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Endogenous antioxidant biomarkers and cancer risk among men with concurrent smoking and alcohol use: A prospective cohort study

Sat, 01 Aug 2026 00:00:00 GMT

Title: Endogenous antioxidant biomarkers and cancer risk among men with concurrent smoking and alcohol use: A prospective cohort study Authors: Shin, Jong Won; Jee, Yongho; Yang, Yeun Soo Abstract: Background: This study aimed to evaluate age-specific associations between endogenous antioxidant biomarkers and cancer risk in a high-risk male population characterized by concurrent smoking and alcohol use. Methods: We analyzed data from the Korean Cancer Prevention Study-II (KCPS-II), including 83,371 men. Associations between serum creatinine, bilirubin, albumin, and uric acid and cancer risk were evaluated using Cox proportional hazards models. Analyses were conducted among all men, ever smokers and drinkers, and current smokers and drinkers, with both overall and age-stratified analyses (<50 and >= 50 years). Restricted cubic spline analyses were performed to assess nonlinear age-dependent associations and age-biomarker interactions. Results: Serum bilirubin, albumin, and uric acid were inversely associated with overall cancer risk, with the strongest associations observed among men aged >= 50 years with concurrent smoking and alcohol use. Creatinine demonstrated contrasting associations according to age. Lung cancer showed consistent inverse associations across biomarkers, whereas stomach, prostate, and pancreatic cancers exhibited heterogeneous age-specific patterns. Restricted cubic spline analyses further indicated significant nonlinear age-biomarker interactions. Conclusions: Among men with concurrent smoking and alcohol use, biomarker-cancer associations showed substantial age-dependent heterogeneity in both magnitude and direction.

Economic burden of typhoid fever by antimicrobial resistance in India: a modelling study 2023

Wed, 01 Apr 2026 00:00:00 GMT

Title: Economic burden of typhoid fever by antimicrobial resistance in India: a modelling study 2023 Authors: V. Mogasale, Vijayalaxmi; John, Jacob; Ray, Arindam; Farooqui, Habib Hasan; Mogasale, Vittal; Hutubessy, Raymond; Dhoubhadel, Bhim Gopal; Edmunds, W. John; Clark, Andrew; Abbas, Kaja Abstract: Background Typhoid fever and rising antimicrobial resistance contribute towards substantial morbidity in India. Introduction of typhoid conjugate vaccine in national immunisation schedule is under consideration to address this growing disease burden. In this study we estimated the economic burden of typhoid fever for 2023, disaggregated by age, provincial states of India, and fluoroquinolone resistance, from societal and government perspectives, to support national vaccination policy. Methods We developed a decision-tree model using Indian empirical data on typhoid epidemiology, care-seeking, clinical outcomes, and estimated direct and indirect costs for hospitalised and non-hospitalised typhoid fever patients. To reflect age-specific uncertainty in hospitalisation patterns and resulting economic burden, we used two primary scenarios. We estimated productivity losses due to premature mortality using the human capital approach, with the friction-cost approach as an alternative. We assessed uncertainty through probabilistic sensitivity analysis. Findings The economic burden of typhoid fever in India in 2023 was estimated at INR 123.0 billion (95% UI 76.7-215.5; US$ 1.5 billion, 0.9-2.6), including a cost of INR 13.0 billion (6.6-27.0; US$ 157 million, 80-326) to the public health system (government perspective). Fluoroquinolone-resistant infections accounted for 87% of total costs. Children under ten years of age incurred the highest economic burden, contributing over half of the total costs. Households bore 91% of expenses, and 70,000 families faced catastrophic health expenditure. Maharashtra, Uttar Pradesh, Andhra Pradesh (including Telangana), Tamil Nadu, and West Bengal were the states estimated to account for 51% of the national costs. Productivity loss was INR 42.6 billion (15.7-111.1; US$ 515 million) based on the human capital approach and declined by 99.8% under the friction-cost approach. Interpretation Typhoid fever imposes a significant economic burden in India, shaped by fluoroquinolone resistance, children less than ten years of age, and high-burden provincial states of the country, resulting in considerable household financial strain. Our findings provide key evidence to support the introduction of the typhoid conjugate vaccine, enhance antimicrobial resistance control, and guide national health financing policies.

