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Objectives: Post-coronavirus disease 2019 (COVID-19) symptoms were widely reported. However, data on post-COVID-19 conditions following infection with the Omicron variant remained scarce. This prospective study was conducted to understand the prevalence, patterns, and duration of symptoms in patients who had recovered from COVID-19. Methods: A prospective study was conducted across 11 districts of Delhi, India, among individuals who had recovered from COVID-19. Study participants were enrolled, and then returned for post-recovery follow-up at 3 months and 6 months interval. Results: The mean age of study participants was 42.07 years, with a standard deviation of 14.89 years. The majority of the participants (79.7%) reported experiencing post-COVID-19 symptoms. The most common symptoms included joint pain (36.0%), persistent dry cough (35.7%), anxiety (28.4%), and shortness of breath (27.1%). Other symptoms were persistent fatigue (21.6%), persistent headache (20.0%), forgetfulness (19.7%), and limb weakness (18.6%). The longest duration of symptom was observed to be anxiety (138.75±54.14 days), followed by fatigue (137.57±48.33 days), shortness of breath (131.89±60.21 days), and joint pain/swelling (131.59±58.76 days). At the first follow-up visit, 2.2% of participants presented with abnormal electrocardiogram readings, but no abnormalities were noticed during the second follow-up. Additionally, 4.06% of participants exhibited abnormal chest X-ray findings at the first followup, which decreased to 2.16% by the second visit. Conclusion: The most frequently reported post-COVID-19 symptoms were joint pain, dry cough, anxiety and shortness of breath. These clinical symptoms persisted for up to 6 months, with evidence of multi-system involvement. Consequently, findings highlighted the need for long-term follow-up during the post-COVID-19 period. [ABSTRACT FROM AUTHOR]

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]

Introduction: Kidney transplantation has emerged as a preferred method for improving survival and quality of life for patients with end‑stage renal disease in comparison with dialysis. Living donation provides a better patient and allograft survival when compared with deceased‑donor transplantation, specifically when the live donor transplant is accomplished before the onset of dialysis. The present study aimed to create and add data for the long‑term survival, complications occurred in donor as well as in recipient both in single study in India. Materials and Methods: We performed a retrospective cohort study of all adult patients undergoing renal transplantation. Data on kidney transplantation and operative variables, as well as follow‑up data, were obtained retrospectively from the Internal Medical Record Department. The primary outcomes examined were both donor and recipient and graft survival after 2 years and 5 years. Secondary outcomes included the presence of acute rejection and delayed graft function, as well as the rate of postoperative complications. Results: A total of 500 donors and 500 recipients participated in the research overall. The mean warm ischemia time was 3.1 ± 1.4 min and cold ischemia time was 44.3 ± 23.4 min. Surgical complications were encountered in 32.8% (164/500) of patients. The 2‑year and 5‑year graft survival rates were 90.2% and 84.8%, respectively. Conclusion: Our patients’ rate of complications was not greater than that noted in the previous publications. A thorough and meticulous medical assessment of the donor and recipient is required, as well as a rigorous and responsible evaluation of the indications. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to evaluate the outcomes of live‑donor renal allografts with multiple and single renal arteries taking into consideration ischemia times, graft function, and other complications including vascular and urological. Materials and Methods: We conducted a retrospective study by analyzing a prospectively maintained database from January 2021 to December 2021 of all patients undergoing live‑related renal allograft transplants at a tertiary care center in North India. A total of 239 live donor kidney transplants were performed during this period. Patients were divided into two groups – Group 1: Single artery single anastomosis and Group 2: Multiple arteries with two or more anastomoses. Duplex imaging of the graft was done at 6 months. Recipients were followed up for possible graft dysfunction, arterial insufficiency, and major urological complications. Results: Mean ischemia times in the two groups were 20.62 ± 1.05 and 30.45 ± 1.77 min, respectively. Failure to normalize creatinine (<1.2 mg/dl) within 72 h was seen in 6/183 and 3/56 (P > 0.05). Slow graft function was encountered in 6 cases in Group 1 and 3 cases in Group 2. Delayed graft function occurred in two patients in both groups. One‑year graft survival among the groups was 5/183 and 2/56, respectively (P > 0.05). One patient from Group 1 developed transplant renal artery stenosis. Six patients from Group 1 developed ureteric complications. Conclusion: Donor grafts with multiple renal arteries may be accepted safely with careful surgical reconstruction and close surveillance posttransplant. [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]

