ociety, published by Elsevier. The analysis of data on substance abuse, revealed through positive toxicology reports and patient histories and recorded in one of the world’s largest and most comprehensive SCD registries, shows higher levels of illicit drugs than is typical for that population, as well as a greater prevalence of multiple substance use.

The investigators analyzed data from a statewide registry on patients aged 18-50 years who experienced out-of-hospital SCD between April 2019 and April 2021 in Victoria, Australia (population 6.5 million). Toxicology assessment results were available for nearly all patients, 32.5% of which were positive for drug use. Previous estimates of drug use in Australia had ranged from approximately 16% overall to 19% for those aged 14-49.

Lead investigator Elizabeth D. Paratz, MBBS, PhD, FRACP, Baker Heart and Diabetes Institute, noted, “As clinicians in Melbourne, we frequently see complications of illicit drug use in young people. We noticed a consistent trend of illicit drugs involved in our registry’s young SCD cohort and were very keen to tease this out further. We found the prevalence of illicit drug use in young SCD patients was astonishingly high at almost one in three cases and exceeds reported rates in the young population.

The study focused on patients for whom a cardiovascular cause of death was identified and does not include those who died suddenly of illicit drug overdoses, i.e., the illicit drugs were thought to be incidental. These patients were more likely to be male, smokers, and excessive alcohol drinkers, and had a psychiatric diagnosis, lower body mass index, and lower rates of hypertension. Their deaths commonly occurred while they were sedentary or sleeping. While cannabis was the most common illicit drug identified, others included cocaine, amphetamines, heroin, and novel/psychoactive substances; more than one substance was frequently involved.

Dr. Paratz commented, “We were surprised by the very high rates of illicit drugs prevalent in the toxicological results of this group as compared to the overall population. Our findings raise the question: Is substance abuse underestimated or does it lead to a higher rate of cardiovascular pathology that results in SCD? We know that some young people may have a genetic predisposition for sudden death or developing coronary disease, but drug use may interact with this tendency to accelerate poor outcomes.”

An editorial accompanying the study by Kristina H. Haugaa, MD, PhD, and Anna I. Castrini, MD, ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, and the University of Oslo, contextualizes the findings in terms of the need to better understand how drug use contributes to cardiac disease in adults under 50-which is critical since it is potentially a reversible risk factor.

Dr. Haugaa and Dr. Castrini explained, “Illicit drugs have well known acute and chronic effects on the cardiovascular system and can act as arrhythmic triggers. Amphetamine and cocaine activate the sympathetic system and induce tachycardia and vasoconstriction, resulting in ischemia and potentially myocardial infarct. These drugs can trigger SCD in younger patients with predisposing diseases including congenital or inherited cardiac diseases, premature coronary disease, and myocarditis. However, still up to 30% of deaths remain unexplained after autopsy. Even when the predisposing disease has been identified, we are often left with a major question about which transient event triggered the cardiac death.”

SCDs represent 50% of all cardiovascular deaths and occur unexpectedly in people without prior history of cardiac disease or a known predisposition for it.

Dr. Haugaa added, “We believe that the paper from Trytell et al. will enlighten further research on the topic. The study underlines the importance of requiring autopsy and toxicology analysis, especially in young individuals, and may help to explain some of the unexplained.”

Reference:

Adam Trytell, Michael Osekowski, Dominica Zentner, Dion Stub, Andre La Gerche, Elizabeth D. Paratz, Prevalence of illicit drug use in young patients with sudden cardiac death, DOI:https://doi.org/10.1016/j.hrthm.2023.06.004.

Based on the results of the study involving the Heidelberg University Hospital, German Center for Infection Research (DZIF), US company Vir Biotechnology, and University Medical Center Hamburg-Eppendorf, clinical trials with the monoclonal antibody VIR-3434 are ongoing. 

