Papers by Gehendra Mahara
Frontiers in Immunology
As modern medicine began to emerge at the turn of the 20th century, glycan-based therapies advanc... more As modern medicine began to emerge at the turn of the 20th century, glycan-based therapies advanced. DNA- and protein-centered therapies became widely available. The research and development of structurally defined carbohydrates have led to new tools and methods that have sparked interest in the therapeutic applications of glycans. One of the latest omics disciplines to emerge in the contemporary post-genomics age is glycomics. In addition, to providing hope for patients and people with different health conditions through a deeper understanding of the mechanisms of common complex diseases, this new specialty in system sciences has much to offer to communities involved in the development of diagnostics and therapeutics in medicine and life sciences.This review focuses on recent developments that have pushed glycan-based therapies into the spotlight in medicine and the technologies powering these initiatives, which we can take as the most significant success of the 21st century.
Objective: To analyze the association between meteorological variables and scarlet fever incidenc... more Objective: To analyze the association between meteorological variables and scarlet fever incidence in Beijing. Methods: Global Moran’s I and Anselin’s local Moran’s I statistics were applied to detect the global and local autocorrelation of scarlet fever incidence. Spatial regression models; spatial lag model, spatial error model and ordinary least squares models were performed to probe the association between scarlet fever incidence and meteorological parameters. Results: This study found that rainfall and sunshine hour were statistically positively associated while, relative humidity was significant negatively associated with scarlet fever incidence. Conclusions: Spatial regression analysis established the relationship between meteorological factors and scarlet fever incidence, which may help to guide scarlet fever control program.
Translational Metabolic Syndrome Research, 2022
Suboptimal health status (SHS) is a state between health and disease, has several associated fact... more Suboptimal health status (SHS) is a state between health and disease, has several associated factors, although, its underlying mechanism is still unclear. This study aimed to investigate the status of SHS and its associated factors of high school students in three areas of China (Shanxi, Guangzhou, and Tibet). A multidimensional sub-health questionnaire of adolescent (MSQA) is used to evaluate SHS. Among 1461 respondents, females proportion 56.47% was higher than males 43.53% where SHS was higher in Shanxi, followed by Tibet and then Guangzhou. The rural area, grade, lack of sleep, home visit in a week, lack of exercise, a heavy burden of study, smoking, drinking, and fewer friends were the risk factors of SHS, while, families living status, seeking help, and extroversion were the protective factors. SHS is significantly associated with different influencing factors. For comprehensive prevention and control measures, reduce the risk factors, and enhance the protective factors.
Risk Management and Healthcare Policy, 2021
Background The household expired drugs disposal has been a huge public issue in many countries, i... more Background The household expired drugs disposal has been a huge public issue in many countries, including China, which may affect various side and toxic effects on human health and environment, water resources, and soil too. This paper explores the knowledge, attitude, and practice of Guangzhou city residents regarding household expired drugs and their effect on human health and provided the scientific pieces of evidence to carry out the long-term recovery mechanism for expired medicines. Methods An observational, cross-sectional study was conducted using a self-structured questionnaire. Descriptive analysis, including univariate and unconditional logistic regression models, was carried out to analyze the data. Results A total of 613 community residents with a 99.4% response rate enrolled for the study. More than half 60.2% of residents stated that expired drugs pollute the environment, soil, and water resources, where 81.2% of respondents knew that it would produce side effects or ...
Journal of Multidisciplinary Healthcare, 2021
Suboptimal health status (SHS) is a state between health and disease, has several adverse effects... more Suboptimal health status (SHS) is a state between health and disease, has several adverse effects, although, its main underlying mechanism is still unclear. This study aimed to investigate SHS and its associated factors of adolescents. Methods: A community-based cross-sectional study was conducted in the three different geographic locations of China (Shanxi, Guangzhou, and Tibet). A multidimensional subhealth questionnaire of adolescent (MSQA) is used to evaluate SHS. Independent twosample K-S test was performed for the quantitative data as the non-parametric test, whereas Chi-square test method was applied to explore the difference of discrete variables data between groups. Then finally, multiple logistic regression analysis was applied to analyze the influential factors of SHS. Results: Among 1461 respondents (between 15 and 18 years old), females proportion (56.47%) was higher than males (43.53%) where SHS was higher in Shanxi followed by Tibet and then Guangdong. The rural area, grade, lack of sleep time, home visit in a week, lack of exercise, a heavy burden of study, smoking, drinking, and fewer friends were the risk factors of SHS, while families living status, seeking help and extroversion were the protective factors. Conclusion: SHS is significantly associated with behavior and lifestyle-related factors. For comprehensively prevention and control of the SHS, it is urgently needed to reduce the risk factors and enhance the protective factors among adolescents.
