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In seeking to explore the meaning of chronic and chronicity, the association with infertility is neither immediate nor evident. However, this paper explores this relationship by analyzing the idea of infertility in relation to chronicity. In the linkages that come forth the idea of chronic lifestyle emerging from certain ways of being and living, as well the imaginings associated with the chronic body become important nodes of exploring the relationship between infertility and chronicity. Most importantly, the role that time plays in marking the chronic state is seen to be especially potent in the practice of infertility treatment, and the narratives that emerge around its temporal inevitability. The rhetoric that marks the diagnosis and prescription of treatment is often based on the identification of the body as susceptible to reproductive decline and failure, due to the contingencies of modern living. This often translates into a more sustained involvement with ARTs, which may or may not fulfil the required desire for a child. In this paper I seek to analyse the ways in which practitioners of infertility medicine create an image of an affliction that borders on chronicity. In the process, I question the idea of both chronic diseases and chronicity by looking at how illness is imagined in narratives that IVF specialists create in public, and through the idea of a cure for infertility. By analysing data collected through ethnographic fieldwork, this paper aims to build on the idea of the chronic as inevitable within clinical discourse and practice. [ABSTRACT FROM AUTHOR]

In response to the global call to upscale mental health services in low--income countries, mental health non-governmental organisations (MHNGOs) have sprung up in Kerala to address mental health needs by partnering with pre-existing locally grown, bottom-up, community-led pain and palliative clinics (PPCs) to increase access to mental health care through task-shifting. The MHNGOs mandate filtering only patients with 'severe mental disorders' from low socioeconomic backgrounds for their free services. This eligibility criterion mandated by the MHNGO is ruffling feathers within the palliative clinics that oppose such -classifications. They believe that suffering cuts across all divisions and should not be discriminated against based on economic background and severity of illnesses. When chronicity and suffering are held universal by the MHNGO and palliative care, respectively, it brings to the fore the enactment of two perspectives of care. Drawing on observations of clinical interactions between patients, MHNGO staff and mental health professionals and interviews with community volunteers of palliative care clinics in Kerala, this paper demonstrates how chronicity narrative promoted by MHNGOs based on biopsychiatric model gains hegemony, whereas the community care model loses traction progressively. The state, caught between these two narratives, frontstages development by submitting its health machinery to the MHNGOs flouting basic medical safety laws in its services to marginalised people like the tribal population. This paper argues that the rising dominance of chronicity narrative in community mental health clinics as well as in popular media discourses evolves out of power relations between the MHNGOs and the palliative clinics. [ABSTRACT FROM AUTHOR]

This paper argues that self-authored depictions of illness, disability, trauma and bodily hurt by marginalised individuals have deep agentic potential, particularly when these experiences are retold within empathetic online spaces on their own terms and in their own words. This is seldom possible in mainstream institutional settings which are structured by hegemonic norms and where the marginalised are often spoken for. Through an analysis of selected writings in Skin Stories, an Indian collective feminist media publication that publishes gendered articulations of disability, illness and healing, this paper explores the potential of marginalised writings in reclaiming control over one's bodily narrative, sharing knowledge and forging spaces of empathy and connection. It analyses ways in which authors through "intimate vulnerable retellings" of everyday as well as traumatic bodily events/processes like ongoing illness, lifelong chronic pain and sudden disability reclaim and own narratives of bodily vulnerability. These retellings are analysed as interconnected, shared experiences that bear deep knowledge and challenge medicalised understandings. By acknowledging "bodies as knowledge" rather than "bodies as data" these retellings could potentially supplement and enrich medical approaches in managing and understanding chronic pain and illness specifically in India, thereby piecing together experience, knowledge(s) and expertise. [ABSTRACT FROM AUTHOR]

This narrative review paper aims to build a common understanding of the vulnerabilities of children with chronic medical conditions who face exceptional challenges due to nature of the illness, deformity, injury, and traumatic healthcare encounters which could potentially lead to long-term psychological effects. The presence of chronic medical diagnoses in children and the subsequent impacts including social stigma, as well as their age and developmental level, may amplify adjustment challenges in parenting considerations, school, peer relations, career, and future relationships. Children may be traumatized by unfamiliar and painful healthcare experiences. Hospitalization can lead to increased feelings of isolation, fear, and self-doubt when children do not receive emotionally safe psychological support necessary to minimize the accompanying stress and anxiety. School experiences and parenting children with chronic illnesses have additional intersecting socialization characteristics. This paper highlights a vision for furthering the groundwork within Indian pediatric settings to promote emotional safety and psychosocial care. Principles from the United Nations Convention on the Rights of the Child and the World Health Organization's definition of health create an impetus for giving a voice to children with chronic medical conditions. While there are sporadic psychosocial services for children with chronic needs, they lack consistency, and this indicates a need and an opportunity for developing a unique career for human development and psychology professionals to address these concerns. As exemplars, two psychosocial care programs in India that help foster resilience in these children are highlighted. Although limited, extant research regarding the experiences of children with chronic medical conditions in India is discussed, and implications for future research and academic initiatives are interwoven within this paper. [ABSTRACT FROM AUTHOR]

Context: Chronic diseases are growing in India and largely affecting the middle-aged and elderly population; many of them are in working age. Though a large number of studies estimated the out-of-pocket payment and financial catastrophe due to this condition, there are no nationally representative studies on productivity loss due to health problems. This paper examined the pattern and prevalence of productivity loss, due to chronic diseases among middle-aged and elderly in India. Methods: We have used a total of 72,250 respondents from the first wave of Longitudinal Ageing Study in India (LASI), conducted in 2017-18. We have used two dependent variables, limiting paid work and ever stopped work due to ill health. We have estimated the age-sex adjusted prevalence of ever stopped working due to ill health and limiting paid work across MPCE quintile and socio- demographic characteristics. Propensity Score Matching (PSM) and logistic regression was used to examine the effect of chronic diseases on both these variables. Findings: We estimated that among middle aged adults in 45–64 years, 3,213 individuals accounting to 6.9% (95%CI:6.46–7.24) had ever-stopped work and 6,300 individuals accounting to 22.7% (95% CI: 21.49–23.95) had limiting paid work in India. The proportion of ever-stopped and limiting work due to health problem increased significantly with age and the number of chronic diseases. Limiting paid work is higher among females (25.1%), and in urban areas (24%) whereas ever-stopped is lower among female (5.7%) (95% CI:5.16–6.25) and in urban areas (4.9%) (95% CI: 4.20–5.69). The study also found that stroke (21.1%) and neurological or psychiatric problems (18%) were significantly associated with both ever stopped work and limiting paid work. PSM model shows that, those with chronic diseases are 4% and 11% more likely to stop and limit their work respectively. Regression model reveals that more than one chronic conditions had a consistent and significant positive impact on stopping work for over a year (increasing productivity loss) across all three models. Conclusion: Individuals having any chronic disease has higher likelihood of ever stopped work and limiting paid work. Promoting awareness, screening and treatment at workplace is recommended to reduce adverse consequences of chronic disease in India. [ABSTRACT FROM AUTHOR]

About 10.5 percent of global adult population is living with diabetes. India has 77 million diabetic patients, it is the second highest in the world. Developing countries such as India face a huge burden of diabetes and its complications. Even children at the age of five are suffering from this disease. It is high time that people understand the gravity of the situation and make themselves fit to fight the disease than to suffer with it. If diabetes is not identified and treated in right time, it may lead to chronical health issues. In this paper a machine learning based prediction model is built to find the factors leading to complicated health issues such as cardio vascular disease. This model identifies the attributes that highly contribute to cardio vascular disease and compare various machine learning algorithms to predict cardio vascular disease among diabetic patients. It identifies the best algorithm from a set of supervised learning algorithms such as KNN, Decision Tree, Random Forest, Naïve Bayes and Gradient Boosting for prediction based on several performance metrics. The algorithms are compared based on the performance metrics such as accuracy, precision, recall, F1 score, time taken to train and time taken to test. We identified that Decision Tree with entropy as the split criterion achieved the highest accuracy. [ABSTRACT FROM AUTHOR]

