.99-14.68). Age-specific rate (ASR) for both men (39.8-855.7) and women (48.2-470.4) was highest in the northeast region. There is an increase in the incidence rate for all six major registries over the past decade with an exception of women in the Delhi Cancer Registry. There is a decline in incidence rate by 0.14 during 1990-2012 in the female population of the Delhi registry. Conclusion: The increasing incidence trends of CUP is a matter of concern for the healthcare professionals and researchers. There is a need for research and advanced and improved diagnostic tools for the improvement of the status of O&U cancers.
DOAJ (DOAJ: Directory of Open Access Journals), 2013
ABSTRACT In order to answer a research question, observations in the form of data are obtained fr... more ABSTRACT In order to answer a research question, observations in the form of data are obtained from a sample of individuals or subjects under study. The sample so obtained should be random in nature. There are random sampling methods to draw samples that adequately represent a cross-section of the entire population. Samples of observations are used to draw valid conclusions. In this approach, the quantification of uncertainties that occur due to the process of sampling is the subject matter of evaluating statistical significance. These are different from the uncertainties related to measurement error in either the instrument or observers occurring due to non-sampling errors, which are not discussed here. Statistical significance is closely related to confidence statements of occurrence of an event. One can never be 100% confident in drawing conclusions. A threshold of 95% confidence indicates an uncertainty of 5% which could result in errors. The statistical inference in hypothesis testing deals with the probability of those errors.
Pap smear testing as a conventional cervical screening approach has limitations for implementatio... more Pap smear testing as a conventional cervical screening approach has limitations for implementation and aided visual cervical testing has varying results in different regions. The aim of this study is to demonstrate the performance of aided visual cervical screening tests as against conventional Pap smear testing in a rural community setting of North India. This was a rural community based cross-sectional study. All 7603 ever married women of age 30-59 years surveyed in a pocket of Dadri Tehsil, Uttar Pradesh, India were targeted for screening by Pap, visual inspection of cervix using acetic acid (VIA) and visual inspection of cervix using Lugol's iodine (VILI) methods. Screen positives were referred to colposcopy and confirmation by histology. Detection of histological cervical intraepithelial neoplasia (CIN) II + and CIN III + assessed separately by sensitivity, specificity and likelihood ratio's and predictive values. Analysis of data was performed by using IBM SPSS statstics software version 16.0. A total of 65.6%(4988/7604) eligible women of 30-59 years age group in the target population were screened. Out of 4988, further analysis was performed on 4148 after excluding those who did not complete all screenings, who lost to follow-up and had missing histology results. Screen positivity rates by Pap (ASCUS and above), VIA and VILI were 2.6%, 9.7% and 13.5% respectively. Sensitivity and specificity of detecting the CIN III+ lesions were 87.5 and 98.8% for Pap, 50.0% and 96.7% for VIA and 50.0% and 95.7% for VILI respectively. VIA screening demonstrated as a feasible primary screening test for detecting high grade CIN and as to perform better when the Pap test is not feasible.
Journal of Epidemiology and Community Health, Aug 6, 2015
Human papillomavirus (HPV) is recommended as a primary screening tool for cervical screening. Ass... more Human papillomavirus (HPV) is recommended as a primary screening tool for cervical screening. Assessment of age-specific performance of newer HPV careHPV DNA testing is important as risk of cervical intraepithelial neoplasia (CIN) varies at different ages. We aim to evaluate careHPV in comparison to Papanicolaou (Pap) test and visual inspection of the cervix with acetic acid (VIA) cervical screening tests for the detection of high-grade CIN. The cross sectional study was conducted in a rural population of North India. Ever-married women 30-59 years of age were invited for screening by careHPV (self-collected vaginal and physician-collected cervical samples), Pap test and VIA. Associations for trend in age for detecting histological-confirmed CINII+ and CINIII+ for each screening test were evaluated. Age-specific association with each screening test was evaluated. Of a total of 7761 women invited, 5032 were screened and analysis was performed on 4658 with all screen test results. No significant (p>0.05) association of age for any screening test in the detection of CINII+ or CINIII+ was observed. For the older age group, cervical HPV (CHPV) showed high sensitivity and specificity for CINII+ detection. Specificity of CHPV or vaginal HPV (VHPV) was equal or higher than Pap in all age groups. Cervical screening options of CHPV or VHPV, or Pap, performed equally in the younger age group while CHPV might be an option for all ages in the detection of high-grade CIN.