Medical sciences (Basel, Switzerland), Jan 21, 2018
Evidence shows that multiple factors, such as socio-economic status and access to health care fac... more Evidence shows that multiple factors, such as socio-economic status and access to health care facilities, affect tuberculosis (TB) incidence. However, there is limited literature available with respect to the correlation between socio-economic/health facility factors and tuberculosis incidence. This study aimed to explore the relationship between TB incidence and socio-economic/health service predictors in the study settings. A retrospective spatial regression analysis was carried out based on new sputum smear-positive pulmonary TB cases in Beijing districts. Global Moran's I analysis was adopted to detect the spatial dependency followed by spatial regression models (spatial lag model, and spatial error model) along with the ordinary least square model were applied to examine the correlation between TB incidence and predictors. A high incidence of TB was seen in densely populated districts in Beijing, e.g., Haidian, Mentougou, and Xicheng. After comparing the R², log-likelihood,...
International Journal of Environmental Research and Public Health, 2016
(1) Background: Evidence regarding scarlet fever and its relationship with meteorological, includ... more (1) Background: Evidence regarding scarlet fever and its relationship with meteorological, including air pollution factors, is not very available. This study aimed to examine the relationship between ambient air pollutants and meteorological factors with scarlet fever occurrence in Beijing, China. (2) Methods: A retrospective ecological study was carried out to distinguish the epidemic characteristics of scarlet fever incidence in Beijing districts from 2013 to 2014. Daily incidence and corresponding air pollutant and meteorological data were used to develop the model. Global Moran's I statistic and Anselin's local Moran's I (LISA) were applied to detect the spatial autocorrelation (spatial dependency) and clusters of scarlet fever incidence. The spatial lag model (SLM) and spatial error model (SEM) including ordinary least squares (OLS) models were then applied to probe the association between scarlet fever incidence and meteorological including air pollution factors. (3) Results: Among the 5491 cases, more than half (62%) were male, and more than one-third (37.8%) were female, with the annual average incidence rate 14.64 per 100,000 population. Spatial autocorrelation analysis exhibited the existence of spatial dependence; therefore, we applied spatial regression models. After comparing the values of R-square, log-likelihood and the Akaike information criterion (AIC) among the three models, the OLS model (R 2 = 0.0741, log likelihood = −1819.69, AIC = 3665.38), SLM (R 2 = 0.0786, log likelihood = −1819.04, AIC = 3665.08) and SEM (R 2 = 0.0743, log likelihood = −1819.67, AIC = 3665.36), identified that the spatial lag model (SLM) was best for model fit for the regression model. There was a positive significant association between nitrogen oxide (p = 0.027), rainfall (p = 0.036) and sunshine hour (p = 0.048), while the relative humidity (p = 0.034) had an adverse association with scarlet fever incidence in SLM. (4) Conclusions: Our findings indicated that meteorological, as well as air pollutant factors may increase the incidence of scarlet fever; these findings may help to guide scarlet fever control programs and targeting the intervention.