Diabetes is a chronic illness and management requires consistent effort. The prevalence of diabetes in India is estimated to reach 80 million by 2030. It becomes essential for a proactive approach to identifying symptoms along with the psychological causal factors. Psychological interventions have been shown to aid in the management of diabetes. Voluntary participation leads to challenges of refusal to participate. This paper aims to understand the common reasons for nonparticipation in a digital intervention among patients with type 2 diabetes. It was identified that knowledge and altruistic benefits of participation in research need to be highlighted in our society. [ABSTRACT FROM AUTHOR]

Slum dwellers due to their low level of living and unhealthy environment can be at higher risk of illness. The present paper explores the dimension and determinants of morbidity in the slums of Chandigarh. The paper revealed that there is high morbidity among the slum dwellers and there is also co-existence of both chronic and acute diseases, infectious and lifestyle diseases. The determinants of morbidity are also explored, and factors responsible in curtailing the morbidity among the slum dwellers are identified. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Quantitative evidence on the impact of social protection such as livelihood programs (LPs) on reducing vulnerability to poverty (VtP) is scant. Therefore, this paper aims to estimate VtP and the ability of LPs to reduce it. The analysis is based on the primary data collected in 2018–19 from 479 households in a tribal region of eastern India. First, household VtP was estimated using the feasible generalized least squares (FGLS) method. Households were categorized into four groups based on their current and predicted future poverty status: chronic poor, transient poor, escaped poverty, and non-poor. Second, factors influencing this movement of households from current to future poverty states were determined using multinomial logistic regression. Third, the impact of the LP on VtP was investigated using the endogenous switching regression (ESR) approach. The FGLS estimates show that 34.7% of households are vulnerable to future poverty, which exceeds the actual poverty rate of 28.6%. The major factors responsible for exacerbating chronic poverty and causing transient poverty are chronic illness, climate shocks, and the sale of assets. The ESR results indicate that a household's VtP is reduced by 3% for those that participate in LPs. Although the LP evaluated in this study has an average positive impact in reducing vulnerability, there is wide heterogeneity among the beneficiaries as the geographically disadvantaged communities lag behind the others. Therefore, the study suggests strengthening such LPs with a particular focus on disadvantaged and vulnerable communities. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to examine the linkages of employment, chronic disease prevalence and medical care of the older population in India. Design/methodology/approach -- This study used the India Human Development Survey data for the analysis. Bivariate, multinomial logit regression and multiple classification analysis are used as methods for the study Findings -- The findings suggest a bi-directional relationship between employment and chronic diseases: the older population who are engaged in regular paid work has lower likelihood to the risk of chronic diseases compared to those who are not working. Conversely, the older population with chronic diseases may be unable to work in regular paid jobs. The greater proportions of not-working older population with savings and retirement pensions are more likely to seek modern treatment for the chronic diseases. Overall, the results foster that employment determines and is determined by chronic disease prevalence among the older population in India. Originality/value -- This paper tor the first time presents evidence on the linkages of employment, chronic disease prevalence and medical care of the older population in India by using a unique and comprehensive data source. [ABSTRACT FROM AUTHOR]

Purpose While interpretative phenomenological analysis (IPA) has been used in health psychology research, it has so far not been applied to seek deeper insights into the patients' experiences about treatment. The purpose of this paper is to address this gap by using IPA to understand patient non-adherence. Design/methodology/approach In total, 18 patients with chronic conditions seeking healthcare services in Goa and Karnataka, India, were selected by using the snowball sampling method. In-depth interviews were conducted face to face. A semi-structured questionnaire developed by the researchers was used to collect the data. IPA was used to explore the themes to predict patient non-adherence. Findings The study results indicate that economic factors, health system related factors, social factors and psychological factors impact patient non-adherence. Patient non-adherence includes medication non-adherence and lifestyle modification non-adherence. Research limitations/implications Being cross sectional in design, the results may not be as appropriate as the results derived from a longitudinal study given that non-adherence occurs over time. Practical implications Patient non-adherence is a global health issue. Multidisciplinary approach to enhance patient adherence to treatment should form part of public healthcare policy. Social implications Exploring the factors influencing patient non-adherence will help the health-care industry stakeholders to reduce healthcare cost and improve patient's quality of life. Originality/value Although there is extensive quantitative research on the prevalence of non-adherence, qualitative research is limited. This paper addresses this gap by using IPA to understand patient non-adherence and its factors and dimensions. [ABSTRACT FROM AUTHOR]

Background: Enterococci are the transient constituents of the oral microbiome and have been now increasingly related to oral and systemic diseases. They have now become the most notable nosocomial pathogens and also been linked to etiology of periodontitis. This study evaluates the prevalence of Enterococci in the chronic periodontitis and healthy Indian cohort in different urban socioeconomic groups. Materials and Methods: In this retrospective study, individuals in the age range of 18-75 years were included. Seventy individuals had mild to moderate periodontitis and 30 healthy persons were taken as controls. A questionnaire was administered. Paper point samples of gingival crevicular fluid were obtained, pooled, and sent to microbiology laboratory in a transport media. Forty six isolates were identified as enterococci for statical analyzes Pearson's Chi square test used and. P < 0.001 was considered to be significant. Results: The prevalence of enterococci was seen mostly in the individuals from lower socioeconomic class, having poor oral hygiene, and smokers. This was significantly different from those of upper class (P < 0.001). The predominant species isolated was Enterococcus faecalis. Conclusion: Enterococci particularly E. faecalis followed by Enterococcus faecium could play a crucial role in the severity or progression of periodontitis particularly in a favorable oral environment. [ABSTRACT FROM AUTHOR]

This paper describes overall socioeconomic gradients and the age patterns of socioeconomic gradients of health of Indian adults for multiple health indicators encompassing the multiple aspects of health. Cross-sectional data on 11,230 Indians aged 18 years and older from the WHO-SAGE India Wave 1, 2007 were analyzed. Multivariate logit models were estimated to examine effects of socioeconomic status (education and household wealth) and age on four health domains: self-rated health, self-reported functioning, chronic diseases, and biological health measures. Results show that socioeconomic status (SES) was negatively associated with prevalence of each health measure but with considerable heterogeneity across age groups. Results for hypertension and COPD were inconclusive. SES effects are significant while adjusting for background characteristics and health risk factors. The age patterns of SES gradient of health depict divergence with age, however, no conclusive age pattern emerged for biological markers. Overall, results in this paper dispelled the conclusion of negative SES-health association found in some previous Indian studies and reinforced the hypothesis of positive association of SES with health for Indian adults. Higher prevalence of negative health outcomes and SES disparities of health outcomes among older age-groups highlight need for inclusive and focused health care interventions for older adults across socioeconomic spectrum. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) reports that Asia and Africa have the highest Chronic Liver Disease (CLD) mortality rate. Cirrhosis, responsible for 22.2 fatalities per 100,000 people, is India's 10th most common cause of mortality. The increasing prevalence of chronic liver disease necessitates a study to identify predictive factors for patients who visit the emergency department. Identifying elements that enhance the predictive value of mortality in unstable patients with CLD complications is important in emergency departments. This study aims to determine Clinical and Laboratory Parameters as mortality predictors in adult chronic liver disease patients. Methodology: The study was conducted at the emergency department of a tertiary healthcare center in Northern India. Patients with chronic liver disease above 18 years of age who satisfied the inclusion criteria were clinically evaluated. Clinical and demographic details were collected, and data was analyzed. Results: Two hundred thirty-six patients were enrolled. The mean age was 50.77 ± 14.26 years. 78.4% of the participants were men. Abdominal distension, affecting 59.7% of patients, was the most common presenting ailment, followed by melena and hematemesis, affecting 41.9% and 32.6%, respectively. The mean stay in the emergency department was 10.29 ± 8.10 h. Refractory septic shock, the leading cause of mortality, accounts for 69.2% of all deaths, alongside grade 4 hepatic encephalopathy and massive Upper Gastrointestinal (UGI) bleeding, as identified in our study. Factors such as altered mental sensorium, high respiratory rate, low SpO2, increased heart rate, low systolic blood pressure, low diastolic blood pressure, and low Glasgow Coma Scale (GCS) on Emergency Department (ED) arrival are significantly associated with mortality. Conclusions: Chronic liver disease, a prevalent condition in India, most commonly seen in middle aged men and lower socioeconomic groups. The parameters independently associated with mortality in our study were presence of altered mental sensorium, Glasgow coma scale, Child Pugh class and need for ICU admission. Understanding the presentation pattern, and mortality predictors can help ED physicians in managing acute events and follow-ups. [ABSTRACT FROM AUTHOR]

