Objective To investigate the demographic, socioeconomic, and geographical distribution of tobacco consumption in India. Design Multilevel cross sectional analysis of the 1998-9 Indian national family health survey of 301 984 individuals in 92 447 households in 3215 villages in 440 districts in 26 states. Setting Indian states. Participants 301 984 adults ( ≥ 18 years). Main outcome measures Dichotomous variable for smoking and chewing tobacco for each respondent (1 if yes, 0 if no) as well as a combined measure of whether an individual smokes, chews tobacco, or both. Results Smoking and chewing tobacco are systematically associated with socioeconomic markers at the individual and household level. Individuals with no education are 2.69 times more likely to smoke and chew tobacco than those with postgraduate education. Households belonging to the lowest fifth of a standard of living index were 2.54 times more likely to consume tobacco than those in the highest fifth. Scheduled tribes (odds ratio 1.23, 95% confidence interval 1.18 to 1.29) and scheduled castes (1.19, 1.16 to 1.23) were more likely to consume tobacco than other caste groups. The socioeconomic differences are more marked for smoking than for chewing tobacco. Socioeconomic markers and demographic characteristics of individuals and households do not account fully for the differences at the level of state, district, and village in smoking and chewing tobacco, with state accounting for the bulk of the variation in tobacco consumption. Conclusion The distribution of tobacco consumption is likely to maintain, and perhaps increase, the current considerable socioeconomic differentials in health in India. Interventions aimed at influencing change in tobacco consumption should consider the socioeconomic and geographical determinants of people's susceptibility to consume tobacco.
The mortality burden, across the life course in India, falls disproportionately on economically disadvantaged and lower-caste groups. Residual state-level variation in mortality suggests an underlying ecology to the mortality divide in India.
Seizures occurred in <25% of patients during initial follow-up after perinatal AIS. Of those with seizures, nearly half had a single episode of seizure and not early epilepsy. Larger stroke size was associated with higher risk of seizure. These data suggest that prolonged treatment with anticonvulsant agents may not be indicated for seizure prophylaxis after perinatal AIS. These findings may help guide clinicians in counseling families and could form the basis for much-needed future research in this area.
SUMMARYThe management of 93 patients with craniocerebral gunshot wounds is reviewed. The contrast between the injuries of urban guerilla warfare, conventional warfare and civilian life is outlined. Emphasis is placed on the need for early and adequate transfusion and for immediate airway control to limit cerebral oedema. Principles of wound surgery evolved in other conflicts were followed and developed.CEREBRAL gunshot wounds differ from other types of head injury. The initial damage is often focal; even when both cerebral hemispheres are affected the level of consciousness is often surprisingly light, but spreading cerebral oedema, if unchecked, leads rapidly to severe generalized brain damage.When a bullet strikes the body the effect depends partly on the kinetic energy of the bullet and partly on its size and shape. As kinetic energy is a function of the mass of the bullet and the square of its velocity ( E = +mu2), it follows that even a small high velocity bullet will carry much more energy than a larger one of low velocity. A high velocity bullet travels faster than the speed of sound
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