Affecting hundreds of millions of people, chronic hepatitis B (HBV) is a widespread global health problem for which there is as yet no cure. Chronic hepatitis B virus infection poses a severe threat to approximately 300 million people worldwide, leading to liver disease and cancer. Approximately four percent of affected persons are chronically coinfected with the hepatitis delta virus (HDV), which exacerbates the gravity of the disease. Current treatments provide only limited cure rates and necessitate indefinite times of therapy.

A team around DZIF scientists from Heidelberg and Hamburg-Eppendorf supported the preclinical development of VIR-3434, a monoclonal antibody (mAb) discovered by Vir Biotechnology, Inc., that specifically targets the hepatitis B surface antigen (HBsAg) located in the viral envelope. This preclinical study shows how the engineered investigational human monoclonal antibody effectively prevents viral dissemination and reduces the amounts of viral particles and antigen in a mouse model for HBV/HDV coinfection.

A targeted approach

The researchers isolated and screened several monoclonal antibodies from memory B cells of HBV-vaccinated individuals that specifically target a conformational epitope (an epitope formed through the three-dimensional folding of the protein bringing distant amino acids together) within the antigenic loop of the small hepatitis B surface antigen. Among a series of more than 30 generated antibodies, which were tested using the most advanced in vitro infection system available and established at Heidelberg University Hospital, one mAb named HBC34 demonstrated potent neutralisation activity against HBV and HDV. The latter is a satellite virus that hijacks HBV surface proteins to infect human hepatocytes. The activity has been shown to be pan-genotypic, providing evidence that HBC34 neutralises all known genotypes of HBV and HDV. Modifications in the structure of the HBC34 mAb for improved potency generated VIR-3434 as a promising mAb candidate for clinical development.

“Aside from the potent neutralisation activity of VIR-3434, we engineered the Fc-portion of the mAb-the tail end of the antibody molecule that is crucial in the immune response-to increase binding to certain immune cells,” explains the co-first and corresponding author of the paper, Dr Florian Lempp, director of virology at Vir. “VIR-3434 has the potential to rapidly eliminate both viral and subviral particles from circulation.”

The researchers then tested VIR-3434’s neutralisation capability in a human liver-chimeric mouse model developed at the University Medical Center Hamburg-Eppendorf (UKE) by the team around Prof. Maura Dandri, a DZIF-scientist on viral hepatitis at UKE and co-author of the paper. The livers of these mice are populated with primary human hepatocytes-the only cell type infected by HBV and HDV in humans. The in vivo studies were essential to demonstrate that the in vitro selected mAb, VIR-3434, was able to block viral dissemination in the liver of both HBV-infected and HBV/HDV-coinfected mice.

“We found that VIR-3434 not only neutralises HBV and HDV infection with high potency in vivo,” explains the co-first author of the study Dr Tassilo Volz, “but it also effectively reduces viraemia-the number of viruses in the bloodstream-and the levels of circulating viral antigens in chronically infected animals.”

"VIR-3434 may provide a potential new option for treating patients with chronic hepatitis B and D, and aid in the prevention of these diseases. The antibody's strong neutralisation properties and promising results in our preclinical infection model may offer hope for patients worldwide," adds Prof. Dandri.

Testing VIR-3434 in the clinic

Based on the findings, clinical studies to ascertain the safety and efficacy of VIR-3434 in human subjects are already underway. The researchers hope that VIR-3434, which is also being studied in combination with other investigational agents, may provide a much-needed therapy to combat chronic hepatitis B and D and the devastating consequences of chronic infection with these viruses.

“The successful isolation and characterisation of VIR-3434 could mark a significant turning point in hepatitis B and D treatment. If further validated through clinical trials, this mAb may offer an important therapeutic option for patients with chronic hepatitis B and D,” emphasises co-author and DZIF-scientist Prof. Stephan Urban of Heidelberg University Hospital.

The described research on VIR-3434, which incorporates Xencor Xtend™ technology (an innovative platform that allows the prolongation of the half-life of antibodies), is the result of a successful collaboration of scientists within the German Center for Infection Research (DZIF) and with the industry partner Vir. The project fits into the DZIF bridging topic “Antibody-based therapies”, which aims to connect experts across DZIF’s different research areas to advance the development, production and clinical testing of therapeutic monoclonal antibodies.