The purpose of this study is to know how students in school and parents perceive social networks. A random sample of 50 adolescents aged 17–21 and 50 parents aged 45–48 irrespective of gender were selected randomly from students in the eleventh and twelfth grades with their parents in Ambala, Haryana, India. A self-developed questionnaire consisting of 60 items about social networking was used, of which half of the items were in favour and half not in favour of social networking. The scoring of the questionnaire was done using scores 1 to 7 correlating to the options from 'strongly disagree' to 'strongly agree'. Descriptive analysis and part–whole correlations and t-ratios were used to analyse the obtained data. The difference in opinion between parents and adolescents about social networking is more evident when one considers the generation gap, income group and rural and urban groups. The attitude of parents, teachers and adolescents towards social networking sites is neutral. Social networking sites are both a boon and a curse, depending upon the level of awareness pertaining to the different aspects such as privacy, accessibility and the purpose for which they are being used. [ABSTRACT FROM AUTHOR]

Introduction: Kidney transplantation is the treatment of choice for patients suffering from end‑stage renal disease and health‑related quality of life (HRQoL) is routinely used for measuring the outcome. Although the generic HRQoL questionnaire provides useful information on multiple dimensions, they fail to capture emotional and behavioral components of well‑being, which is supplemented by the Transplant Effects Questionnaire (TxEQ). The present research studies the impact of these two questionnaires on various parameters affecting the health of kidney transplant recipients. Methodology: This cross‑sectional study included 500 postrenal transplant patients within 5 years of transplant (18–70 years) evaluating HRQoL using a Short Form Survey‑36 Questionnaire and emotional/behavioral outcomes using a TxEQ. Results: Mean age of participants was 44.92 ± 5.86 years and males constituted the majority (>75%). The mean physical component score (PCS) was 41.3 ± 9.2 and the mental component score (MCS) was 48.1 ± 8.4. The highest score was observed for bodily pain, followed by role limitations attributable to emotional problems (RE). The PCS was significantly higher among younger participants, among males, among participants who have got a transplant >24 months ago, and among participants who had serum creatinine levels <2 mg/dl (*P < 0.05). However, the mental component score did not differ significantly in any of the matched variables. In TxEQ, medication adherence had the highest mean score, followed by perceived responsibility toward others. Conclusion: In our study, we concluded that reduced physical functioning among female gender, illiterate patients, with increasing age, in employed section, and with associated comorbidities such as hypertension and with a history of rehospitalization. [ABSTRACT FROM AUTHOR]

Abundant literature is available on an extremely high temperature associated with mortality for cities of the developed world, but there is a dearth in the literature for coastal, desert and dry cities of the developing world, especially for India. We examined all-cause mortality and extreme high temperature in three Indian cities representing coastal, desert and dry areas for summer months (March to June) from 2006 to 2015. We obtained the data on temperature and all-cause mortality for ten years for the summer months. The city-specific effect of ambient heat on all-cause mortality was assessed through time series ordinary least square linear regression model. A total of 75,571, 122,117 and 53,042 deaths for 1,203, 1,220 and 1,180 summer days from 2006 to 2015 were analysed with ambient temperature for Jaipur, Hyderabad and Surat, respectively. There were 994 (27.6%) out of 3,603 summer days having temperature ≥40°C and 2,495 (69.3%) out of 3,602 summer days having feel temperature/heat index (HI) of ≥41°C. According to the Indian Meteorological Department (IMD) criteria for the heatwave, Surat has the maximum number of 75 days with a maximum temperature of ≥40°C, whereas Hyderabad has only 4 days and Jaipur faced 35 days with a maximum temperature of ≥45°C during the study period. The per-day mean all-cause mortality increased to 39% and 11% for Jaipur and Hyderabad, respectively, at ≥45°C and 20% for the coastal city of Surat at ≥40°C as per IMD heatwave criteria. A time-series linear regression model shows that adjusted R-squared is 0.593, 0.629 and 0.348, which explained the variation of 59.3%, 62.9% and 34.8% for all-cause mortality (dependent variable) by independent variables (maximum temperature, humidity and HI) for Jaipur, Hyderabad and Surat, respectively. The maximum temperature threshold (cut-off) for all-cause mortality for Jaipur, Hyderabad and Surat is 42°C, 41°C and 40°C, respectively. The impact of ambient heat in the rise of all-cause mortality for all study sites was evident. Hence, findings support the efforts for reducing the public health burden of high ambient temperature through developing and implementing city-specific heat action plans. [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]