Medicine, 2016
The competing risk method has become more acceptable for time-to-event data analysis because of i... more The competing risk method has become more acceptable for time-to-event data analysis because of its advantage over the standard Cox model in accounting for competing events in the risk set. This study aimed to construct a prediction model for diabetes using a subdistribution hazards model. We prospectively followed 1857 community residents who were aged ≥ 55 years, free of diabetes at baseline examination from August 1992 to December 2012. Diabetes was defined as a self-reported history of diabetes diagnosis, taking antidiabetic medicine, or having fasting plasma glucose (FPG) ≥ 7.0 mmol/L. A questionnaire was used to measure diabetes risk factors, including dietary habits, lifestyle, psychological factors, cognitive function, and physical condition. Gray test and a subdistribution hazards model were used to construct a prediction algorithm for 20-year risk of diabetes. Receiver operating characteristic (ROC) curves, bootstrap cross-validated Wolber concordance index (C-index) statistics, and calibration plots were used to assess model performance. During the 20-year follow-up period, 144 cases were documented for diabetes incidence with a median follow-up of 10.9 years (interquartile range: 8.0-15.3 years). The cumulative incidence function of 20-year diabetes incidence was 11.60% after adjusting for the competing risk of nondiabetes death. Gray test showed that body mass index, FPG, self-rated heath status, and physical activity were associated with the cumulative incidence function of diabetes after adjusting for age. Finally, 5 standard risk factors (poor selfrated health status [subdistribution hazard ratio (SHR) = 1.73, P = 0.005], less physical activity [SHR = 1.39, P = 0.047], 55-65 years old [SHR = 4.37, P < 0.001], overweight [SHR = 2.15, P < 0.001] or obesity [SHR = 1.96, P = 0.003], and impaired fasting glucose [IFG] [SHR = 1.99, P < 0.001]) were significantly associated with incident diabetes. Model performance was moderate to excellent, as indicated by its bootstrap cross-validated discrimination C-index (0.74, 95% CI: 0.70-0.79) and calibration plot. Poor self-rated health, physical inactivity, being 55 to 65 years of age, overweight/obesity, and IFG were significant predictors of incident diabetes. Early prevention with a goal of achieving optimal levels of all risk factors should become a key element of diabetes prevention. Abbreviations: 95% CI = 95% confidence interval, BADL = basic activities of daily living, BLSA = Beijing Longitudinal Study of Aging, BMI = body mass index, BP = blood pressure, CES-D = Center for Epidemiological Studies Depression, CIF = cumulative incidence function, C-index = Wolber concordance index, FPG = fasting plasma glucose, HDL-C = high-density lipoprotein cholesterol, IADL = instrumental activities of daily living, ICD = international classification of disease, IFG = impaired fasting glucose, LDL-C = low-density lipoprotein cholesterol, MMSE = mini mental state examination, SHR = subdistribution hazard ratio, SRH = selfrated health, TC = total cholesterol, TG = triglycerides.
Medicine, 2016
The quadratic inference function (QIF) method becomes more acceptable for correlated data because... more The quadratic inference function (QIF) method becomes more acceptable for correlated data because of its advantages over generalized estimating equations (GEE). This study aimed to evaluate the relationship between platelet indices and blood pressure using QIF method, which has not been studied extensively in real data settings. A population-based longitudinal study was conducted in Beijing from 2007 to 2012, and the median of follow-up was 6 years. A total of 6515 cases, who were aged between 20 and 65 years at baseline and underwent routine physical examinations every year from 3 Beijing hospitals were enrolled to explore the association between platelet indices and blood pressure by QIF method. The original continuous platelet indices were categorized into 4 levels (Q 1-Q 4) using the 3 quartiles of P 25 , P 50 , and P 75 as a critical value. GEE was performed to make a comparison with QIF. After adjusting for age, usage of drugs, and other confounding factors, mean platelet volume was negatively associated with diastolic blood pressure (DBP) (Q 4 :b = À0.7649, 95% confidence interval/À1.1313 to À0.3985, P = 0.00004) in males and positively linked with systolic blood pressure (SBP) (Q 4 :b = 3.1926, 95% CI 2.0853-4.2999, P = 0.00001 in female;b = 1.8477, 95% CI 1.3148-2.3806; P = 0.00001 for male). Platelet distribution width was negatively associated with SBP (Q 4 :b = 1.5926, 95% CI 2.5921 to À0.5931, P = 0.00179 for female; Àb = 1.0568, 95% CI 1.5335 to À0.5801, P = 0.00001 for male). Blood platelet count was associated with DBP (Q 4 :b = 0.4212, 95% CI 0.0200-0.8223, P = 0.03958) in males. Adults in Beijing with prolonged exposure to extreme value of platelet indices have elevated risk for future hypertension and evidence suggesting using some platelet indices for early diagnosis of high blood pressure was provided. Abbreviations: AR-1 = first-order autoregressive correlation working matrix model, BMI = body mass index, DBP = diastolic blood pressure, Exch = exchangeable correlation working matrix model, FPG = fasting plasma glucose, GEE = generalized estimating equations, HCT = red blood cell specific volume, HDL = high-density lipoprotein. WBC = white blood cell, HGB = hemoglobin, MCV = erythrocyte mean corpuscular volume, MPV = mean platelet volume, PCT =plateletcrit, PDW = platelet distribution width, PLT =blood platelet count, QIF = quadratic inference function, RBC = red blood cell, SBP = systolic blood pressure, TG = triglyceride, Unstr = unstructured correlation working matrix model.