Background: The WHO defines LBW as "Birth weight less than 2500 grams" regardless of gestational age. Being born with a low birth weight also incurs enormous economic costs, including higher medical expenditures and social service expenses, and decreased productivity in adulthood. Objective: To study distribution of newborns' according to pregnancy related factors and its association with newborns' birth weight. Methods: An institutional based cross-sectional study. New-borns delivered at study institute were considered as study participants. Estimated final sample size was 500. Guardians (mothers) were face-to-face interviewed and also recorded data were collected from the case file and Mother and Child Protection Card. Results: Prevalence of LBW newborns was higher in mothers with late ANC registration, <4 ANC visits, chronic medical conditions, infection during pregnancy, PIH, anemia, consuming tobacco, exposure to second hand smoke, LSCS/Assisted delivery, in female newborns', current pregnancy birth order number more than 2, in pre term newborns' and mothers with bad obstetric history. Conclusion: Create awareness and adoption of suitable family planning methods. Need to do early (within 12 weeks) ANC registration with minimum four ANC visits for better pregnancy outcome. Effective tracking and suitable intervention provided to improve current pregnancy outcome. Health care professional should pay special attention to high-risk pregnancy. Develop social culture in such a way that females are neither addicted nor exposed to any tobacco containing products in their life. [ABSTRACT FROM AUTHOR]

Objective: There is increasing evidence to suggest that the epidemiologic transition is well underway in India and other less industrialized countries. Hence there is a need to review the status of our understanding of the impending epidemic of non-communicable chronic diseases (NCD) in India, given their chronic nature and their impact on society. Materials and Methods: In this paper, attempt has been made to study the extent to which the risk factors contribute to chronic diseases. Specifically, inside the chronic disease afflicted group, one could be interested to quantify the extent of influence of each of the risk factors and behaviors. Data set used here is a primary one collected through a household survey. Baye's method has been used to calculate the posterior probabilities. Results: Given a person suffers from a chronic disease; the probabilities of him/her belonging to a particular group are calculated. Conclusion: Such an exercise can help in focusing attention to the risk factors. [ABSTRACT FROM AUTHOR]

Purpose Changing demographic trends in India have resulted in a growing ageing population, and this poses many health challenges for older people. Lack of formal care institutions and social security nets further aggravate the situation. Living arrangements are, thus, expected to play a significant role in determining the healthcare needs of older people. The purpose of this paper is to examine the association of living arrangements with health among older people in India.Design/methodology/approach Data for the study were drawn from the Building Knowledge Base on Population Ageing in India (2011). The health status of older people was measured by assessing chronic illness, self-rated health and limitations in activities of daily living. Logistic regression was used to examine the influence of living arrangements on health outcomes. Further, a structural equation model was employed to observe whether poor health preceded co-residence.Findings Older people living in co-residential arrangements report more health disadvantages and older people with poor health prefer co-residence with their offspring. Perhaps the support, care and health awareness in co-residential arrangements helps older people obtain the healthcare interventions they require for the various illnesses they have had, and enable them to improve their ongoing health status.Originality/value The present study has extended the research on the relationship between health and living arrangements, and has also addressed the case of older people with poor health who prefer to stay in co-residential arrangements which has been taken up by limited studies. [ABSTRACT FROM AUTHOR]

In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems. [ABSTRACT FROM AUTHOR]

Background: Expenditure on medications for highly prevalent chronic conditions such as diabetes mellitus (DM) can result in financial impoverishment. People in developing countries and in low socioeconomic status groups are particularly vulnerable. China and India currently hold the world's two largest DM populations. Both countries are ageing and undergoing rapid economic development, urbanisation and social change. This paper assesses the determinants of DM medication use and catastrophic expenditure on medications in older adults with DM in China and India.Methods: Using national standardised data collected from adults aged 50 years and above with DM (self-reported) in China (N = 773) and India (N = 463), multivariable logistic regression describes: 1) association between respondents' socio-demographic and health behavioural characteristics and the dependent variable, DM medication use, and 2) association between DM medication use (independent variable) and household catastrophic expenditure on medications (dependent variable) (China: N = 630; India: N = 439). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010).Results: Prevalence of DM medication use was 87% in China and 71% in India. Multivariable analysis indicates that people reporting lifestyle modification were more likely to use DM medications in China (OR = 6.22) and India (OR = 8.45). Women were more likely to use DM medications in China (OR = 1.56). Respondents in poorer wealth quintiles in China were more likely to use DM medications whereas the reverse was true in India. Almost 17% of people with DM in China experienced catastrophic healthcare expenditure on medications compared with 7% in India. Diabetes medication use was not a statistically significant predictor of catastrophic healthcare expenditure on medications in either country, although the odds were 33% higher among DM medications users in China (OR = 1.33).Conclusions: The country comparison reflects major public policy differences underpinned by divergent political and ideological frameworks. The DM epidemic poses huge public health challenges for China and India. Ensuring equitable and affordable access to medications for DM is fundamental for healthy ageing cohorts, and is consistent with the global agenda for universal healthcare coverage. [ABSTRACT FROM AUTHOR]

Instead of diminishing with the spectacular advancement of medical expertise in the country , unqualified biomedical practice in India has been strengthened by the growth of the pharmaceutical production in the twenty first century. In public health discourse, the view that the informal health practitioners have to be punished and abolished has been countered by the recommendation that they could be trained and incorporated in primary health care where public health amenities are inadequate. The quality of care provided by the informal health care practitioners has also been subject to clinical assessment based on standardized patient vignettes. Based on a sociological approach, this paper examines the time line of chronically ill patients under lived conditions to arrive at an understanding of the role of informal health practitioners in long term treatment and highlights the setbacks. This paper draws on 253 household surveys from two villages in Madhya Pradesh, in depth interviews with four unqualified practitioners in the area, twenty five unstructured interviews of chronic patients, twenty five structured interviews on the cases of untimely death and FGDs with health workers in 2021. Informal health care practitioners offer consultation cum dispensing of medicines and are the primary source of biomedical care in the remote study area without any public transport. But they are 'for profit' economic actors who are ill-equipped to handle chronic diseases. What sets them aside from the qualified private doctors in the town is their social obligation to balance their profit motive with the ethics of proximity and neighborly ties with the villagers amidst whom they reside. These features of the market and community place the informal health care practitioners at the cusp of economy and society and defy simple binaries that they are either crooks or assets. • Unqualified health practitioners provide medical care in India where none is available. • Assessing their practices, clientele and exact role is crucial to health care policy. • One point standardized patient vignettes are used to assess their quality of care. • Their treatment of chronically and severely ill patients over time also has to be examined. • They are 'for profit' economic actors, but embedded in the community. [ABSTRACT FROM AUTHOR]

