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This study examines the health care utilization pattern, associated financial catastrophes, and inequality across Indian states to understand the subnational variations and aid the policy makers in this regard. Data from recent National Sample Survey (2017–2018), titled, "Household Social Consumption: Health," covering 113,823 households, was employed in the study. Descriptive statistics, Erreygers concentration index (CI), and recentered influence function decomposition were applied in the study. We found that, in India, 7 percent of households experienced catastrophic health expenditure (CHE) and 1.9 percent of households were pushed below poverty line due to out-of-pocket expenditure on hospitalization. Notably, outpatient care was more burdensome (CHE: 12.1%; impoverishment: 4%). Substantial interstate variations were observed, with high financial burden in poorer states. Utilization of health care services from private health care providers was pro-rich (hospitalization CI 0.31; outpatient CI 0.10), while the occurrence of CHE incidence was pro-poor (hospitalization CI −0.10; outpatient CI −0.14). Education level, economic status, health insurance, and area of residence contributed significantly to inequalities in utilization of health care services from private providers and financial burden. The high financial burden of seeking health care necessitates the need to increase public health spending and strengthen public health infrastructure. Also, concerted efforts directed towards increasing awareness about health insurance and introducing comprehensive health insurance products (covering both inpatient and outpatient services) are imperative to augment financial risk protection in India. [ABSTRACT FROM AUTHOR]

The study is designed for sustainable healthcare system with providers' initiatives to provide quality services in healthcare organisations. Healthcare providers' initiatives promote quality and ensure better healthcare services. Among the healthcare providers who were studied and reviewed, it was observed that the initiatives of the healthcare providers improved the overall quality. There is a distinct scope of further enhancement with the participation of healthcare providers in healthcare organisations. The purpose of this research is to learn and determine the answers to questions through scientific application. This study shows that an augmented frequency of sustainable healthcare systems is only possible through the initiatives of healthcare providers. In healthcare services, patients remain satisfied without expressing their dissatisfaction to the management. To know the needs of patients, there has to be a certain level of relationship between healthcare providers and patients. For this purpose, the system has to be very proficient in the service conditions and their applicability for quality in the hospital. Healthcare organisations management has the conviction that the participative role of healthcare professionals in hospitals will increase patient satisfaction. In this perspective, the pressing priority of healthcare providers for hospitals will always be patients. Thus, apart from the availability of healthcare facilities and quality of care, the location of the hospital has predominant importance. Based on the findings, it is to be stated that sustainable healthcare is subject to provider's initiatives and actions for quality in healthcare organisations. [ABSTRACT FROM AUTHOR]

Autonomic imbalance is attributed as key mechanism altering metabolic regulation in diabetes mellitus. In view of controversial reports on autonomic function in FDRD and prediabetes, we aimed to assess and compare the autonomic function across the complete glycaemic spectrum in Indian population. Short term heart rate variability and cardiac autonomic reactivity tests – blood pressure and heart rate response to orthostatic tolerance and deep breathing exercise, and diastolic response to isometric handgrip exercise were recorded in normoglycemic apparently healthy individual, normoglycemic first degree relatives of diabetes, prediabetes and diabetes individuals. Resting heart rate is significantly higher in FDRD, prediabetes and diabetes as compared to controls (control < FDRD = prediabetes = diabetes). Total power, LF power (control < FDRD < prediabetes = diabetes) and HF power (control < FDRD < prediabetes < diabetes) decreased along the glycaemic spectrum. Time-domain variables of HRV (SDNN, RMSSD, NN50, pNN50) were reduced as we move along the glycaemic spectrum (control < FDRD < prediabetes = diabetes). Cardiac autonomic function reactivity parameters such as 30:15 ratio and E:I ratio are decreased in prediabetes and diabetes group as compared to control and FDRD group (control = FDRD < prediabetes = diabetes). Diastolic response to isometric hand grip increases along the glycaemic spectrum starting from FDRD (control < FDRD < prediabetes = diabetes). Autonomic dysfunction is observed even in first degree relatives of diabetes. Autonomic dysfunction increases as we move along the glycaemic spectrum (control < FDRD < prediabetes < diabetes). [ABSTRACT FROM AUTHOR]

