Search

Google Scholar OpenURL Placeholder Text WorldCat 2 Kurdi A, Mueller T, Weir N. An umbrella review and meta-analysis of renin-angiotensin system drugs use and COVID-19 outcomes. Response to: A statistical commentary on 'Does vitamin D supplementation reduces COVID-19 severity? Meta-analysis of meta-analysis is not an uncommon form of research especially when multiple primary outcomes are considered.[2],[3] Regarding this particular study, we wanted to assess role of vitamin D supplementation on mortality, Intensive care unit (ICU) stay and mechanical ventilation requirement in COVID patients. [Extracted from the article]

We are pleased to respond to the comments received from Dr. Bajpai and wish to thank him for his interest in our study exploring the impact of the vitamin D supplementation on COVID-19 severity.[1] We are herewith responding to the comments in point-by-point manner. Google Scholar Crossref Search ADS PubMed WorldCat 3 Pollock M, Fernandes RM, Becker LA, Pieper D, Hartling L. Chapter V: overviews of reviews. [Extracted from the article]

Background: The Surgical Accredited & Trained Healthcare Initiative (SATHI) project demonstrates how community healthcare workers (CHWs) with merely 8 y of formal schooling and training for a short period can reduce unmet surgical needs., Methods: A pilot study was carried out in the slums of a metropolitan city in India to know the effectiveness of a SATHI in reducing the burden of unmet surgical needs. In total, 12 730 people from 3000 households were included in the study for a duration of 6 months., Results: We found 10% surgical needs (n=293) out of which 57% had unmet surgical needs. Out of total surgical needs, about half of the needs were cataract and abdominal, followed by extremities and chest conditions. SATHIs were able to convert 99 patients (60%) from unmet to met needs, who underwent surgery/treatment. The conversion from unmet to met among all surgery needs was highest for abdominal conditions (29%) followed by cataracts (17%)., Conclusions: SATHIs with short training can reduce the burden of unmet surgical needs. SATHIs were able to convert a significant proportion of unmet to met needs by trust building, facilitating access to healthcare and ensuring post-operative adherence. Scaling up could help in the achievement of equitable healthcare across India., (© The Author(s) 2023. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Introduction: We carried out a household study of surgical unmet needs and trust in the physician and perception of quality in the health system in a rural Tribal area and an urban slum in India., Methods: A community-based, cross-sectional study was carried out in a Tribal and in an urban slum in Gujarat, India. We surveyed 7914 people in 2066 households in urban slum and 5180 people of 1036 households in rural Tribal area. The Surgeons Overseas Assessment of Surgical need was used to identify surgical met and unmet needs. Two instruments for trust deficit 'the Socio-culturally Competent Trust in Physician Scale for a Developing Country Setting' and 'Patient perceptions of quality' were also administered to understand perception about healthcare. Frequencies and proportions (categorical variable) summarized utilization of surgical services and surgical needs. P < 0.05 was statistically significant., Results: Slums and Tribal areas were significantly different in sociodemographic indicators. Unmet surgical needs in Tribal area were less than 5% versus 39% in the urban slum. Major need of surgery in Tribal area was for eye conditions in older population, while surgical conditions in extremities and abdomen were predominant in the urban area. Trust level was high for physicians in both areas., Conclusions: Surgical unmet needs were significantly lower in Tribal versus urban area, possibly due to high priority given by the Indian government to alleviate poverty, social deprivation and participation of NGOs. Our study will give impetus to study unmet surgical needs and formulation of health policies in India and low-and-middle- income countries., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Climate change-driven temperature increases worsen air quality in places where coal combustion powers electricity for air conditioning. Climate solutions that substitute clean and renewable energy in place of polluting coal and promote adaptation to warming through reflective cool roofs can reduce cooling energy demand in buildings, lower power sector carbon emissions, and improve air quality and health. We investigate the air quality and health co-benefits of climate solutions in Ahmedabad, India-a city where air pollution levels exceed national health-based standards-through an interdisciplinary modeling approach. Using a 2018 baseline, we quantify changes in fine particulate matter (PM 2.5 ) air pollution and all-cause mortality in 2030 from increasing renewable energy use (mitigation) and expanding Ahmedabad's cool roofs heat resilience program (adaptation). We apply local demographic and health data and compare a 2030 mitigation and adaptation (M&A) scenario to a 2030 business-as-usual (BAU) scenario (without climate change response actions), each relative to 2018 pollution levels. We estimate that the 2030 BAU scenario results in an increase of PM 2.5 air pollution of 4.13 µ g m -3 from 2018 compared to a 0.11 µ g m -3 decline from 2018 under the 2030 M&A scenario. Reduced PM 2.5 air pollution under 2030 M&A results in 1216-1414 fewer premature all-cause deaths annually compared to 2030 BAU. Achievement of National Clean Air Programme, National Ambient Air Quality Standards, or World Health Organization annual PM 2.5 Air Quality Guideline targets in 2030 results in up to 6510, 9047, or 17 369 fewer annual deaths, respectively, relative to 2030 BAU. This comprehensive modeling method is adaptable to estimate local air quality and health co-benefits in other settings by integrating climate, energy, cooling, land cover, air pollution, and health data. Our findings demonstrate that city-level climate change response policies can achieve substantial air quality and health co-benefits. Such work can inform public discourse on the near-term health benefits of mitigation and adaptation., (© 2023 Natural Resources Defense Council.)