Current Medicine Research and Practice, Jul 1, 2019
Abstract Background Earlier studies are mostly based on the first three National Family Health Su... more Abstract Background Earlier studies are mostly based on the first three National Family Health Surveys (NFHSs) for estimating and comparing prevalence of underweight, overweight and obesity among Indian women and lack the information on latest survey. Objectives The objective of this work was to study and compare the prevalence of underweight, overweight and obesity among Indian women using the updated data from different NFHSs. Materials and methods Data collected under three surveys – NFHS-2, NFHS-3 and NFHS-4 – from different states of India were arranged according to geographical regions. Data on age, marital status, area of urban or rural, education, religion and wealth index were also collected. Body mass index (BMI) less than 18.5 kg/m2 was labelled as ‘underweight’, 25–30 kg/m2 ‘overweight’ and greater than or equal to 30 kg/m2 ‘obese’. Results Overall prevalence of underweight in Indian women reduced to 22.9%, while overweight (15.5%) and obese (5.1%) increased over different survey years. There was a decline in prevalence of underweight (−17.1%) and increase in prevalence of overweight (7.3%) and obese (2.3%) among illiterate. The urban areas showed comparatively higher burden of obesity (9.1%) than the rural areas (3.1%), but there was not much change (4.8–6%) over years. Prevalence of underweight remained higher in rural areas (26.7%) although there was apparent decline (13.8%). The states/union territories (UTs) belonging to Central (25.3%–28.3%) and Eastern regions (21.3%–31.5%) of India showed higher prevalence of underweight. Conclusion Indian women are recovering from throes of underweight, but a rising trend in overweight and obesity is a great concern.
Current Medicine Research and Practice, May 1, 2013
ABSTRACT Aim: To study a community's attitudes to screening for cervical cancer in a rura... more ABSTRACT Aim: To study a community's attitudes to screening for cervical cancer in a rural area of Uttar Pradesh, India. Setting and design: Descriptive study in a rural community of Uttar Pradesh. Patients and Methods: Five hundred and eleven women were selected by a two-stage random sampling method. A structured schedule was used to collect data on the community's awareness of cervical cancer and its views on a screening programme. Results: Of the total number of participants, 84.9% had a knowledge of cancer in general and 72.3% had a knowledge of cancer of the uterine cervix in particular. As many as 96.1% of the women expressed willingness to visit a government health centre to undergo screening. About 79.1% stated that their husbands would have no objection if they underwent screening. Overall, the community's awareness of cervical cancer was good and the response to the idea of screening was positive. Conclusion: The study found that the community's attitude was positive towards the screening programme for the prevention of cervical cancer. The findings will help in the implementation of the screening programme for cervical cancer.
Medical Biostatistics, Fourth Edition By Abhaya Indrayan and Rajeev Kumar Malhotra Chapman & Hall... more Medical Biostatistics, Fourth Edition By Abhaya Indrayan and Rajeev Kumar Malhotra Chapman & Hall/CRC Press, 2018 Medical Biostatistics (IV edition) looks like the most comprehensive book on biostatistics. All the topics of medical statistics are widely covered by the authors and the explanations are provided in non-mathematical easy language conducive to medical professionals. The book is a treasure tower for practicing medical statisticians, epidemiologists, clinicians and medical researchers of all disciplines. The first author of the book, Dr Indrayan, is just about the best known biostatistician of the country. The book consists of 21 chapters, which are well demarcated and segregated from each other.Each section deals with a specific biostatistical topic. Each topic is again divided to various subheadings which intern divided into specific topic. Each chapter has provided a list of references which could be useful for further reading.The exercises at the end of each chapter ...
Research Question What ;ire co-relales of infant deaths in KanpurObjective To assess infant morta... more Research Question What ;ire co-relales of infant deaths in KanpurObjective To assess infant mortality rale in rural & urban areas of Kanpur and various factors responsible for it. Study Design Cross sectional study.Study unit Each of household having live birth and infant death within one year of study.Study area Rural & Urban area of Kanpur.Study variableLive birth, infant death, co-relales.Statistical analysis :- By Chi-square lest of significance.