World is suffering from a pandemic situation due to coronavirus disease (COVID-19) since December 2019. In this emergency, everyone at individual/country/global level is trying to contribute at their best with their available knowledge and resources. However, more and more research and developmental activities are going on but, the reality is far away for a grass-root level health professional. They rely on the indirect sources, that is, published or unpublished literature, social media, internet etc. Many a time, these sources may share an unrealistic or false positive/negative information. Our study was intended to assess the knowledge, attitude and practices related to COVID-19 among the healthcare professionals of different levels. We conducted an online survey after the initiation of the first lockdown in India. Our research team in consultation with the subject experts designed a mix method-based study tool and shared it by sending emails to 1,200 participants. A total of 180 respondents participated in the online survey of which 34% were government health professionals and 24% were working with a research/academic institution. All participants were between 23 and 74 years age group (mean 39 years). Participants shared their views on first, knowledge about symptoms, preventive measures and treatment options for COVID-19. Second, on attitude towards handling COVID-19 pandemic using social distancing, following lockdown and travel advisory, etc. Third, on the practice of non-pharmaceutical measures to prevent COVID-19. We found that the social media platform acted as one of the most important platforms for awareness generation regarding COVID-19 but it was also generating stigma among people. Till the time of the survey, there is still a dearth of knowledge about social distancing and what it means, especially physical distance of 1–3 metres and correct usage of mask in different situations. Various important issues pertaining to infant feeding practices, mother and childcare and disposal of dead bodies of COVID infected persons require deliberations and awareness. [ABSTRACT FROM AUTHOR]

Ayushman Bharat is a flagship programme of Government of India and has been much publicised; however, the extent of its translation to the ground level has not been documented. A study was conducted to assess the implementation and satisfaction of the AB-PMJAY scheme in the inpatient department of AIIMS, New Delhi. Data were collected from January 2019 to June 2019. The sample size was a universal sample, and therefore, all the beneficiaries who availed the services at AIIMS, New Delhi were enrolled. A total of 120 patients were enrolled in the study. The mean age of the participant was 36.37 years, about 45.83% of the participants were illiterate and 69.17% resided in the rural area. A total of 88% of patients did not face any problem in availing the scheme, while 18% of the patients were asked to purchase medications from outside. Patients were highly satisfied with the ease and benefits of availing the scheme. The government should examine the reasons why some medications are being purchased from outside, and a contingency fund may be given to the hospital to prevent people from purchasing the medications from outside. [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]