Objective: Rhino-orbito-cerebral mucormycosis is a rapidly progressive disease with high mortality rates of about 60 per cent. The increasing incidence of rhino-orbito-cerebral mucormycosis in coronavirus disease 2019 patients in India and worldwide has become a matter of concern owing to the case fatality rate. This study explored the use of low dose aspirin in decreasing the mortality rate of coronavirus disease 2019 associated mucormycosis. Method: This was a retrospective observational study. Patients suffering from post-coronavirus disease 2019 mucormycosis were included in the study. Each patient was treated with surgical debridement and systemic amphotericin B. Low dose aspirin was added, and mortality rates were compared with the patients who did not receive aspirin. Results: The demographic data and rhino-orbito-cerebral mucormycosis staging between the two groups were not significantly different. There was a statistically significant difference in mortality outcomes between the two groups (p = 0.029) and a 1.77 times higher risk of dying for patients not receiving aspirin. Kaplan–Meier survival indicated that patients receiving aspirin had better survival rates (p = 0.04). Conclusion: Low dose aspirin improves survival rates in coronavirus disease 2019 associated mucormycosis. [ABSTRACT FROM AUTHOR]

Introduction: Tinnitus is defined as the perception of sound that results completely from activity within the nervous system without any corresponding mechanical, vibratory activity within the cochlea, and not related to external stimulation of any kind. It disrupts the daily life of 1 out of every 200 adults. The source of tinnitus generation is not limited to the peripheral auditory system. However, there are abnormalities seen in BERA in tinnitus patients depicting auditory pathway involvement. Oto-acoustic emissions are mechanical vibrations generated in the cochlea, which are evaluated by TEOAE and DPOAE whereas BERA evaluates both cochlea and brainstem auditory pathway for any conduction abnormalities. The aim of the study is to analyze the changes in OAE and BERA in patients suffering from tinnitus with normal hearing, which may help us to understand the patho-physiology of tinnitus. Material and methods: This is a prospective study conducted in a tertiary care hospital in Northern India between 1st December 2015 to 31st July 2017. All patients of tinnitus with normal hearing were included in the study group, whereas Individuals with normal hearing with no other ear complaints were included in control group. Total 160 Ears were evaluated with 80 ears in both study and control group each. Patients with PTA >25dB, age >55 years or any chronic medical illness were excluded from the study. Results: 80 individuals (46 Males and 34 Females) were divided into study and control Group (80 Ears each). Tinnitus was bilateral in 28 subjects (53.84%) and unilateral in 24 subjects (46.16%). Both control and study group showed significant difference in TEOAE and DPOAE study. In TEOAE, 8 (10%) ears in control group and 30 ears (37.5%) in study group showed test result as REFER whereas in DPOAE 10 (12.5%) ears in control group and 35 (43.8%) ears showed test result as REFER. All these result were statistically significant. In BERA the latency of wave I was significantly prolonged in study group as compared to control group, while difference between all other parameters between the two groups was insignificant. Conclusion: There were various significant abnormalities seen in parameters of Oto-Acoustic Emissions (OAE) and Brainstem Evoked Response Audiometry (BERA). So these tests should be included in the test battery for the screening of patients complaining of tinnitus even with normal hearing. [ABSTRACT FROM AUTHOR]

Objectives: Pregnancy hypertension is associated with 7.1% of maternal deaths in India. The objective of this trial was to assess whether task-sharing care might reduce adverse pregnancy outcomes related to delays in triage, transport, and treatment.Study Design: The Indian Community-Level Interventions for Pre-eclampsia (CLIP) open-label cluster randomised controlled trial (NCT01911494) recruited pregnant women in 12 clusters (initial four-cluster internal pilot) in Belagavi and Bagalkote, Karnataka. The CLIP intervention (6 clusters) consisted of community engagement, community health workers (CHW) provided mobile health (mHeath)-guided clinical assessment, initial treatment, and referral to facility either urgently (<4 h) or non-urgently (<24 h), dependent on algorithm-defined risk. Treatment effect was estimated by multi-level logistic regression modelling, adjusted for prognostically-significant baseline variables. Predefined secondary analyses included safety and evaluation of the intensity of mHealth-guided CHW-provided contacts.Main Outcome Measures: 20% reduction in composite of maternal, fetal, and newborn mortality and major morbidity.Results: All 14,783 recruited pregnancies (7839 intervention, 6944 control) were followed-up. The primary outcome did not differ between intervention and control arms (adjusted odds ratio (aOR) 0.92 [95% confidence interval 0.74, 1.15]; p = 0.47; intraclass correlation coefficient 0.013). There were no intervention-related safety concerns following administration of either methyldopa or MgSO4, and 401 facility referrals. Compared with intervention arm women without CLIP contacts, those with ≥8 contacts suffered fewer stillbirths (aOR 0.19 [0.10, 0.35]; p < 0.001), at the probable expense of survivable neonatal morbidity (aOR 1.39 [0.97, 1.99]; p = 0.072).Conclusions: As implemented, solely community-level interventions focussed on pre-eclampsia did not improve outcomes in northwest Karnataka. [ABSTRACT FROM AUTHOR]