Background: Cancer of unknown primary (CUP) origin is cancer in which malignant cancer cells are ... more Background: Cancer of unknown primary (CUP) origin is cancer in which malignant cancer cells are in the body but the site of cancer where it began is unknown. Detailed incidence and time trends of these cancers, specific to various regions in India is needed. This paper aims to summarize and report the incidence of other and unknown (O&U) cancers across India in 27 population-based cancer registries (PBCRs) and to study the trends among these cancers using joinpoint regression analysis. Methods: Data on the incidence of CUP were obtained from the published reports on 27 PBCRs of the National Cancer Registry Programme (NCRP) of the Indian Council of Medical Research (ICMR). A joinpoint regression model was used to analyze the long-term trends of incidence related to CUP based on published data from PBCRs between 1986 and 2014. Annual Percent Change (APC) in incidence rate was estimated for various registries. Results: The northeast region had the highest age-adjusted rate (AAR) for both men (1.76-29.7) and women (1.99-14.68). Age-specific rate (ASR) for both men (39.8-855.7) and women (48.2-470.4) was highest in the northeast region. There is an increase in the incidence rate for all six major registries over the past decade with an exception of women in the Delhi Cancer Registry. There is a decline in incidence rate by 0.14 during 1990-2012 in the female population of the Delhi registry. Conclusion: The increasing incidence trends of CUP is a matter of concern for the healthcare professionals and researchers. There is a need for research and advanced and improved diagnostic tools for the improvement of the status of O&U cancers.
DOAJ (DOAJ: Directory of Open Access Journals), 2013
ABSTRACT In order to answer a research question, observations in the form of data are obtained fr... more ABSTRACT In order to answer a research question, observations in the form of data are obtained from a sample of individuals or subjects under study. The sample so obtained should be random in nature. There are random sampling methods to draw samples that adequately represent a cross-section of the entire population. Samples of observations are used to draw valid conclusions. In this approach, the quantification of uncertainties that occur due to the process of sampling is the subject matter of evaluating statistical significance. These are different from the uncertainties related to measurement error in either the instrument or observers occurring due to non-sampling errors, which are not discussed here. Statistical significance is closely related to confidence statements of occurrence of an event. One can never be 100% confident in drawing conclusions. A threshold of 95% confidence indicates an uncertainty of 5% which could result in errors. The statistical inference in hypothesis testing deals with the probability of those errors.
Pap smear testing as a conventional cervical screening approach has limitations for implementatio... more Pap smear testing as a conventional cervical screening approach has limitations for implementation and aided visual cervical testing has varying results in different regions. The aim of this study is to demonstrate the performance of aided visual cervical screening tests as against conventional Pap smear testing in a rural community setting of North India. This was a rural community based cross-sectional study. All 7603 ever married women of age 30-59 years surveyed in a pocket of Dadri Tehsil, Uttar Pradesh, India were targeted for screening by Pap, visual inspection of cervix using acetic acid (VIA) and visual inspection of cervix using Lugol's iodine (VILI) methods. Screen positives were referred to colposcopy and confirmation by histology. Detection of histological cervical intraepithelial neoplasia (CIN) II + and CIN III + assessed separately by sensitivity, specificity and likelihood ratio's and predictive values. Analysis of data was performed by using IBM SPSS statstics software version 16.0. A total of 65.6%(4988/7604) eligible women of 30-59 years age group in the target population were screened. Out of 4988, further analysis was performed on 4148 after excluding those who did not complete all screenings, who lost to follow-up and had missing histology results. Screen positivity rates by Pap (ASCUS and above), VIA and VILI were 2.6%, 9.7% and 13.5% respectively. Sensitivity and specificity of detecting the CIN III+ lesions were 87.5 and 98.8% for Pap, 50.0% and 96.7% for VIA and 50.0% and 95.7% for VILI respectively. VIA screening demonstrated as a feasible primary screening test for detecting high grade CIN and as to perform better when the Pap test is not feasible.
Journal of Epidemiology and Community Health, Aug 6, 2015
Human papillomavirus (HPV) is recommended as a primary screening tool for cervical screening. Ass... more Human papillomavirus (HPV) is recommended as a primary screening tool for cervical screening. Assessment of age-specific performance of newer HPV careHPV DNA testing is important as risk of cervical intraepithelial neoplasia (CIN) varies at different ages. We aim to evaluate careHPV in comparison to Papanicolaou (Pap) test and visual inspection of the cervix with acetic acid (VIA) cervical screening tests for the detection of high-grade CIN. The cross sectional study was conducted in a rural population of North India. Ever-married women 30-59 years of age were invited for screening by careHPV (self-collected vaginal and physician-collected cervical samples), Pap test and VIA. Associations for trend in age for detecting histological-confirmed CINII+ and CINIII+ for each screening test were evaluated. Age-specific association with each screening test was evaluated. Of a total of 7761 women invited, 5032 were screened and analysis was performed on 4658 with all screen test results. No significant (p>0.05) association of age for any screening test in the detection of CINII+ or CINIII+ was observed. For the older age group, cervical HPV (CHPV) showed high sensitivity and specificity for CINII+ detection. Specificity of CHPV or vaginal HPV (VHPV) was equal or higher than Pap in all age groups. Cervical screening options of CHPV or VHPV, or Pap, performed equally in the younger age group while CHPV might be an option for all ages in the detection of high-grade CIN.