Reference:

Florian A. Lempp, Tassilo Volz, Elisabetta Cameroni, Fabio Benigni, Jiayi Zhou, Laura E. Rosen, Julia Noack, Fabrizia Zatta, Hannah Kaiser, Siro Bianchi, Gloria Lombardo, Stefano Jaconi, Lucia Vincenzetti, Hasan Imam, Leah B. Soriaga, Nadia Passini, David M. Belnap, Andreas Schulze, Marc Lütgehetmann, Amalio Telenti, Potent broadly neutralizing antibody VIR-3434 controls hepatitis B and D virus infection and reduces HBsAg in humanized mice, Published:July 15, 2023DOI:https://doi.org/10.1016/j.jhep.2023.07.003.

MANGOES ARE sweet, creamy fruits that have a range of possible health benefits. The nutrients they contain may help boost eye, skin, and hair health and prevent cancer and heart disease. The mango is a tropical stone fruit and member of the drupe...

View the full post GG visits Top Hill Home and Princess Royal Hospital on NOW Grenada.

The full form of NEET UG is the National Eligibility cum Entrance
Test- Undergraduate, which is the main entrance exam for students seeking
admission to undergraduate medical programmes in India. It was introduced in
2013 by the Medical Council of India (MCI) and the Central Board of Secondary
Education (CBSE).

NEET UG replaced many medical entrance exams like the All India Pre-Medical Test (AIPMT) and
other state exams, streamlining the admission process and ensuring a more
transparent and standardized evaluation system.

Before NEET UG, each Indian state conducted its separate medical
entrance exams, resulting in varying eligibility criteria, syllabus, and
difficulty levels. As there was a lack of a uniform evaluation system, students
had to face stress and financial burden and give multiple examinations during
the same academic year. Therefore, NEET UG was introduced in 2013 to address
these problems.

After implementing
NEET UG, students are assessed on the same parameters, promoting
fairness and eliminating regional disparities. NEET UG has also helped decrease corruption and malpractices in the admission process.

NEET UG Exam Pattern:

NEET UG is an offline,
pen-and-paper-based examination which is conducted annually by the National
Testing Agency (NTA). The exam comprises of a single-question paper with 180
multiple-choice questions (MCQs) covering Physics, Chemistry, and Biology
(Botany and Zoology). The exam lasts 3 hours and 20 minutes and is held in
various languages, making it accessible to many students.

Each subject has two sections,
Section A has 35 questions, and Section B has 15 questions. Candidates can attempt
any 10 questions out of the 15 questions section.

No.

Subjects

Sections

No. of Questions

Marks- Each question carries 4 marks

Question Type

1.

Botany

Section A

35

140

MCQ

Section B

15

40

2.

Zoology

Section A

35

140

Section B

15

40

3.

Physics

Section A

35

140

Section B

15

40

4.

Chemistry

Section A

35

140

Section B

15

40

Total Marks

720

The test aims to assess a
candidate's understanding of concepts, problem-solving skills, and application
of knowledge in medical sciences.

In Section A MCQs- Each
correct answer is given four marks, while one mark is deducted for each wrong
answer and the unanswered question gets no marks.

In Section B MCQs: Candidates
need to attempt 10 out of the 15 questions. If a candidate
attempts more than 10 questions only the first 10 questions attempted are
considered while checking. There is no negative marking for section B. But, if any
discrepancy is found later on, this rule will be followed: Each correct answer
is given four marks, while one mark is deducted for each wrong answer, and the unanswered question gets no marks.

The duration of the exam is 03
hours and 20 minutes. PwBD candidates (those with physical limitations
affecting writing) are given compensatory time of one hour and five minutes,
irrespective of whether they used a scribe or not, for the three hours and
twenty minutes (03:20 hrs) duration of the examination.