Objectives: Exploring data on primary caregiver experiences of dealing with chronically ill children (CIC) strengthens the ability of paediatricians to improve the quality of care by detecting unmet needs in paediatric palliative care and understanding their original concerns instead of presumed needs. Hence, this study aims to identify and describe the primary concerns and challenges faced by caregivers of children with complex chronic conditions in a tertiary care hospital in Kerala. Materials and Methods: Primary caregivers of 25 children aged <13 years with non-malignant life-limiting illnesses, admitted to the paediatric department of a government medical college in Kerala between 1 July 2021 and 28 February 2022, underwent in-depth interviews to analyse their most worrisome issues. Thematic analysis was the method chosen for qualitative data analysis. Results: The main themes identified were medical issues, unmet needs, caregiver health issues, and social and financial issues. Among the medical issues, poor seizure control and infected bedsores, sleep deprivation in both patient as well as caregivers, and difficulty in maintaining the personal hygiene of patients were the major issues. Parents of almost all the CICs reported that they required diapers more than any other material or device. Maternal depression was the major caregiver health issue. The unavailability of antiepileptic drugs in peripheral health centres resulted in missing doses and undue expenses for travel to tertiary centres to obtain the same. Caregivers reported their dismay when they finally realised that they were given false hopes of a cure by different systems of medicine. Conclusion: The challenges faced by caregivers of children with complex chronic conditions are multifaceted. Their most problematic issues related to medical issues are the occurrence of breakthrough seizures and development of infected bedsores. The most important material hardship reported was diaper needs. Caregiver issues such as sleep deprivation and maternal depression must be identified and addressed while providing comprehensive palliative care. [ABSTRACT FROM AUTHOR]

Background: Chronic conditions are on rise globally and in India. Prevailing intra-urban inequities in access to healthcare services compounds the problems faced by urban poor. This paper reports the trends in self-reported prevalence of chronic conditions and health-seeking pattern among residents of a poor urban neighborhood in south India. Methods: A cross sectional survey of 1099 households (5340 individuals) was conducted using a structured questionnaire. The prevalence and health-seeking pattern for chronic conditions in general and for hypertension and diabetes in particular were assessed and compared with a survey conducted in the same community three years ago. The predictors of prevalence and health-seeking pattern were analyzed through a multivariable logistic regression analysis. Results: The overall self-reported prevalence of chronic conditions was 12 %, with hypertension (7 %) and diabetes (5.8 %) being the common conditions. The self-reported prevalence of chronic conditions increased by 3.8 percentage point over a period of three years (OR: 1.5). Older people, women and people living below the poverty line had greater odds of having chronic conditions across the two studies compared. Majority of patients (89.3 %) sought care from private health facilities indicating a decrease by 8.7 percentage points in use of government health facility compared to the earlier study (OR: 0.5). Patients seeking care from super specialty hospitals and those living below the poverty line were more likely to seek care from government health facilities. Conclusion: There is need to strengthen health services with a preferential focus on government services to assure affordable care for chronic conditions to urban poor. [ABSTRACT FROM AUTHOR]

Background: Stroke is one of the most commonly occurring disease which leads to hemiparesis along with other symptoms like spasticity, sensory disturbances etc. considered to be a part of positive signs of upper motor neuron (UMN) syndrome. Spasticity is a common disorder in patients with injury of the brain and spinal cord. Aim: The aim of the present study was to corelate the foot posture index, H/M ratio and spatial gait parameters in the assessment of poststroke patients with ankle planter-flexor spasticity. Methodology: It was an observational study which consisted of 32 chronic stroke patients. Both male and female with age group 45-70 years and stroke duration more than 3 months were included in the study. Spasticity was assessed using H/M ratio, foot posture was assessed by Foot Posture Index (FPI) and Step length and Stride length were taken. Result: Statistical analysis was done using SPSS 20 for windows. The correlation between Hmax/Mmax ratio, FPI, step length and Stride length were evaluated using Spearman's correlation coefficient test. It was suggestive of strong negative correlation between FPI and Hmax/Mmax ratio, weak negative correlation between step length Hmax/Mmax ratio, strong negative co-relation between stride length and H/M ratio, moderate positive co-relation between Foot Posture Index (FPI) and step length and strong positive corelation between FPI and stride length. (p<0.05) Conclusion: From the present study it can be concluded that there is co-relation between Spasticity, Foot posture and Gait parameters in planter-flexor spasticity in post-stroke patients. It can also be concluded that Hmax/Mmax ratio and FPI are needed to be assessed in every post stroke patient as it has influence on Gait parameters such as step length and stride length. [ABSTRACT FROM AUTHOR]

Background: Only a few studies have explored the relationship between psychosocial factors and medication adherence in Indian patients with noncommunicable diseases (NCDs). We aimed to examine the association of psychosocial variables with medication adherence in people with NCDs and comorbid common mental disorders (CMDs) from primary care in rural southern India. Methods: We performed a secondary analysis using baseline data from a randomized controlled trial in 49 primary care health centers in rural southern India (HOPE study). Participants were adults (≥30 years) with NCDs that included hypertension, diabetes, and/or ischemic heart disease, and comorbid depression or anxiety disorders. Medication adherence was assessed by asking participants if they had missed any prescribed NCD medication in the past month. Data were collected between May 2015 and November 2018. The association between psychosocial and demographic variables and medication nonadherence were assessed via logistic regression analyses. Results: Of the 2486 participants enrolled, almost one-fifth (18.06%) reported missing medication. Male sex (OR = 1.74, 95% CI 1.37–2.22) and higher internalized mental illness stigma (OR = 1.46, 95% CI 1.07–2.00) were associated with higher odds of missing medication. Older age (OR = 0.40, 95% CI 0.26–0.60, for participants aged 64–75 years vs 30–44 years), reporting more social support (OR = 0.65, 95% CI 0.49–0.86), and higher satisfaction with health (OR = 0.74, 95% CI 0.61–0.89) were associated with lower odds of missing medication. Conclusions: Greater internalized mental illness stigma and less social support are significantly associated with lower rates of medication adherence in patients with NCDs and comorbid CMDs in rural India. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases (NCDs) are a leading cause of death globally and disproportionately affect those in low- and middle-income countries lower-middle-income countries. Poor medication adherence among patients with NCDs is prevalent in India due to lack of initiation, missed dosing or cessation of treatment, and represents a growing healthcare and financial burden. Objective: This study aimed to identify factors influencing medication adherence in adults with NCDs in India. Methods: We performed a cross-sectional study, conducting secondary data analysis on the second wave of the World Health Organisation’s ‘Study on global AGEing and adult health (SAGE)’, a survey that collected data from predominantly older adults across India. Bivariate analysis and multivariate logistic regression modelling were conducted to specifically interrogate the reasons for lack of initiation and cessation of treatment. Reporting of this study was informed by the STROBE guidelines. Results: The average medication adherence rate was 51% across 2,840 patients with one or more NCDs, reflecting non-initiation and lack of persistence of treatment. The strongest factor significantly predicting non-adherence to medication across these components was multimorbidity (odds ratio 0.47, 95% CI 0.40–0.56). Tobacco use (OR = 0.76, CI 0.59–0.98) and never having attended school (OR = 0.75, CI 0.62–0.92) were significantly associated with poor medication adherence (p < 0.05) while rural living (OR = 0.70, CI 0.48–1.02), feelings of anxiety (OR = 0.84, CI 0.66–1.08) and feelings of depression (OR = 0.90, CI 0.70–1.16) were factors lacking statistically significant association with medication adherence on multivariate analysis. Older age (OR = 2.02, CI 1.51–2.71) was significantly associated with improved medication adherence whilst there was a weak association between increased wealth and improved medication use. Limitations: The SAGE2 survey did not capture whether patients were taking their medication doses according to prescribed instructions—as a result our findings may under-estimate the true prevalence of medication non-adherence. Conclusion: Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Future large-scale surveys interrogating adherence should assess all components of adherence specifically, whilst public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and anxiety, and low educational status. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is not the first, and certainly not the last, to strike the world. COVID-19 has conjointly been a serious concern in higher-income countries, with several European countries and over eleven million individuals in the Republic of India had been infected with COVID-19. Though some countries and regions are seeing improvements in hospitalization and death rates, COVID-19 remains a significant concern for vulnerable and underserved populations globally. The COVID-19 pandemic is unexampled and heavy, and numerous of the policy measures taken to mitigate and contain it were necessary and comprehensible. Factors associated with difficulty in accessing medicine due to the COVID-19 situation With the diversion of human resources to COVID-19 work, active case finding for TB has been postponed by a number of states in India. Though regulative authorities in many countries have approved one or a lot of COVID-19 vaccines for emergency use, necessary challenges remain in mass manufacturing and distributing vaccines in developing countries. The national authorities need to arrange for the challenges associated with the health of their population coincidental with combating the COVID-19 pandemic. It's unclear, however, whether the twin impacts of COVID-19 and also the health care disruptions have an effect on these people within the semi-permanent. [ABSTRACT FROM AUTHOR]