Current Medicine Research and Practice, Jul 1, 2019
Abstract Background Earlier studies are mostly based on the first three National Family Health Su... more Abstract Background Earlier studies are mostly based on the first three National Family Health Surveys (NFHSs) for estimating and comparing prevalence of underweight, overweight and obesity among Indian women and lack the information on latest survey. Objectives The objective of this work was to study and compare the prevalence of underweight, overweight and obesity among Indian women using the updated data from different NFHSs. Materials and methods Data collected under three surveys – NFHS-2, NFHS-3 and NFHS-4 – from different states of India were arranged according to geographical regions. Data on age, marital status, area of urban or rural, education, religion and wealth index were also collected. Body mass index (BMI) less than 18.5 kg/m2 was labelled as ‘underweight’, 25–30 kg/m2 ‘overweight’ and greater than or equal to 30 kg/m2 ‘obese’. Results Overall prevalence of underweight in Indian women reduced to 22.9%, while overweight (15.5%) and obese (5.1%) increased over different survey years. There was a decline in prevalence of underweight (−17.1%) and increase in prevalence of overweight (7.3%) and obese (2.3%) among illiterate. The urban areas showed comparatively higher burden of obesity (9.1%) than the rural areas (3.1%), but there was not much change (4.8–6%) over years. Prevalence of underweight remained higher in rural areas (26.7%) although there was apparent decline (13.8%). The states/union territories (UTs) belonging to Central (25.3%–28.3%) and Eastern regions (21.3%–31.5%) of India showed higher prevalence of underweight. Conclusion Indian women are recovering from throes of underweight, but a rising trend in overweight and obesity is a great concern.
Current Medicine Research and Practice, May 1, 2013
ABSTRACT Aim: To study a community's attitudes to screening for cervical cancer in a rura... more ABSTRACT Aim: To study a community's attitudes to screening for cervical cancer in a rural area of Uttar Pradesh, India. Setting and design: Descriptive study in a rural community of Uttar Pradesh. Patients and Methods: Five hundred and eleven women were selected by a two-stage random sampling method. A structured schedule was used to collect data on the community's awareness of cervical cancer and its views on a screening programme. Results: Of the total number of participants, 84.9% had a knowledge of cancer in general and 72.3% had a knowledge of cancer of the uterine cervix in particular. As many as 96.1% of the women expressed willingness to visit a government health centre to undergo screening. About 79.1% stated that their husbands would have no objection if they underwent screening. Overall, the community's awareness of cervical cancer was good and the response to the idea of screening was positive. Conclusion: The study found that the community's attitude was positive towards the screening programme for the prevention of cervical cancer. The findings will help in the implementation of the screening programme for cervical cancer.
Medical Biostatistics, Fourth Edition By Abhaya Indrayan and Rajeev Kumar Malhotra Chapman & Hall... more Medical Biostatistics, Fourth Edition By Abhaya Indrayan and Rajeev Kumar Malhotra Chapman & Hall/CRC Press, 2018 Medical Biostatistics (IV edition) looks like the most comprehensive book on biostatistics. All the topics of medical statistics are widely covered by the authors and the explanations are provided in non-mathematical easy language conducive to medical professionals. The book is a treasure tower for practicing medical statisticians, epidemiologists, clinicians and medical researchers of all disciplines. The first author of the book, Dr Indrayan, is just about the best known biostatistician of the country. The book consists of 21 chapters, which are well demarcated and segregated from each other.Each section deals with a specific biostatistical topic. Each topic is again divided to various subheadings which intern divided into specific topic. Each chapter has provided a list of references which could be useful for further reading.The exercises at the end of each chapter ...
Research Question What ;ire co-relales of infant deaths in KanpurObjective To assess infant morta... more Research Question What ;ire co-relales of infant deaths in KanpurObjective To assess infant mortality rale in rural & urban areas of Kanpur and various factors responsible for it. Study Design Cross sectional study.Study unit Each of household having live birth and infant death within one year of study.Study area Rural & Urban area of Kanpur.Study variableLive birth, infant death, co-relales.Statistical analysis :- By Chi-square lest of significance.
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