NEET UG is held for admissions
to various medical courses like MBBS, BDS, BAMS, BSMS, BUMS, and BHMS. These
courses are offered by medical institutions that follow the norms, guidelines,
and regulations the relevant Regulatory Bodies set forth under the NCISM
Act, 2020 and NCH Act, 2020.

Languages offered for question paper:

The candidates can choose exam
question papers in 13 languages- English, Hindi, Odia, Punjabi, Tamil, Telugu,
Assamese, Bengali, Gujarati, Kannada, Malayalam, Marathi, and Urdu.

Candidates who opt to take the test in English, Hindi, or a
regional language will be given a test booklet with questions in English and
their chosen language. As an example, if an applicant selects Tamil, the test
booklet will have questions in Tamil, English, and Hindi. However, the English original of a test question shall be taken as the definitive and final version
if there is any ambiguity or doubt in the translation. The National Testing
Agency's (NTA) judgement shall be final and binding.

Benefits of NEET UG:

NEET UG has brought about
significant changes in the Indian undergraduate admission system. Some of the
key impacts include:

·
Standardization of Evaluation: NEET UG has standardized the
evaluation process, ensuring that students from different states are judged
fairly and equally.

·
Boost to Meritorious Students: NEET UG rewards students based on
merit rather than their state of origin or other discriminatory factors. As a
result, deserving candidates, regardless of their background, have a better
chance of securing seats in reputed medical colleges.

·
Curbing Commercialization of Education: The centralized nature of
NEET UG has significantly reduced the commercialization of medical education.
Earlier, private medical colleges used to conduct separate exams, leading to
exorbitant fees and rampant profiteering.

·
Strengthening Medical Infrastructure: With the elimination of
capitation fees and a more transparent admission process, NEET UG has helped in
attracting better talent to government medical colleges. This, in turn, has
strengthened the medical infrastructure of the country.

NEET UG Eligibility:

The candidate must be 17 years old at the time of admission or
will turn 17 on or before December 31st of the year they are admitted to the
first year of the undergraduate medical course.

The candidate must have a 10+2 or
equivalent diploma from a recognised board, with Physics,
Biology/Biotechnology, Chemistry, and English as core courses.

According to the Under Graduate Medical Education Board (UGMEB), NEET (UG) exam applicants have no upper age limit. This indicates that
there is no upper age limit on applicants for the exam and that candidates of
any age may do so.

For Overseas Citizens of India (OCI) applicants who wish to be
accepted into Indian medical or dental schools, they must also pass the NEET
(UG) exam.

NEET Syllabus:

The NEET (UG) syllabus is vast and comprehensive because it covers
topics in Biology (Botany and Zoology), Chemistry, and Physics. The aim of the
syllabus is to evaluate the candidate's knowledge of multiple issues as well as
their problem-solving skills. A general summary of the subjects covered in each
is given below:

Physics:

Current Electricity

Kinematics

Laws of Motion

Magnetic Effects of Current and Magnetism

Electromagnetic Induction and Alternating Currents

Electromagnetic Waves

Optics

Thermodynamics

The behaviorBehaviour of Perfect Gas and Kinetic Theory

Oscillations and Waves

Electrostatics

Dual Nature of Matter and Radiation

Atoms and Nuclei

Electronic Devices

Physical-world and measurement

Work, Energy, and Power

Properties of Bulk Matter

Chemistry:

Some Basic Concepts of Chemistry

Structure of Atom

Classification of Elements and Periodicity in Properties

Chemical Bonding and Molecular Structure

States of Matter: Gases and Liquids

Thermodynamics

Equilibrium

Redox Reactions

Hydrogen

Coordination Compounds

Haloalkanes and Haloarenes

Alcohols, Phenols, and Ethers

Aldehydes, Ketones, and Carboxylic Acids

Organic Compounds Containing Nitrogen

Biomolecules

Polymers

Chemistry in Everyday Life

s-Block Elements (Alkali and Alkaline earth metals)