Family Medicine and Community Health, 2016
Malaysia is on its way to achieving developed nation status in the next 4 years. Currently, Malay... more Malaysia is on its way to achieving developed nation status in the next 4 years. Currently, Malaysia is on track for three Millennium Development Goals (MDG1, MDG4, and MDG7). The maternal mortality rate, infant mortality rate, and mortality rate of children younger than 5 years improved from 25.6% (2012) to 6.6% (2013), and 7.7% (2012) per 100,000 live births, respectively whereas immunization coverage for infants increased to an average of 90%. As of 2013 the ratio of physicians to patients improved to 1:633 while the ratio of health facilities to the population was 1:10,272. The current government administration has proposed a reform in the form of the 10th Malaysian Plan coining the term "One Care for One Malaysia" as the newly improved and reorganized health care plan, where efficiency, effectiveness, and equity are the main focus. This review illustrates Malaysia's transition from pre-independence to the current state, and its health and socioeconomic achievement as a country. It aims to contribute knowledge through identifying the plans and reforms by the Malaysian government while highlighting the challenges faced as a nation.
Family Medicine and Community Health, 2016
Maternal health is still a public health problem in developing countries, especially in low-resou... more Maternal health is still a public health problem in developing countries, especially in low-resource settings rural and poor communities. The main aim of this article is to critically evaluate and explore the situation of maternal health in Nepal based on published or unpublished governmental or nongovernmental organization's scientific reports regarding maternal health. We found that there were several direct or indirect causes and affecting factors of maternal death in Nepal, which are preventable. Women have been facing different consequences during pregnancy and delivery, attributed to lack of proper knowledge or less available and affordable health facilities in rural communities. Therefore, there is needed an essential maternal health knowledge to women and also establish health facilities with a quality health care service on affordable and accessible to prevent maternal death and minimize complications.
International journal of environmental research and public health, Jan 15, 2016
Objective: To probe the spatiotemporal patterns of the incidence of scarlet fever in Beijing, Chi... more Objective: To probe the spatiotemporal patterns of the incidence of scarlet fever in Beijing, China, from 2005 to 2014. Methods: A spatiotemporal analysis was conducted at the district/county level in the Beijing region based on the reported cases of scarlet fever during the study period. Moran's autocorrelation coefficient was used to examine the spatial autocorrelation of scarlet fever, whereas the Getis-Ord Gi* statistic was used to determine the hotspot incidence of scarlet fever. Likewise, the space-time scan statistic was used to detect the space-time clusters, including the relative risk of scarlet fever incidence across all settings. Results: A total of 26,860 scarlet fever cases were reported in Beijing during the study period (2005-2014). The average annual incidence of scarlet fever was 14.25 per 100,000 population (range, 6.76 to 32.03 per 100,000). The incidence among males was higher than that among females, and more than two-thirds of scarlet fever cases (83.8%) w...
Blood pressure, Jan 4, 2015
This systematic review and meta-analysis was conducted to assess the association between the leve... more This systematic review and meta-analysis was conducted to assess the association between the level of atmospheric particulate matter (PM) and the increase in blood pressure (BP) for different exposure terms (≤ 7 vs > 7 days) and age groups (< 65 vs ≥ 65 years). Some databases were searched to investigate the association between increased atmospheric PM (diameter < 2.5 mm [PM2.5] or < 10 mm [PM10]) and BP (systolic blood pressure [SBP] and diastolic blood pressure [DBP]). Among a total of 719 identified articles, 68 were reviewed in depth, of which only 20 satisfied the inclusion criteria. A significant association was found between PM10 levels and higher BP. The β values were 0.270mmHg (95% confidence interval [CI] 0.068-0.482) for SBP and 0.215mmHg (95% CI 0.058-0.372) for DBP. These β values mean that, for every 10 mg/m(3) increase in PM10, SBP increased by 0.270mmHg and DBP by 0.215 mmHg. Subgroup analyses were conducted for different exposure terms and age groups. A ...
Maternal death is a public health problem in like Nepal. Still women have been facing the pregnan... more Maternal death is a public health problem in like Nepal. Still women have been facing the pregnancy related problems due to inaccessible and poor quality health service as well as a less available health service from skilled health workers. This is due to lack of essential knowledge about pregnancy and its complications. The main aim of this article is to evaluate and synthesize the current public health issues of maternal health of women in Nepal. Syntheses the problems, challenges and issues regarding maternal health and what can be done for the improvement of those problems with the evidence base practice. There should be making such a kind of policy, program, approaches and strategy from the state or the stockholder to tackle the health problem.