Introduction: Public Health's (PH) global rise is accompanied by an increasing focus on training the new generation of PH graduates in interdisciplinary skills for multisectoral and cross-cultural engagement to develop an understanding of commonalities in health system issues and challenges in multi-cultural settings. Online teaching modalities provide an opportunity to enhance global health skill development through virtual engagement and peer exchange. However, current teaching pedagogy is limited in providing innovative modes of learning global health issues outside of traditional classroom settings with limited modalities of evidence-informed implementation models., Methods: This study designed, implemented, and evaluated a novel global health online synchronous module as proof of concept that incorporated elements of virtual Practice-based learning (PBL) using a case study approach offered to currently enrolled public health students at the University of Canberra (UC) and a partnering public health university from India, the Indian Institute of Public Health Gandhinagar (IIPH-G). Using constructive learning theory and the Social Determinants of Health framework, four online sessions were designed and implemented in August-September 2022. Formal process and outcome evaluation using a quantitative adapted survey of the validated International Student Experience survey (IES) at session end and findings provided., Results: Over 100 participating public health students from Australia and India provided narrative feedback and quantitative responses from the adapted IES instrument across four key dimensions, namely "motivation," "personal development," intellectual development, and "international perspectives" reporting an overall high mean impact of 4.29 (out of 5) across all four themes seen together. In essence, the sessions supported students to explore global health issues from a different cultural perspective while developing intercultural communication skills and enhancing their global exposure in real-time., Discussions: This innovation, implemented as a proof of concept, provided evidence, and demonstrated the implementation feasibility of a flexible virtual integrated practice-based module that can supplement classroom teaching. It provides participating students with the opportunity to develop intercultural understanding and communication competence as well as support global mindedness by engaging with international peers around focused global health case studies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ahmad, McFarlane, Smith, Saxena, Somerset and Mavalankar.)

Background: The evidence regarding the efficacy of vitamin D supplementation in reducing severity of COVID-19 is still insufficient. This is partially due to the lack of primary robust trial-based data and heterogeneous study designs., Aim: This evidence summary, aims to study the effect of vitamin D supplementation on morbidity and mortality in hospitalized COVID-19 patients.Design: Evidence summary of systematic reviews., Methods: For this study, systematic reviews and meta-analysis published from December 2019 to January 2022 presenting the impact of vitamin D supplementation on COVID-19 severity were screened and selected from PubMed and Google scholar. After initial screening, 10 eligible reviews were identified and quality of included reviews were assessed using AMSTAR and GRADE tools and overlapping among the primary studies used were also assessed., Results: The number of primary studies included in the systematic reviews ranged from 3 to 13. Meta-analysis of seven systematic reviews showed strong evidence that vitamin D supplementation reduces the risk of mortality (Odds ratio: 0.48, 95% CI: 0.346-0.664; P < 0.001) in COVID patients. It was also observed that supplementation reduces the need for intensive care (Odds ratio: 0.35; 95%CI: 0.28-0.44; P < 0.001) and mechanical ventilation (Odds ratio: 0.54; 95% CI: 0.411-0.708; P < 0.001) requirement. The findings were robust and reliable as level of heterogeneity was considerably low. However the included studies were of varied quality. Qualitative analysis showed that supplements (oral and IV) are well tolerated, safe and effective in COVID patients., Conclusion: The findings of this study show that vitamin D supplementation is effective in reducing the COVID-19 severity. Hence, vitamin D should be recommended as an adjuvant therapy for COVID-19.However, more robust and larger trials are required to substantiate it further., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: We carried out a mixed method study to understand why patients did not avail of surgical care in an urban slum in India. Methods: In our earlier study, we found that out of 10,330 people, 3.46% needed surgery; 42% did not avail of surgery (unmet needs). We conducted a follow-up study to understand reasons for not availing surgery, 141 in met needs, 91 in unmet needs. We administered 2 instruments, 16 in-depth interviews and 1 focused group discussion. Results: Responses from the 2 groups for "the Socio-culturally Competent Trust in Physician Scale for a Developing Country Setting" scale did not have significant difference except for, prescription of medicines, patients with unmet needs were less likely to agree ( p = 0.076). Results between 2 groups regarding "Patient perceptions of quality" did not show significant difference except for doctors answering questions where a higher proportion of unmet need group agreed ( p = 0.064). Similar observations were made in the in depth interviews and focus group. Conclusion: There is a need for understanding trust issues with health service delivery related to surgical care for marginalized populations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Vora, Saiyed, Mavalankar, Baines and Jindal.)