Hydrocarbons

Environmental Chemistry

Solid State

Solutions

Electrochemistry

Chemical Kinetics

Surface Chemistry

General Principles and Processes of Isolation of Elements

p-Block Elements

d- and f-Block Elements

Some p-Block Elements

Organic Chemistry - Some Basic Principles and Techniques

Biology:

Diversity in Living World

Structural Organization in Animals and Plants

Cell Structure and Function

Plant Physiology

Human Physiology

Reproduction

Genetics and Evolution

Biology and Human Welfare

Biotechnology and Its Applications

Ecology and Environment

Exam Strategy:

In order to do well in the NEET UG exam,
candidates must deeply study each topic according to the NEET UG syllabus. They
should also concentrate on frequent practice, working on sample papers, and
taking mock exams to improve their time management and problem-solving skills.
Candidates can succeed in NEET UG and gain admission to top medical colleges by
following a well-structured study strategy and constantly trying.

Success in NEET UG mostly
depends on time management, consistent practice, and conceptual clarity. Many
candidates join coaching classes to gain advice and experienced mentoring. A
well-structured study strategy, commitment, and perseverance are necessary for
NEET preparation.

Counselling and Reservation:

Admissions to all seats of Undergraduate Medical/Dental Courses
for the NEET (UG) - 2023 followed the following specific quotas:

All India Quota Seats

State Government Quota Seats

Deemed Universities/Central Institutions/Universities

State or Management or Dental Colleges or any Private University
or NRI Quota Seats in Private Medical

Central Pool Quota Seats

All seats, which include NRI Quota and Management Quota, are in
private unaided/aided minority/non-minority medical colleges.

AIIMS Institutes across India/JIPMER.

For successful candidates, the counselling for seats under 15% All
India Quota and 100%, which includes 85% of State quota seats of Central
Institutions- ABVIMS & RML Hospital/VMMC & Safdarjung Hospital/ESIC)/
Central Universities (including DU/BHU/AMU)/ AIIMS/ JIPMER, and Deemed
Universities, will be conducted by the DGHS/MCC for Undergraduate Medical/Dental
Courses.

For AFMC (Armed Forces Medical College), MCC handles the
registration process and forwards the registered candidates' data to AFMC
Authorities for admission.

Additionally, DU/BHU and other Universities may utilize the NEET
(UG) - 2023 scores for additional relevant courses they offer.

AACCC (Ayush Admissions Central Counselling Committee), which
falls under the Ministry of Ayush, will serve as the counselling authority for
the All-India Quota (AIQ) about BAMS (Bachelor of Ayurvedic Medicine and
Surgery), BUMS (Bachelor of Unani Medicine and Surgery), and BSMS (Bachelor of
Siddha Medicine and Surgery) courses under the National Commission for Indian
Systems of Medicine (NCISM) Act. AACCC will also counsel Bachelor of
Homeopathic Medicine and Surgery (BHMS) courses under the National Commission
for Homeopathy (NCH) Act.

Stepwise approach for taking the NEET UG exam:

Step 1: Eligibility and
Information- Check the eligibility criteria for the NEET (UG) - examination. Read the Information Bulletin and familiarize yourself with the
exam guidelines, instructions, and important dates. Regularly check the
official NEET website for updates and additional information.

Step 2: Registration- Visit the NEET (UG) official website and
register for the exam. Fill in personal details accurately, including name,
date of birth, gender, nationality, and identification information. Give a
valid mobile number and email address for communication purposes.

Step 3: Prepare Documents- Gather all necessary documents,
including photographs, signatures, thumb impressions, category certificates,
Class 10 and 12 certificates, and address proof. Ensure all documents are in
the specified format and within the specified size limits.

Step 4: Filling Application Form: Log in to the NEET (UG) website and complete the application form carefully. Enter educational details, including Class 10, 11, and 12
examinations. Provide information on the examination city choices, question
paper medium, and category details.

Step 5: Fee Payment- Pay the examination fee through online
payment options (Debit/Credit Card, Net-banking, UPI). Verify the payment
status and keep a copy of the fee payment confirmation.