The study was conducted to assess patterns of prescribed drug therapy and clinical predictors of need for therapy escalation in outpatients with diabetes mellitus (DM). This was a prospective cohort study, conducted at an apex tertiary care teaching hospital in central India for a period of 18 months. The demographic, clinical, and treatment details on the baseline and follow up visits were collected from the patients' prescription charts. Glycemic control, adherence, pill burdens along with pattern of antidiabetic therapy escalation, and deescalations were analyzed. A total of 1,711 prescriptions of 925 patients of diabetes with a mean age of 53.81 ± 10.42 years and duration of disease of 9.15 ± 6.3 years were analyzed. Approximately half of the patients (n=450) came for ≥1 follow up visits. Hypertension (59.35%) was the most common comorbidity followed by dyslipidemia and hypothyroidism. The mean total daily drugs and pills per prescription were 4.03 ± 1.71 and 4.17 ± 1.38, respectively. Metformin (30.42%) followed by sulphonylureas (SUs) (21.39%) constituted majority of the AHA's and dual and triple drug therapy regimens were most commonly prescribed. There were improvements in HbA1c, fasting/postprandial/random blood sugar (FBS/PPBS/RBS) as well as adherence to medication, diet, and exercise in the follow up visits. Among patients with follow ups, therapy escalations were found in 31.11% patients, among whom dose was increased in 12.44% and drug was added in 17.28%. Apart from Hb1Ac, FBS, and PPBS levels (p<0.001), characteristics such as age, BMI, duration of diagnosed diabetes, presence of hypertension and dyslipidemia, and daily pill burdens were found to be significantly higher in the therapy escalation group (p<0.05). Inadequate medication adherence increased the relative risk (RR) of therapy escalation by almost two times. Disease and therapy patterns are reflective of diabetes care as expected at a tertiary care center. Higher BMI, age, pill burden, duration of diabetes, presence of comorbidities, and poor medication adherence may be the predictors of therapy escalation independent of glycemic control and such patients should be more closely monitored. [ABSTRACT FROM AUTHOR]

Disclosure is governed by a host of individual, health and psychological factors that operate in and shape the decisions related to disclosure in a patient among people living with human immunodeficiency virus (PLHIV).This article studies process of disclosure, how gender affects disclosure and how it differs among PLHIV by studying their life events integrating quantitative and qualitative information from 204 respondents. Mix method approach was used to collect the data from selected male and female respondents. A total of 204 completed interviews were carried out. Bivariate and multivariate statistical techniques have been used in the study. One-third respondents reported to not have disclosed status to their partner. Female PLHIV were significantly more likely (AOR: 2.8, p <.05) to disclose their HIV status to their spouse/regular partner. Three-fifths of women were tested after they lost their husbands to AIDS or living with HIV. Around 94% women reported self-perceived stigma and 83% feared of being discriminated. Female PLHIV are approximately 3 times (p <.05) more likely to have the fear of discrimination. Findings of the study reinforce the necessity of integrating gender in every HIV prevention efforts as disclosure of HIV status may provide opportunity for early initiation of anti-retroviral therapy (ART), which may ensure adherence to ART services and suppressing the viral load. [ABSTRACT FROM AUTHOR]

Background: Allogeneic hematopoietic stem cell transplantation activity is growing globally as one of the curative treatment options for many hematological diseases. A stem cell transplant registry plays an important role in such treatment. Setting up a functional stem cell donor registry is quite challenging with several issues such as resources, donor recruitment, donor attrition, ethnicity, lack of support, and impact of coronavirus disease 2019 (COVID-19). Aim: The aim of the current study was to present the experience of a resource-constrained registry in India as well as the effect of COVID-19 on its operations. Settings and Design: The present study was a descriptive study which was designed to study the functioning of a resource-constrained registry from north India. Materials and Methods: The study data for the period of 2012--2020 pertaining to donor recruitment, number of searches, number of matched donors, number of transplants performed, and donor attrition was collected from the registry software "Prometheus." Statistical Analysis: Descriptive statistics such as frequency and percentage was used. Results: During the past 9 years of operation, the registry has faced several issues pertaining to lack of funds, donor recruitment, donor attrition, and COVID-19 has exacerbated their pain points significantly. The registry has recruited a total of 20,093 donors, of which only 7794 have been human leukocyte antigen typed, with the remaining samples awaiting funding. Out of this small number of typed donors, registry has performed 15 matched unrelated donor transplants for Indian and international patients. As a result of COVID-19, donor attrition was on the rise and showed a peak in 2020. During the year 2020, the number of searches, donor recruitment camps, and donors all decreased considerably. Conclusion: The establishment and operation of a stem cell transplant registry necessitate extensive planning and resources. The resource-constrained registries face a number of issues pertaining to effective functioning and future developments. The external support and awareness for the cause can help minimize the pain points of these registries. [ABSTRACT FROM AUTHOR]