Background: Identifying people with early and late onset of chronic conditions might help target the subpopulations that are more vulnerable to negative mental, physical and functional health outcomes. The current study aimed to examine the association of early and late onset of chronic single and multiple morbidities with self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults. Methods: Cross-sectional study was conducted using data from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017–2018). The total sample size for the present study was 31,386 older adults age 60 years or older. Multivariable binary logistic regression analysis was used to establish the association between the outcomes (poor perceived physical/mental health, functional difficulty and physical inactivity) and explanatory variables (early [ = < 50 years of age] and late [> 50 years]) onset of chronic illnesses such as hypertension, diabetes, heart attack, heart disease, stroke, cancer, lung disease, arthritis, osteoporosis and psychiatric disease). Results: Overall, 24.21% of the sample population had poor self-perceived physical health, whereas 8.67% of participants had poor self-perceived mental health. The prevalence of difficulty in ADL, difficulty in IADL, and physical inactivity was 23.77%, 48.36%, and 68.9%, respectively. Odds of poor perceived mental health were higher for the respondents with early as well as late onset of hypertension, stroke, and arthritis; while individuals with late onset of diabetes, and heart disease had higher odds of poor perceived mental health than those without chronic disease. Individuals with early onset of single morbidity were more likely to report ADL difficulty (adjusted odds ratio [AOR]: 1.33, confidence interval [CI]: 1.06–1.67); while those with late onset of single (AOR: 1.34, CI: 1.17–1.53) and multimorbidity (AOR: 1.91, CI: 1.63–2.24) were more likely to report ADL difficulty compared with individuals without morbidity. Individuals with early as well as late-onset of multimorbidity had more than two times higher odds of reporting poor physical health, poor mental health and IADL difficulty compared with individuals without chronic disease. Conclusions: The present study revealed that early and/or late onset of chronic single and/or multiple morbidities significantly predicted poor self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults. The findings further suggest that late onset of chronic diseases such as cancer and stroke and multi-morbidity had stronger associations with physical inactivity that may help identify high risk groups for screening and support. [ABSTRACT FROM AUTHOR]

The current research aims to aid policymakers and healthcare service providers in estimating expected long-term costs of medical treatment, particularly for chronic conditions characterized by disease transition. The study comprised two phases (qualitative and quantitative), in which we developed linear optimization-based mathematical frameworks to ascertain the expected long-term treatment cost per patient considering the integration of various related dimensions such as the progression of the medical condition, the accuracy of medical treatment, treatment decisions at respective severity levels of the medical condition, and randomized/deterministic policies. At the qualitative research stage, we conducted the data collection and validation of various cogent hypotheses acting as inputs to the prescriptive modeling stage. We relied on data collected from 115 different cardio-vascular clinicians to understand the nuances of disease transition and related medical dimensions. The framework developed was implemented in the context of a multi-specialty hospital chain headquartered in the capital city of a state in Eastern India, the results of which have led to some interesting insights. For instance, at the prescriptive modeling stage, though one of our contributions related to the development of a novel medical decision-making framework, we illustrated that the randomized versus deterministic policy seemed more cost-competitive. We also identified that the expected treatment cost was most sensitive to variations in steady-state probability at the "major" as opposed to the "severe" stage of a medical condition, even though the steady-state probability of the "severe" state was less than that of the "major" state. [ABSTRACT FROM AUTHOR]

There is a sudden blast of the "65 plus" population in the last decade, and India is no exception to that. A continuing progress in the medical field has raised the longevity of life. This changing face of population offers the oral professionals to observe unique challenges to treat the rapidly growing segment of the elderly and the dependant overage population-- the Homebound residents and the Nursing homebound residents. The old age of the residents is compounded with chronic medical problems they are suffering from and the medications they are taking. This cohort is characteristically different from other elderly due to their dependency to carry even the routine activities such as tooth cleaning which results in increased risk towards the oral ailments. As very few surveys are done regarding the oral health status among this section, the prevalence of oral and dental problems in them is under a cloud. "Dental care at home or at destinations of residents" is yet a novel concept in India, hence not only there is a need to reach to the residents but also to treat them in the holistic manner. The purpose of this paper is to review the existing oral health conditions in the elderly in India. [ABSTRACT FROM AUTHOR]

Major noncommunicable diseases (NCDs) share common behavioral risk factors and deep-rooted social determinants. India needs to address its growing NCD burden through health promoting partnerships, policies, and programs. High-level political commitment, inter-sectoral coordination, and community mobilization are important in developing a successful, national, multi-sectoral program for the prevention and control of NCDs. The World Health Organization's "Action Plan for a Global Strategy for Prevention and Control of NCDs" calls for a comprehensive plan involving a whole-of-Government approach. Inter-sectoral coordination will need to start at the planning stage and continue to the implementation, evaluation of interventions, and enactment of public policies. An efficient multi-sectoral mechanism is also crucial at the stage of monitoring, evaluating enforcement of policies, and analyzing impact of multi-sectoral initiatives on reducing NCD burden in the country. This paper presents a critical appraisal of social determinants influencing NCDs, in the Indian context, and how multi-sectoral action can effectively address such challenges through mainstreaming health promotion into national health and development programs. India, with its wide socio-cultural, economic, and geographical diversities, poses several unique challenges in addressing NCDs. On the other hand, the jurisdiction States have over health, presents multiple opportunities to address health from the local perspective, while working on the national framework around multi-sectoral aspects of NCDs. [ABSTRACT FROM AUTHOR]

Noncommunicable diseases (NCDs) have become a major public health problem in India accounting for 62% of the total burden of foregone DALYs and 53% of total deaths. In this paper, we review the social and economic impact of NCDs in India. We outline this impact at household, health system and the macroeconomic level. Cardiovascular diseases (CVDs) figure at the top among the leading ten causes of adult (25-69 years) deaths in India. The effects of NCDs are inequitable with evidence of reversal in social gradient of risk factors and greater financial implications for the poorer households in India. Out-of-pocket expenditure associated with the acute and long-term effects of NCDs is high resulting in catastrophic health expenditure for the households. Study in India showed that about 25% of families with a member with CVD and 50% with cancer experience catastrophic expenditure and 10% and 25%, respectively, are driven to poverty. The odds of incurring catastrophic hospitalization expenditure were nearly 160% higher with cancer than the odds of incurring catastrophic spending when hospitalization was due to a communicable disease. These high numbers also pose significant challenge for the health system for providing treatment, care and support. The proportion of hospitalizations and outpatient consultations as a result of NCDs rose from 32% to 40% and 22% to 35%, respectively, within a decade from 1995 to 2004. In macroeconomic term, most of the estimates suggest that the NCDs in India account for an economic burden in the range of 5-10% of GDP, which is significant and slowing down GDP thus hampering development. While India is simultaneously experiencing several disease burdens due to old and new infections, nutritional deficiencies, chronic diseases, and injuries, individual interventions for clinical care are unlikely to be affordable on a large scale. While it is clear that "treating our way out" of the NCDs may not be the efficient way, it has to be strongly supplemented with population-based services aimed at health promotion and action on social determinants of health along with individual services. Since health sector alone cannot deal with the "chronic emergency" of NCDs, a multi-sectoral action addressing the social determinants and strengthening of health systems for universal coverage to population and individual services is required. [ABSTRACT FROM AUTHOR]