Burden of antimicrobial resistance in culture-confirmed Salmonella Typhi isolates in India from 1977 to 2024: A systematic review and meta-analysis

Wed, 01 Apr 2026 00:00:00 GMT

Title: Burden of antimicrobial resistance in culture-confirmed Salmonella Typhi isolates in India from 1977 to 2024: A systematic review and meta-analysis Authors: Mogasale, Vijayalaxmi V.; Zhang, Peixuan; John, Jacob; Farooqui, Habib Hasan; Ray, Arindam; Mogasale, Vittal; Parry, Christopher M.; Dhoubhadel, Bhim Gopal; Edmunds, W. John; Clark, Andrew; Abbas, Kaja Abstract: Background Antimicrobial-resistant (AMR) Salmonella Typhi (S. Typhi) is a persistent public health threat in India. We conducted a systematic review and meta-analysis to estimate the prevalence and temporal trends of AMR S. Typhi across Indian states to inform prevention and treatment strategies. Methods We systematically reviewed antimicrobial resistance in S. Typhi isolates from India, including studies published up to March 31, 2025, with no start-date restriction. We screened eligible articles from PubMed-MEDLINE, EMBASE, Scopus, Web of Science, and AMR surveillance networks and excluded studies on chronic carriers and travellers. We assessed risk of bias using the Risk Of Bias In Non-randomised Studies - of Exposures (ROBINS-E) tool. We conducted meta-analysis using a random-effects model to estimate the prevalence of multidrug resistance (MDR; resistance to chloramphenicol, ampicillin, and co-trimoxazole) and resistance to fluoroquinolones, third-generation cephalosporins, and azithromycin across five-year periods, Indian states, and age groups (<18 versus all ages). Results We analysed data from 188 of 4,430 identified studies. MDR declined from 65% (95% CI 63-67) in 1990-94 to nearly 0% (95% CI 0-1) >= 2020. Fluoroquinolone resistance rose from 2% (95% CI 1-2) in 1990-94-85% (95% CI 84-86) in 2015-19, then declined slightly, with similar trends in children but marked variation across Indian states. Resistance to third-generation cephalosporins, azithromycin, and carbapenems remained below 5%, 8%, and 2%, respectively. Our meta-analysis of studies with samples collected from 2015 onwards showed a pooled summary resistance estimate of 82% (95% CI 74-87) for fluoroquinolones, 3% (95% CI 2-4) for third-generation cephalosporins, and 3% (95% CI 1-6) for azithromycin. Conclusion Fluoroquinolone resistance in S. Typhi in India is high but is declining, while resistance to third-generation cephalosporins and azithromycin is low. As many isolates originated from major cities, caution is warranted when generalising nationally. Continued AMR surveillance is crucial to guide vaccination strategies and treatment decisions.

Long-term impact of health policy and management training for health experts from the LMICs: 2022 Dr. LEE Jong-wook fellowship program

Wed, 01 Apr 2026 00:00:00 GMT

Title: Long-term impact of health policy and management training for health experts from the LMICs: 2022 Dr. LEE Jong-wook fellowship program Authors: Rajaguru, Vasuki; Park, Jun Su; Choi, Soo Hyeok; Kim, Sunmin; Seo, Jungeun; Kim, Yumin; Jung, Hyejin; Kim, Tae Hyun Abstract: Background Strengthening health leadership and management capacity in low- and middle-income countries (LMICs) is critical for building resilient health systems. The Dr. Lee Jong-wook Fellowship Program (LJWFP), implemented by the Korea Foundation for International Healthcare, was designed to equip public health administrators with competencies in policy implementation and system strengthening. However, long-term behavioural impacts of such programs are rarely evaluated beyond satisfaction and knowledge gains. This study assessed the long-term impact of the 2022 LJWFP cohort on competency achievement, satisfaction and workplace application using the Kirkpatrick evaluation framework. Methods This mixed methods study analysed data from 13 fellows who participated in the 2022 LJWFP. Quantitative data were collected through pre- and post-training assessments, participant surveys and supervisor and peer evaluations. Qualitative evidence was obtained through follow-up assessments and structured field visits. Descriptive statistics summarized key outcomes and Pearson's correlation analysis examined associations among competency achievement, training satisfaction and workplace application over a 2-y follow-up period. Results The program demonstrated high training satisfaction, with substantial gains in knowledge and competency. The correlation between competency achievement and satisfaction was moderate and statistically significant (r=0.488, p<0.05), whereas the relationship between competency and field application was moderate but not statistically significant (r=0.445, p<0.05). A strong, statistically significant correlation was observed between satisfaction and field application (r=0.776, p<0.001), suggesting that participants who were more satisfied with the training were more likely to apply their learning in practice. Conclusions The program effectively enhanced leadership skills and supported post-training applications. Future iterations should integrate mentorship and follow-up mechanisms, expand digital learning tools and measure system-level impact longitudinally. These findings highlight the value of context-tailored fellowships in advancing public health leadership and governance in LMICs.