Background: The binarian model views melancholia as a distinct depressive class, whereas the unitarian model views it as a more severe expression of depression. This study aims to investigate the sociodemographic, clinical, and course differences between melancholic and non-melancholic depression. Methods: This prospective observational study was carried out at Kasturba Hospital, Manipal, India from November 2010 to September 2011. We recruited consecutive inpatients aged 18 to 60 years who have a diagnosis of depressive disorder (based on ICD-10), with or without any psychiatric or physical comorbidities. Patients were categorised into melancholia and non-melancholia using the CORE questionnaire, with scores of >8 indicating the presence of melancholic depression. In addition, patients were evaluated using the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Somatoform Symptom Checklist, Columbia Suicide Severity Rating Scale, Clinical Global Impression, and Presumptive Stressful Life Events Scale at baseline and at 1,3, and 6 months. Results: Of 87 inpatients with a diagnosis of depression, 50 met the inclusion criteria and 37 were excluded. Compared with patients with non-melancholic depression, patients with melancholic depression had higher depression score (30.8 vs 23.8, p < 0.001), had higher number of patients with psychotic depression (39.1% vs 7.4%, p = 0.007), had higher overall illness severity score (5.9 vs 4.8, p < 0.001), and had higher number of patients with suicidal ideation and suicidal behaviour. Regarding the course of melancholia, the number of melancholic patients decreased from 23 at baseline to eight at 1 month, three at 3 months, and three at 6 months. Scores of non-interactiveness, retardation, and agitation decrease significantly over 3 months. Conclusions: The construct and course of melancholia may be viewed as a part of depression, more in line with severe depression. Melancholia increases the risk for suicidal ideation and suicidal behaviour. [ABSTRACT FROM AUTHOR]

Introduction Laboratory diagnosis of hereditary spherocytosis ( HS) relies on increased incubated red cell osmotic fragility test for screening. We evaluated the diagnostic role of eosin-5′-maleimide ( EMA) binding test by flow cytometry in spherocytic and microcytic hypochromic hematological disorders in North Indians. Methods EMA binding test using flow cytometry was performed on 55 HS (40 families), 26 iron deficiency anemia ( IDA), 32 β-thalassemia trait (β TT), and 10 autoimmune hemolytic anemia ( AIHA) cases and 121 normals. Mean channel fluorescence ( MCF) and coefficient of variation ( CV) were studied. Different MCF parameters ( MCF, MCF ratio, percent decrease MCF) and percent increase in CV were analyzed. Receiver operating characteristics analysis was performed to determine best cutoff values, sensitivity, and specificity for discriminating HS from other red cell disorders. Results MCF ratio of HS group was significantly lower than normals (0.67 ± 0.07 vs. 1.01 ± 0.05, P < 0.001) and other cases. All patients with HS showed MCF ratio to be ≤0.79. Four postsplenectomy cases with near-normal hemograms also revealed low MCF ratio, showing the specificity of the test. Conclusions EMA assay was efficient to diagnose cases of HS including postsplenectomy cases and shows no overlap with IDA, β TT, and AIHA. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article regarding elevated mean neutrophil volume+CRP is a highly sensitive and specific predictor of neonatal sepsis.

The purpose of this study was to compare self-esteem, job-satisfaction and burnout between psychiatric and general nurses as well as to determine how these three elements are interrelated to each other. Like other professionals, nurses are also at risk of developing problems like professional burnout and a sense of dissatisfaction regarding their jobs. Causal factors of burnout among professionals are multi-factorial, starting from socio-demographic and occupational background to one’s personality characteristics. In this study, 30 psychiatric nurses and 30 general nurses were selected through a purposive sampling method. This was a one-time cross-sectional hospital-based study, data was collected during the period September, 2008 to November, 2008 and written consent was taken from the subjects. Statistical measures like descriptive statistics, Chi-square test, t-test and Pearson’s correlation-coefficient were used to analyze the data. In this study psychiatric nurses had been found to have higher level of self-esteem than general nurses. Nurses working in a general hospital had been observed to have a higher level of burnout and lower job satisfaction than psychiatric nurses. [ABSTRACT FROM PUBLISHER]