High levels of fluoride (beyond 1.5 ppm) in ground water as source of drinking water are common in many parts of Andhra Pradesh, India, causing fluorosis. The study carried out in endemic Nalgonda District, Andhra Pradesh, has indicated that the fluoride-rich ground water present in the wells located down stream and close to the surface water bodies is getting diluted by the low-fluoride surface water. Encouraged by this result, check dams were constructed upstream of the identified marginally high fluoride bearing ground water zones in Anantapur District to reduce fluoride levels as an alternate solution for safe drinking water.In this paper, an attempt is made to study the utility and effect of these check dams in dilution of fluoride concentration in drinking water and its resultant impact on the health aspects of certain villagers of Anantapur District through the analysis of their blood serum and urine. Ground water samples from three fluoride-affected villages, blood and urine of males and females from the same villages were collected and analyzed for fluoride using ion selective electrode method. The results indicated that the fluoride levels in blood serum and urine of males in the age group of 5-11 years are found to be the highest. The concentration of fluoride in ground water is directly proportional to the concentration of fluoride in blood serum and urine. The concentration of fluoride in ground water with depth of the aquifer is a function of lithology, amount and duration of rainfall, rate of infiltration, level of ground water exploitation in the area etc. The construction of check dams upstream of the identified marginally high fluoride waters will not only cause additional recharge of ground water but also reduces the fluoride concentration eventually improving the health of the villagers. [ABSTRACT FROM AUTHOR]

Background: Resource allocation in health is universally challenging, but especially so in resource-constrained contexts in the Global South. Pursuing a strategy of evidence-based decision-making and using tools such as Health Technology Assessment (HTA), can help address issues relating to both affordability and equity when allocating resources. Three BRICS and Global South countries, China, India and South Africa have committed to strengthening HTA capacity and developing their domestic HTA systems, with the goal of getting evidence translated into policy. Through assessing and comparing the HTA journey of each country it may be possible to identify common problems and shareable insights. Objectives: This collaborative paper aimed to share knowledge on strengthening HTA systems to enable enhanced evidence-based decision-making in the Global South by: Identifying common barriers and enablers in three BRICS countries in the Global South; and Exploring how South-South collaboration can strengthen HTA capacity and utilisation for better healthcare decision-making. Methods: A descriptive and explorative comparative analysis was conducted comprising a Within-Case analysis to produce a narrative of the HTA journey in each country and an Across-Case analysis to explore both knowledge that could be shared and any potential knowledge gaps. Results: Analyses revealed that China, India and South Africa share many barriers to strengthening and developing HTA systems such as: (1) Minimal HTA expertise; (2) Weak health data infrastructure; (3) Rising healthcare costs; (4) Fragmented healthcare systems; and (5) Significant growth in non-communicable diseases. Stakeholder engagement and institutionalisation of HTA were identified as two conducive factors for strengthening HTA systems. Conclusion: China, India and South Africa have all committed to establishing robust HTA systems to inform evidence-based priority setting and have experienced similar challenges. Engagement among countries of the Global South can provide a supportive platform to share knowledge that is more applicable and pragmatic. [ABSTRACT FROM AUTHOR]

Financial burden influences elderly individuals' health-related quality of life (HRQoL). Very little is understood concerning the association between financial strain and HRQoL in vulnerable groups. This study aimed to examine the relationships among financial load and HRQoL of Odisha State, India who suffer from chronic illness, along with cancer. In this crosssectional investigation, 72 Citizens of Odisha (aged 60-89) with one or maybe more chronic diseases took part in a randomized preliminary trial. We investigated financial burden components using factor analysis. A 27 -point FACT-G (Functional Assessment of Cancer Therapy-General) was applied to measure HRQoL. The correlations among financial burden and HRQoL sub-dimensions were investigated using multiple linear regression. The factor analysis showed three financial burden constructs: health costs issues, financial burden medication compliance, and monetary stress. Financial burden was related to lower HRQoL throughout various areas in this research of older adults of Odisha with chronic conditions. [ABSTRACT FROM AUTHOR]

In low-and-middle-income countries, people develop chronic diseases at a younger age, leading to health-and-economic loss. Estimates of the age of onset of chronic disease provide evidence for policy intervention, but in the Indian context, evidence is limited. The present study aims to explore the onset of seven chronic diseases across adults and the elderly, along with the prognostic factors of chronic disease onset. Using Wave 1 data of the Longitudinal Ageing Study in India (LASI), we estimated the statistical distributions, the median age at onset, and Loglogistic and Weibull accelerated failure time model to understand the onset of seven medically diagnosed self-reported chronic diseases across age groups. We also obtained the sub-distribution hazard ratio (SHR) from the Fine-Gray model to determine the risk of contracting selected chronic diseases in a competing risk setup. The seven chronic diseases– hypertension, diabetes, lung disease, heart disease/stroke, arthritis, neurological disease, and cancer– were developing early, especially in individuals aged 45–54 and 55–64. Arthritis risk was higher in rural areas, and physically active adults and elderly were 1.32 times (95% CI 1.12–1.56) more likely to develop heart disease/stroke. The emerging evidence of the early onset of neurological diseases in middle-aged adults (i.e., among the 45–54 age group) reminds us of the need to reinforce a balance between the physical and mental life of individuals. The early onset of chronic diseases in the independent and working-age category (45–54 years) can have many social and economic implications. For instance, it can create a greater healthcare burden when these individuals grow older with these diseases. Further, disease-specific interventions would be helpful in reducing future chronic disease burden. [ABSTRACT FROM AUTHOR]

Context: Expeditious diagnosis and treatment of chronic conditions are critical to control the burden of non-communicable disease in low- and middle-income countries. We aimed to estimate sociodemographic and geographic inequalities in diagnosis and treatment of chronic conditions among adults aged 45 + in India. Methods: We used 2017–18 nationally representative data to estimate prevalence of chronic conditions (hypertension, diabetes, lung disease, heart disease, stroke, arthritis, cholesterol, and neurological) reported as diagnosed and percentages of diagnosed conditions that were untreated by sociodemographic characteristics and state. We used concentration indices to measure socioeconomic inequalities in diagnosis and lack of treatment. Fully adjusted inequalities were estimated with multivariable probit and fractional regression models. Findings: About 46.1% (95% CI: 44.9 to 47.3) of adults aged 45 + reported a diagnosis of at least one chronic condition and 27.5% (95% CI: 26.2 to 28.7) of the reported conditions were untreated. The percentage untreated was highest for neurological conditions (53.2%; 95% CI: 50.1 to 59.6) and lowest for diabetes (10.1%; 95% CI: 8.4 to 11.5). Age- and sex-adjusted prevalence of any diagnosed condition was highest in the richest quartile (55.3%; 95% CI: 53.3 to 57.3) and lowest in the poorest (37.7%: 95% CI: 36.1 to 39.3). Conditional on reported diagnosis, the percentage of conditions untreated was highest in the poorest quartile (34.4%: 95% CI: 32.3 to 36.5) and lowest in the richest (21.1%: 95% CI: 19.2 to 23.1). Concentration indices confirmed these patterns. Multivariable models showed that the percentage of untreated conditions was 6.0 points higher (95% CI: 3.3 to 8.6) in the poorest quartile than in the richest. Between state variations in the prevalence of diagnosed conditions and their treatment were large. Conclusions: Ensuring more equitable treatment of chronic conditions in India requires improved access for poorer, less educated, and rural older people who often remain untreated even once diagnosed. Highlights: • Little is known about sociodemographic and geographic inequalities in the diagnosis and treatment of chronic illness among middle-aged and older adults in India. • Self-reported diagnosed chronic conditions are more prevalent among socially advantaged groups but the disadvantaged are more likely to be untreated. • To ensure more equitable treatment of chronic conditions, efforts to improve access should be directed towards poorer, less educated, and ruralolder people. [ABSTRACT FROM AUTHOR]