Background: Well-planned health research is fundamental to the success of any public health system in leading to better population health outcomes. Although the Indian public health system is unique, it lacks strong linkages between research and practice. There is a pressing need to address the gap in the research to reduce the disease burden in the country. Although various efforts are made to enhance public health research, such research is rarely documented as a process. The objective of the present paper is to document issues and challenges in managing public health research grants awarded to the PHRI fellows from 2013-to 2021 under the PHRI project., Method: A mixed-method approach, including qualitative (in-depth) interviews and secondary review, was adopted to collect the challenges in executing PHRI grants (during 2013-2021). The in-depth interviews were conducted among the PHRI execution team, whereas the secondary document review was conducted among the PHRI fellows, and the findings are documented under major themes like administrative, technical, and financial issues and/or challenges., Result: A total of 35 candidates 16 intramural (IM) candidates affiliated with PHFI or IIPH institutes and 19 extramural (EM) candidates affiliated to other academic institutes were selected for the fellowship, The common challenges identified amongst intra & extramural fellows were inability to disseminate the study findings, challenges in communication and getting audited statements, changes in study methods without prior permission, mid study attrition of CO-PIs and high budget utilization. The specific difficulties identified from extramural fellows were change in institute affiliation, lack of support to fund utilization from the parent institute and difficulties in field validation., Conclusion: The present perspective emphasizes that the management and implementation of a research grant is the crucial part of achieving a project's desired outcome. The learnings of PHRI grant execution allows the researchers to understand the issues in terms of methodological rigour and financial guidelines, rigorous tracking of the project activities, and complying with the terms of funding agreement are crucial. The challenges explored in this grant execution recommend developing a structured public health grant management leadership program for researchers and executors., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Deepak Saxena reports financial support was provided by Department of Science and Technology., (© 2022 The Authors.)

Most of India's current electricity demand is met by combustion of fossil fuels, particularly coal. But the country has embarked on a major expansion of renewable energy and aims for half of its electricity needs to be met by renewable sources by 2030. As climate change-driven temperature increases continue to threaten India's population and drive increased demand for air conditioning, there is a need to estimate the local benefits of policies that increase renewable energy capacity and reduce cooling demand in buildings. We investigate the impacts of climate change-driven temperature increases, along with population and economic growth, on demand for electricity to cool buildings in the Indian city of Ahmedabad between 2018 and 2030. We estimate the share of energy demand met by coal-fired power plants versus renewable energy in 2030, and the cooling energy demand effects of expanded cool roof adaptation in the city. We find renewable energy capacity could increase from meeting 9% of cooling energy demand in 2018 to 45% in 2030. Our modeling indicates a near doubling in total electricity supply and a nearly threefold growth in cooling demand by 2030. Expansion of cool roofs to 20% of total roof area (associated with a 0.21 TWh reduction in cooling demand between 2018 and 2030) could more than offset the city's climate change-driven 2030 increase in cooling demand (0.17 TWh/year). This study establishes a framework for linking climate, land cover, and energy models to help policymakers better prepare for growing cooling energy demand under a changing climate., Competing Interests: Conflict of interestsThe authors report no conflicts of interest and no competing interests., (© The Author(s) 2022.)

Background: Given the limited and diverse nature of published literature related to COVID-19 in pediatrics, it is imperative to provide evidence-based summary of disease characteristics for guiding policy decisions. We aim to provide comprehensive overview of epidemiological, clinical and biomarker profile of COVID-19 infection in pediatric population., Methods: For this umbrella review, published systematic reviews from PubMed and pre-print databases were screened. Literature search was conducted from December 2019 to April 2021. Details of clinical, radiological and laboratory features were collected from each review. Qualitative observations were synthesized and pooled prevalence of mortality and asymptomatic cases were assessed using meta-analysis., Results: Evidence synthesis of 38 systematic reviews included total 1145 studies and 334 398 children and adolescents. Review revealed that COVID-19 is relatively milder with better prognosis in pediatrics. However, patients with comorbidity are at higher risk. Meta-analysis of reviews showed that 21.17% (95% CI: 17.818-24.729) of the patients were asymptomatic and mortality rate was 0.12% (95% CI: 0.0356-0.246). Though there was no publication bias, significant heterogeneity was observed. Fever (48-64%) and cough (35-55.9%) were common symptoms, affecting almost every alternate patient. Ground-glass opacities (prevalence range: 27.4-61.5%) was most frequent radiographic observation. Rise in C-reactive protein, lactate dehydrogenase and D-dimer ranged from 14% to 54%, 12.2-50% and 0.3-67%, respectively. Some of the included reviews (44.7%-AMSTAR; 13.2%-GRADE) were of lower quality., Conclusion: Current umbrella review provides most updated information regarding characteristics of COVID-19 infection in pediatrics and can be used to guide policy decision regarding vaccination prioritization, early screening and identification of at-risk population., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com.)