Step 6: Check Application Status- After successful fee payment,
verify the status of the application form to ensure it is complete and
error-free. Rectify any discrepancies, if necessary, by contacting the
helpdesk.

Step 7: Download Admit Card- Download the Admit Card from the
official NEET (UG) website using login credentials. Verify all the
details written on the Admit Card, such as name, photograph, and examination
centre details. In case of any discrepancies, immediately contact the helpdesk.

Step 8: Exam Day Preparations- Prepare all required materials,
including Admit Card, identity proof, pen, etc., for the exam day.

Step 9: Exam Day- Reach the examination centre on time as per the
reporting time mentioned on the Admit Card. Follow all the examination
guidelines and instructions strictly during the exam.

Step 10: Post-Exam- Preserve the Admit Card and all necessary
documents for future reference and stay updated with the official NEET (UG) website for information on results and counselling.

KIDNEY stones can be incredibly painful and cause serious problems if not taken care of properly.

These little, hard mineral deposits form in the kidneys and can cause discomfort when passing through the urinary tract. The good news is that there are ways to prevent kidney stones and keep your kidneys healthy.

In this article we'll explore some practical steps you can take to lower your risk of developing kidney stones.

1.
Stay hydrated: The power of drinking water

One of the simplest and most effective ways to prevent kidney stones is to drink plenty of water. Keeping yourself well-hydrated helps dilute your urine, making it less likely for minerals to stick together and form stones in your kidneys. Doctors often suggest drinking around 8-10 glasses of water a day but remember, your specific needs might vary depending on factors like age, activity level, and the climate you live in.

2. Watch your diet

Making some changes to your diet can make a big difference in preventing kidney stones. Here are some key dietary tips:

a. Cut back on sodium

A diet high in sodium can increase the levels of calcium in your urine, which can lead to the formation of stones. So, try to limit your salt intake and steer clear of processed foods that are packed with sodium.

b. Be mindful of oxalate-rich foods

In certain foods is a substance called oxalate that can combine with calcium in your urine to form kidney stones. Foods that are high in oxalates — like spinach, beets, nuts, and chocolate — should be eaten in moderation.

c. Balance your calcium intake

It might seem counter-intuitive but cutting back on calcium won't necessarily prevent kidney stones — in fact, not getting enough calcium can actually increase your risk. It's all about getting the right amount, either through your diet or with the help of supplements, as advised by your health-care professional.

d. Enjoy citrus fruits: Citrate, which is found in citrus fruits like lemons and oranges, can be helpful in preventing kidney stone formation by stopping crystals from growing. So, go ahead and add some citrus fruits to your diet.

3. Keep animal protein in check

Eating too much animal protein, like red meat, can raise uric acid and calcium levels in your urine, making it more likely for kidney stones to form. A good idea is to have a balanced diet that includes lean proteins from different sources, like fish, poultry, and plant-based alternatives, for the sake of your kidney health.

4. Maintain a healthy weight

Being overweight or obese can increase your chances of getting kidney stones. By exercising regularly and eating a balanced diet you not only reduce the risk of kidney stones but also improve your overall health and well-being.

5. Be aware of medications

Some medications, such as diuretics and calcium-containing antacids, can contribute to kidney stone formation. It's essential to have a chat with your health-care professional about potential side effects and consider alternatives if necessary.

Taking care of your kidneys and preventing kidney stones involves making some lifestyle changes and being mindful of what you eat. Drinking plenty of water, watching your diet, moderating your animal protein intake, maintaining a healthy weight, and being aware of medications can go a long way in safeguarding your kidney health. Remember, personalised advice from health-care professionals is crucial, especially if you have a history of kidney stones or other kidney-related issues. By taking preventive measures you can lead a happier and healthier life, free from the discomfort of kidney stones.

Dr Jeremy Thomas is a consultant urologist. He works privately in Montego Bay, Savanna-la-Mar and Kingston, and publicly at Cornwall Regional Hospital. He may be contacted on Facebook and Instagram: @jthomasurology or by e-mail: jthomasurology@gmail.com

In the last 15 years since WHO's MPOWER tobacco control measures were introduced globally, smoking rates have fallen. Without this decline there would be an estimated 300 million more smokers in the world today.