Background: Maternal Mortality is a public health problem in Nepal, which was highest in 1990 amo... more Background: Maternal Mortality is a public health problem in Nepal, which was highest in 1990 among the South Asian countries. Associated factors of maternal mortality are various; among them maternal health sevices such as antenatal (ANC) and postnatal care (PNC) services are the main. Methods: A multivariate secondary data analysis out based on Nepal Demographic Health Surveys 2001 and 2006. Logistic regression models was performed to compare the utilization of the ANC and PNC services, with background characteristics of women aged between 15 to 49 years old. Results: A total of 8913 reproductive aged groups (15-49) women were taken f or analysis and the mean age was 28.59±7.040 years. Logistic regression analysis revealed that health facility delivery (AO R=1.297, 95% CI=1.135-1.481), PNC check-up at health facility (AOD=4.442, 95% CI=2.815-7.011) and PNC service wit h a skilled health worker (AOD=4.533, 95% CI=2.753- 7.465) utilized more in 2006 compared to 2001. This study also...
Objective: To assess the knowledge and practice regarding the health seeking behavior of mothers ... more Objective: To assess the knowledge and practice regarding the health seeking behavior of mothers having under five children during an illness in rural areas of Bangalore, India. Methods: A community based descriptive study was conducted using the self-structured questionnaire to collect the data. The inferential and descriptive statistics along with the chisquare test (χ 2 ) was carried out to determine the influencing factors of knowledge and practice of mothers. Results: Among the total 60 respondents, about one third 32% respondents had inadequate, where more than half 60% had moderate, and only 8% of respondents had sufficient knowledge. More than one third 42% respondents had inadequate, while less than half 45% respondents had moderate and only 13% respondents had an appropriate practice regarding health seeking behavior of mother during the illness of under-five children. Age, occupation, education, the source of health information of mother, and family income were found a si...
Disaster Medicine and Public Health Preparedness, May 30, 2018
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Papers by Gehendra Mahara
Methods:
Global Moran’s I and Anselin’s local Moran’s I statistics were applied to detect the global and local autocorrelation of scarlet fever incidence. Spatial regression models; spatial lag model, spatial error model and ordinary least squares models were performed to probe the association between scarlet fever incidence and meteorological parameters.
Results:
This study found that rainfall and sunshine hour were statistically positively associated while, relative humidity was significant negatively associated with scarlet fever incidence.
Conclusions:
Spatial regression analysis established the relationship between meteorological factors and scarlet fever incidence, which may help to guide scarlet fever control program.
Methods: A spatiotemporal analysis was conducted at the district/county level in the Beijing area based on the reported cases of scarlet fever. Moran’s I autocorrelation statistic was used to examine the spatial autocorrelation, whereas the Getis-Ord Gi* statistic was used to determine the hotspot incidence of scarlet fever. Then finally, the space-time scan statistic was employed to detect the space-time clusters, including the relative risk of scarlet fever incidence across all settings.
Results: A total of 26,860 scarlet fever cases were reported in Beijing during the study period (2005–2014). The average annual incidence of scarlet fever was 14.25 per 100,000 population (range, 6.76 to 32.03 per 100,000). The incidence among males was higher than that among females, and more than two-thirds of scarlet fever cases (83.8%) were among children 3–8 years old. The seasonal incidence peaks occurred from March to July. A higher relative risk area was mainly in the city and urban districts of Beijing. The most likely space-time clusters and secondary clusters were detected to be diversely distributed in each study year.
Conclusions: The spatiotemporal patterns and space-time scan analysis of scarlet fever were relatively unsteady in Beijing from 2005 to 2014. The at-risk population was mainly scattered in urban settings and dense districts with high population, indicating a positive relationship between population density and increased risk of scarlet fever exposure. Children under 15 years of age were the most susceptible to scarlet fever.
Key words: scarlet fever; spatiotemporal patterns; children; Beijing
relative risk of scarlet fever incidence across all settings. Results: A total of 26,860 scarlet fever cases were reported in Beijing during the study period (2005–2014). The average annual incidence of scarlet fever was 14.25 per 100,000 population (range, 6.76 to 32.03 per 100,000). The incidence among males was higher than that among females, and more than two-thirds of scarlet fever cases (83.8%) were among children 3–8 years old. The seasonal incidence peaks occurred from March to July. A higher relative risk area was mainly in the city and urban districts of Beijing. The most likely space-time clusters and secondary clusters were detected to be diversely distributed in every
study year. Conclusions: The spatiotemporal patterns of scarlet fever were relatively unsteady in Beijing from 2005 to 2014. The at-risk population was mainly scattered in urban settings and dense districts with high population, indicating a positive relationship between population density and increased risk of scarlet fever exposure. Children under 15 years of age were the most susceptible to scarlet fever.