Introduction: A healthy mouth is the gateway to a healthy body. Oral health is an integral component of the overall health and well-being and dental caries is probably the commonest chronic disease in the world (Levine 2011)1. Worldwide, 60-90% of school children and nearly 100% of adults have dental cavities, often leading to pain and discomfort. (WHO, April 2012)2. Unfortunately, many children are afflicted with dental caries at an early age. According to the National Health Survey3 conducted nationwide in 2004 in India, the percentage prevalence of dental caries were found to be 51.9% in 5 year old, 53.8% in 12 year old and 63.1% in 15 year old children. AIM: To analyse the possibility of early detection of caries prone children from their rate of flow of unstimulated saliva and salivary pH. DMF: For children over 7 (seven) years and upto 11 or 12 the decayed, missing and filled primary molars and canines have been used to determine a dmft or dmfs when the surfaces are counted. A primary molar or canine is presumed missing because of dental caries when it is missing before the normal exfoliation time. III. dft and dfs: Description: In the deft and defs as described, both 'd' and 'e' are used to describe teeth with dental caries. Because of that 'd' and 'e' are sometimes combined and the index becomes the dft and dfs. Teeth not counted: 1) Missing teeth including unerupted and congenitally missing. 2) Supernumerary teeth 3) Teeth restored for reasons other than dental caries are not counted as f. Over 7,187 DMF index publications included in PubMed (Larmas M, 2010)102. underlines its leading role in the present epidemiological caries research. [ABSTRACT FROM AUTHOR]

Behind the statistics forecasting millions of deaths associated with antimicrobial resistance (AMR) is an even greater burden of morbidity leaving many people with long-term chronic illnesses and disability. Despite growing recognition of the importance of inter-sectoral and inter-disciplinary knowledge in forming responses to address this global health threat, there remains a paucity of social science research to understand the social burdens of AMR. In this qualitative study we explore the experiences of people living with chronic AMR infections, their interactions with health providers and therapeutic quests for care, and the effects upon their lives and that of their families and caregivers. Our analysis reveals that the resistant infections impacted not only the physical health but also the mental health of the sufferers and their caregivers, causing major disruptions to their social and work lives. Most undertook arduous treatment regimes – of powerful antibiotics with debilitating side effects, combined a range of other complementary and alternate therapies, including travel to seek treatment overseas. Further, we question the notion of 'AMR survivorship' currently being promoted as part of a public education campaign by the World Health Organisation and whether people with the diverse AMR experience really self-identify as 'survivors' of a biosocial group. [ABSTRACT FROM AUTHOR]

Drawing on interviews conducted in 2019–2020, across twenty villages in India, this paper unpacks how people with chronic illness navigate complex care-seeking terrain. We show how the act of seeking care involves navigating through personal, family, social, economic, cultural, and most importantly, difficult health systems spaces—and entails making difficult social, moral, and financial choices. We show how the absence of reliable and accessible points of first contact for primary care results in people running from pillar to post, taking wrong turns, and becoming disappointed, frustrated, and, sometimes, impoverished. We reveal the complex individual and social dynamics of hope and misplaced and misguided expectations, as well as social obligations and their performance that animate the act of navigating care in rural India. We shine light on how a health system with weak primary care and poor regulation amplifies the medical, social, and financial consequences of an otherwise manageable chronic illness, and how these consequences are the worst for those with the least social, network and economic capital. Crucially we highlight the problematic normalisation of the absence of reliable primary care services for chronic illness in India, in rural India specifically. We signpost implications for research, and for policy and practice in India and similar health system contexts, i.e. those with weak primary care and poor regulation of the private sector. We argue that in India, having in place accessible, good quality, and trustworthy sources of advice and care for chronic illness at the first point of call, for all, is critical. We contend that this first point of call should be quality, public primary care services. We conclude that if such arrangements are in place in public services, people will use them. • Lack of reliable, trustworthy advice and care is a big gap in India's health system. • Being misled and suffering catastrophic consequences of ill-health is the result. • People need to be protected from bad actors in their care-seeking journeys. • People want reliable, trustworthy advice and care, at their first point of call. • India's health system must urgently act to ensure appropriate care at all levels. [ABSTRACT FROM AUTHOR]

Multimorbidity remains an underexplored domain in Indian primary care. We undertook a study to assess the prevalence, correlates, and outcomes of multimorbidity in primary care settings in India. This paper describes the process of development and validation of our data collection tool “Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC).” An iterative process comprising desk review, chart review, and expert consultations was undertaken to generate the questionnaire. The MAQ-PC contained items on chronic conditions, health care utilization, health related quality of life, disease severity, and sociodemographics. It was first tested with twelve adults for comprehensibility followed by test-retest reliability with 103 patients from four primary care practices. For interrater reliability, two interviewers separately administered the questionnaire to sixteen patients. MAQ-PC displayed strong internal consistency (Cronbach’s alpha: 0.69), interrater reliability (Cohen’s Kappa: 0.78–1), and test-retest reliability (ICC: 0.970–0.741). Substantial concordance between self-report and physician diagnosis (Scott Kappa: 0.59–1.0) was observed for listed chronic conditions indicating strong concurrent validity. Nearly 54% had one chronic condition and 23.3% had multimorbidity. Our findings demonstrate MAQ-PC to be a valid and reliable measure of multimorbidity in primary care practice and suggest its potential utility in multimorbidity research in India. [ABSTRACT FROM AUTHOR]

Background: India is undergoing a huge demographic and epidemiological change, resulting in an increase in population ageing. With this, the number of people with co-existence of multiple chronic diseases is also set to rise. The present study aims to identify gender differential in the most prevalent combinations of chronic conditions among the elderly living with multimorbidity in India. This study also examines the factors affecting multimorbidity status among the Indian elderly. This study used the data from Building a Knowledge Base on Population Ageing in India (BKPAI), conducted in 2011. The presence or not of multimorbidity was considered as the outcome variable. The bivariate and logistic regression analysis was done to access the pattern and predictors of multimorbidity among the elderly. The relative risk of having different chronic conditions were calculated among the population with multimorbidity. The prevalence of most prevalent disease combinations among the overall population and multimorbidity group was also calculated. The overall prevalence of multimorbidity among the elderly was 32.96% and higher among women (34.69%). The most prevalent diseases among respondents with multimorbidity conditions were arthritis or rheumatism (54.75%), hypertension (45.79%), loss of all-natural teeth (32.94%), cataract (31.34%), diabetes (23.01%) and asthma (21.06%). The prevalence of arthritis or rheumatism, diabetes and hypertension were higher among women in the multimorbidity group than men of the same group. The relative risks for conditions like dementia, loss of all-natural teeth, depression, cerebral embolism, stroke or thrombosis and osteoporosis are higher in the multimorbidity group. Hence these conditions have a higher possibility to co-exist with other chronic conditions. The most prevalent combination of diseases in the multimorbidity group was arthritis, rheumatism or osteoarthritis, hypertension, and cataract (4.68%). The prevalence of this combination is higher among women than men (women: 5.79%, men: 3.30%). Age, gender, religion, wealth quintile, current working status, smoking, alcohol were significant determinants of multimorbidity among the elderly. Multimorbidity is an emerging issue and highly associated with ageing. There lie gender differences in the combination of diseases and their prevalence. Therefore, there is a need to strengthen healthcare services for both men and women using gender-specific analysis as both genders have different priorities regarding healthcare utilisation. One of the relevant implications based on our findings is that researchers and policymakers need to work together to develop effective intervention strategies separately for men and women, which will help to reduce the burden of multimorbidity in the population. [ABSTRACT FROM AUTHOR]