The MPOWER interventions have been shown to save lives and reduce costs from averted healthcare expenditure. The first MPOWER report was launched in 2008 to promote government action on six tobacco control strategies in-line with the WHO FCTC to: Monitor tobacco use and prevention policies; protect people from tobacco smoke; offer help to quit tobacco use; warn people about the dangers of tobacco; enforce bans on tobacco advertising, promotion and sponsorship; and raise taxes on tobacco.

This WHO Report on the global tobacco epidemic, supported by Bloomberg Philanthropies, is focused on protecting the public from second-hand smoke, highlighting that almost 40 per cent of countries now have completely smoke-free indoor public places.

The report rates country progress in tobacco control and shows that two more countries, Mauritius and the Netherlands, have achieved best-practice level in all MPOWER measures, a feat that only Brazil and Türkiye had accomplished until now.

"These data show that slowly but surely, more and more people are being protected from the harms of tobacco by WHO's evidence-based best-practice policies," said Dr Tedros Adhanom Ghebreyesus, WHO director general. "I congratulate Mauritius on becoming the first country in Africa, and the Netherlands on becoming the first in the European Union to implement the full package of WHO tobacco control policies at the highest level. WHO stands ready to support all countries to follow their example and protect their people from this deadly scourge."

"With a strong political commitment, we have made great progress in tobacco control policies in Mauritius. Our country has adopted the MPOWER strategy and is moving resolutely towards a smoke-free country." stated Pravind Kumar Jugnauth​, prime minister, Republic of Mauritius.

Maarten van Ooijen, state secretary for health, welfare and sports for the Netherlands, said, "Civil society organisations, health experts and medical professionals are strong driving forces behind everything that we are achieving with regard to tobacco control in the Netherlands. They deserve the primary credits for the praise that our country receives from the World Health Organization. Although we are making progress in reducing smoking prevalence and improving our tobacco control policy, we also still have a long way to go. Together we will keep fighting for a smoke-free generation by 2040!"

Smoke-free public spaces is just one policy in the set of effective tobacco control measures, MPOWER, to help countries implement the WHO Framework Convention on Tobacco Control and curb the tobacco epidemic.

Smoke-free environments help people breathe clean air, shield the public from deadly second-hand smoke, motivate people to quit, denormalise smoking and help prevent young people from ever starting to smoke or use e-cigarettes.

"While smoking rates have been going down, tobacco is still the leading cause of preventable death in the world — largely due to relentless marketing campaigns by the tobacco industry," said Michael R Bloomberg, WHO Global ambassador for non-communicable diseases and injuries and founder of Bloomberg Philanthropies. "As this report shows, our work is making a big difference, but much more remains to be done. By helping more countries implement smart policies, backed by public opinion and science, we'll be able to improve public health and save millions of more lives."

Eight countries are just one MPOWER policy away from joining the leaders in tobacco control: Ethiopia, Iran, Ireland, Jordan, Madagascar, Mexico, New Zealand, and Spain.

There is still much work to be done, 44 countries remain unprotected by any of WHO's MPOWER measures and 53 countries still do not have complete smoking bans in healthcare facilities. Meanwhile, only about half of countries have smoke-free private workplaces and restaurants.

"WHO urges all countries to put in place all of the MPOWER measures at best-practice level to fight the tobacco epidemic, which kills 8.7 million people globally, and push back against the tobacco and nicotine industries, who lobby against these public health measures," said Dr Ruediger Krech, WHO, director for health promotion.

Around 1.3 million people die from second-hand smoke every year. All of these deaths are entirely preventable. People exposed to second-hand tobacco smoke are at risk of dying from heart disease, stroke, respiratory diseases, type two diabetes and cancers.

This report demonstrates that all countries irrespective of income levels can drive down the demand for deadly tobacco, achieve major wins for public health and save economies billions of dollars in health care and productivity costs.