Background: Leveraging artificial intelligence (AI)-driven apps for health education and promotion can help in the accomplishment of several United Nations sustainable development goals. SnehAI, developed by the Population Foundation of India, is the first Hinglish (Hindi + English) AI chatbot, deliberately designed for social and behavioral changes in India. It provides a private, nonjudgmental, and safe space to spur conversations about taboo topics (such as safe sex and family planning) and offers accurate, relatable, and trustworthy information and resources.Objective: This study aims to use the Gibson theory of affordances to examine SnehAI and offer scholarly guidance on how AI chatbots can be used to educate adolescents and young adults, promote sexual and reproductive health, and advocate for the health entitlements of women and girls in India.Methods: We adopted an instrumental case study approach that allowed us to explore SnehAI from the perspectives of technology design, program implementation, and user engagement. We also used a mix of qualitative insights and quantitative analytics data to triangulate our findings.Results: SnehAI demonstrated strong evidence across fifteen functional affordances: accessibility, multimodality, nonlinearity, compellability, queriosity, editability, visibility, interactivity, customizability, trackability, scalability, glocalizability, inclusivity, connectivity, and actionability. SnehAI also effectively engaged its users, especially young men, with 8.2 million messages exchanged across a 5-month period. Almost half of the incoming user messages were texts of deeply personal questions and concerns about sexual and reproductive health, as well as allied topics. Overall, SnehAI successfully presented itself as a trusted friend and mentor; the curated content was both entertaining and educational, and the natural language processing system worked effectively to personalize the chatbot response and optimize user experience.Conclusions: SnehAI represents an innovative, engaging, and educational intervention that enables vulnerable and hard-to-reach population groups to talk and learn about sensitive and important issues. SnehAI is a powerful testimonial of the vital potential that lies in AI technologies for social good. [ABSTRACT FROM AUTHOR]

The paper presents a comparative analysis of a live project study carried out to understand the impact and performance of ICT initiatives taken by the Universities located in the Western Himalayan Region of India. A basic four-tier framework has been used to carry out this study. Accordingly, a pre- structured questionnaire on ICT initiatives, status and accomplishments, 117 questions divided in 18 groups, was prepared and given to the Head of the Department (HOD) of ICT in the Universities, who along with his technical team, supplied the feedback on a five- point scale. In each of the groups, one question was related to performance (as performance indicator) which was identified and thus another special group 'S' was created with 18 responses. In order to assess the respective performance and impact, a standard statistical analysis was carried out in terms of the weighted mean and the correlation (Pearson's) coefficient (CC). The findings of the study are: *A dynamic academic leadership and a properly trained skilled human resource yield better performance and impact leading to effective problem solving capability, research output and actual placements. This aspect is being implemented in most of the universities effectively and the performance is found to vary from one to another university *For most of the groups the CC, with the 'S' group, was found to be significant, indicating a positive ICT- based performance in the universities (iii) The universities, to a greater extent, have been found to act as nuclei towards creating skilled professionals with enhanced core competence. [ABSTRACT FROM AUTHOR]

The article discusses a comparative study of rhizosphere and rhizoplane microflora in both healthy and diseased mulberry (Morus Spp.) gardens. The experiment was conducted in healthy and diseased mulberry gardens infested with root knot, root rot, and root disease complex at four locations in the Mysore district in India. The prevalence of beneficial, harmful, and saprophytic microflora in rhizosphere and rhizoplane habitats and the effective management of soilborne diseases is discussed.

The study examines the status and use of the Internet in Punjab Agricultural University and Haryana Agricultural University. A well structured questionnaire was distributed among the 200 teachers and research scholars of both the agriculture universities under study. Findings of this study show that Internet is being heavily used for e-mail and research purpose and also highlight purposes and frequency of use of the Internet by the teachers and research scholars, their method of locating, accessing and using information on the net. The study also discusses the problems that are preventing wide use of the Internet in both the universities. [ABSTRACT FROM AUTHOR]

The Revised National Tuberculosis Control Programme (RNTCP), which incorporated the WHO DOTS strategy was introduced in India in the mid-1990s. An operational research project was conducted between 1996 and 1998 to assess the needs and perspectives of patients and providers in two chest clinics in Delhi, Moti Nagar and Nehru Nagar, during the introduction of the new strategy. This paper reports on the findings of the project, concentrating on information collected from 40 in-depth interviews with patient defaulters and from non-participant observations in clinics and directly observed treatment centres. In Moti Nagar chest clinic, 117 of 1786 (6.5%) patients and 195 of 1890 (10%) patients in Nehru Nagar left care before their treatment was complete. It was argued that the reasons for default stem from a poor correlation between patient and programme needs and priorities, and from particular characteristics of the disease and its treatment. Patient needs that were not met by the health system included convenient clinic timings, arrangements for the provision for treatment in the event of a family emergency and provision for complicated cases like alcoholics. The problems facing the provider were poor interpersonal communication with the health staff, lack of attention and support at the clinic, difficulty for patients to re-enter the system if they missed treatment and, in certain areas, long distances to the clinic. Problems related to diseases were inability of the staff to deal with drug side-effects, and patients' conception of equating well-being with cure. Simple, practical measures could improve the provision of tuberculosis (TB) treatment: more flexible hours, allowances for poor patients to reach the clinics and training health care staff for respectful communication and monitoring drug side-effects. The findings indicate a need to rethink the label of 'defaulter' often given to the patients. The important areas for future operational research is also highlighted. [ABSTRACT FROM AUTHOR]