Globally, elder abuse/mistreatment is a common form of violence against the elderly. This study examines the association between multimorbidity and abuse/mistreatment among the elderly population (60+) in India. Cross-sectional data from the United Nations Population Fund (UNFPA)'s "Building Knowledge Base on Population Aging in India" (BKPAI, 2011) was analyzed. We generated a multimorbidity variable by combining 20 self-reported diagnosed chronic diseases. Bivariate analysis was used to understand the sample distribution and prevalence estimation of elder abuse/mistreatment by multimorbidity and state. Furthermore, multilevel mixed-effect logistic regression was used to examine the association between multimorbidity and elder abuse/mistreatment. The overall prevalence of elder abuse/mistreatment in the study population is 11.4%. The prevalence of elder abuse/mistreatment among elderly with no chronic diseases is 6.01% which increases to 22.7% among elderly with four or more chronic diseases. Furthermore, the result from the multilevel mixed-effect logistic regression showed a close association between multimorbidity and elder abuse. Elderly with two, three, and four or more chronic diseases are 3.02 (CI = 2.33, 3.91, p <.000), 4.16 (CI = 3.02, 5.74, p <.000), and 5.06 (CI = 3.50, 7.31, p <.000) times more likely to experience abuse/mistreatment than elderly with no chronic diseases, respectively. In specific, this association is stronger for the elderly population residing in the urban areas. Furthermore, economic status and educational attainment have a protective role in determining elder abuse/mistreatment in India. In conclusion, multimorbidity has emerged as a significant risk factor of elder abuse/mistreatment in India. Measures to prevent elder abuse should consider the role of multimorbidity. [ABSTRACT FROM AUTHOR]

Legumes are a chief source of sustainable, inexpensive protein, also abundant in complex carbohydrates, dietary fibre and essential vitamins and minerals. India is the largest global producer (25%) of legumes. Among these legumes, chickpea (Cicer arietinum L.) accounts for 40% of India's pulse production and is considered a better-quality protein source than other pulses. India is also the largest consumer (76%) of the total chickpea produced globally. Besides their nutritional benefits, chickpea is also being used for its nutraceutical and prebiotic potential. Recent studies have also suggested their role in alleviating chronic diseases like diabetes, blood pressure, obesity and even cancer. Chickpea contains several bioactive compounds that are now being researched for their health benefits in human beings. Like other pulses, chickpea also has some antinutritional factors that can be annihilated by different processing and cooking methods. This literature review seeks to evaluate the research done on the nutritional, antinutritional, nutraceutical, prebiotic and health benefits of chickpea. [ABSTRACT FROM AUTHOR]

Background: Age is one of the predominant reasons for perceived discrimination in developing world where older people are considered a non-contributing burden. The present study explores the prevalence and correlates of perceived age discrimination among older Indian adults.Methods: A cross-sectional study was conducted using a large representative survey data from the Longitudinal Ageing Study in India conducted during 2017-18. Participants included 31,464 older adults aged 60 years and above. Multivariable logistic regression analysis was used to test the associations between selected background characteristics and perceived age discrimination.Results: The analysis revealed that 10.33 percent of older adults perceived their age as the main reason for discrimination, which was 11.86% among the oldest-old. Older adults with more than 10 years of schooling were 32% [adjusted odds ratio (AOR): 0.68; confidence interval (CI): 0.51-0.89] less likely to perceive age discrimination compared to their uneducated counterparts. The odds of perceived age discrimination were higher among older adults who earlier worked [AOR: 1.73; CI: 1.46-2.05] and currently working [AOR: 1.61; CI: 1.31-1.96] as compared to those who never worked. Further, having difficulty in instrumental activities of daily living (IADL) [AOR: 1.43; CI: 1.25 -1.65] and having one chronic condition [AOR: 1.16; CI: 1.02 -1.34] were associated with increased odds of perceived age discrimination among older adults.Conclusion: Older adults with lower socioeconomic status, currently working, having more chronic conditions, difficulty in IADL and belonging to rural areas were found to perceive higher age discrimination than their counterparts. The findings of the study have important implications for policy makers with respect to strategies such as making the vulnerable populations aware of their legal rights that help in the prevention of age-based discrimination in the country. [ABSTRACT FROM AUTHOR]

Chronic diseases are the leading causes of disability and premature death among the elderly population in India. The study, using data from the 75th round of the NSSO survey (N = 44,631), examined the prevalence and determinants of chronic diseases among the population aged 60+ in India by applying bivariate and logistic regression analyses and used a non-linear decomposition technique to understand the urban-rural differences in the prevalence of chronic diseases. About 21% of the elderly in India reportedly have at least one chronic disease. Seventeen percent elderly in rural areas and 29% in urban areas suffer from a chronic disease. Hypertension and diabetes account for about 68% of all chronic diseases. The prevalence of chronic diseases is the highest in Kerala (54%), followed by Andhra Pradesh (43), West Bengal (36), and Goa (32). Those with higher levels of education, staying in urban areas, those who are economically dependent on others, staying alone or without spouse and children, and belonging to wealthy households have a higher likelihood of having a chronic disease. The probability of having a chronic disease is 1.15 times higher among urban residents as compared to their rural counterparts. Elderly rural women, compared to elderly rural men, and never-married, widowed, and divorced elderly urban women, compared to married elderly urban men, are significantly more likely to suffer from chronic ailments. Differences in education, wealth status, and caste are the three most significant contributors to the urban-rural gap in chronic diseases. The high risk of chronic diseases among certain subsets of the elderly population must be recognized as a key public health concern. The findings of our study will likely help promote healthy ageing in India. [ABSTRACT FROM AUTHOR]

Background: Though extensive studies have been conducted on assessing the predictors of cognitive functioning among older adults in small community-based samples, very few studies have focused on understanding the impact of socioeconomic status (SES), demographic characteristics and other risk factors such as lifestyle and chronic diseases on the cognitive functioning among adults of all ages in a nationally representative population-based sample across low- and middle-income countries. This study, therefore, seeks to evaluate the impact of SES, demographic characteristics and risk factors on the cognitive functioning of adults across all ages in five selected developing countries. Methods: Data from 12,430 observations obtained from the WHO Study on Global AGEing and Adult Health (SAGE) Wave 1; consisting of 2,486 observations each for China, Ghana, India, the Russian Federation, and South Africa, were used for the study. A meta-regression and a five-step hierarchical linear regression were used to analyze the data, with cognitive functioning as the dependent variable. Independent variables used in this study include SES; assessed by household income and education, demographic characteristics, other risk factors such as lifestyle, self-reported memory difficulty and chronic diseases. Results: This study found that SES and lifestyle significantly predicted cognitive functioning in all the five selected countries as obtained by the pooled results of the meta-regression analysis. The hierarchical linear regression results also revealed that demographic characteristics such as age, type of residency, and self-reported memory difficulty significantly impact cognitive functioning in China, Ghana, Russia, and South Africa. Conclusion: The findings in this study provide new insights for policymakers, caregivers, parents, and individuals, especially those in developing countries, to implement policies and actions targeted at improving SES and eliminating risk factors associated with cognitive decline, as these measures could help improve the cognitive functioning among their populations. [ABSTRACT FROM AUTHOR]