Background: Organ transplantation is a life-saving treatment for patients with end-stage organ failure all over the world, and the demand for organs has increased as a result. Organ donation involves legal, psychological, and ethical considerations. Many countries around the world have reported that people's attitudes toward organ donation are influenced by various factors such as knowledge, education, and religion. The existing study sought to explore the awareness, attitude, and willingness of organ donation among adult population in Western Rajasthan. Materials and Methods: A cross-sectional hospital-based survey was conducted with 445 adult populations who were visiting the hospital. Self-Structured Awareness Assessment Scale for Organ Donation and Attitude Assessment Scale for Organ Donation were used. Data analysis was done using the SPSS software 22.0 version. Results: 74.61% of participants were aware about organ donation. Statistically (P < 0.001) higher odds for organ donation willingness was found among participants who were aware that organ such as eye (odd ratio [OR]: 10.34, 95% confidence interval [CI]: 4.40--24.25, P < 0.001), heart (OR: 4.71.95% CI: 2.68--8.25), P ≤ 0.001), intestine (OR: 2.26, 95% CI: 1.41--3.6, P = 0.001), skin OR: 2.93, 95% CI: 1.83--4.70) P ≤ 0.001), extremities (Lower and upper) (OR: 2.46,95% CI: 1.53--3.95, P ≤ 0.001) can be donated or transplanted. 40.6% of the participants disagree that it is better to die than to receive an organ from another person. Interestingly, 35.28% of the participants agreed that organ donation is a true donation and a real service to mankind. Conclusions: This study not only echoes low awareness of organ donation among the adult population in Western Rajasthan, India but also reflects low and neutral level of positive attitude and willingness for organ donation. [ABSTRACT FROM AUTHOR]

Background: Despite well-known benefits, rates of exclusive breastfeeding and early initiation of breastfeeding are very low. This study was conducted to identify most important and easily modifiable barriers to Early Initiation of Breast Feeding (EIBF). Methods: This hospital-based cross-sectional study was conducted from January 2018 to December 2018. Data on factors which could impact EIBF was collected by interviewing with mothers using semi-structured questionnaire. Results: Only 306 (33.7 percent) of the total 908 mother–neonate dyads enrolled received breastfeeding within 1 hour of birth. Factors affecting EIBF included: delivery by lower segment cesarean section (LSCS), lack of prenatal advice on breastfeeding, use of prelacteal feeds, and maternal illness. Conclusion: Rates of EIBF were very low in present setting. Counseling during antenatal visits on the importance of EIBF, and having adequate staff to support initiation of BF, may improve the EIBF. [ABSTRACT FROM AUTHOR]

The National Health Policy 2017 recommended the establishment of health and wellness centres (HWC) as the primary platform to deliver comprehensive primary health care in India and emphasised that about two-thirds of the health budget of the government should be invested on primary care. In February 2018, the government announced its plan to create 150,000 HWCs under the Ayushman Bharat initiative by transforming the already existing sub-centres (SCs), primary health centres (PHCs) and urban PHCs as HWCs by 2022. The operationalisation of HWCs has been planned in a phased manner. However, for scaling up and replicability, it is imperative for the government to know how much to budget for this initiative, so that there are no interruptions in the smooth flow of services. Taking Gujarat as a case study, the study took a sample of eight HWCs for estimating the total and per-unit costs for each type of HWC. OPD footfalls were taken as an indicator for measuring output. The incremental unit costs were estimated by calculating the difference between the pre and post-conversion unit costs, in order to understand the cost implications of the conversion. The study also estimated the possible total costs in relation to the health budget of the state to understand the financial implications of scaling up HWCs. The results indicated that though the costs have gone up after conversion, outpatient department (OPD) footfalls have also increased at all facilities, but most significantly for the SCs, resulting in costs per OPD footfalls coming down significantly. For nearly all the centres, there has been a fall in the incremental costs per OPD visits indicating that the conversion to HWC has been quite economical. It was estimated that a total of about ₹7.13 billion will be spent on running 1,500 HWCs in the year 2020–2021, though, the incremental costs of scaling up would be significantly less at about ₹940 million. If, however, the entire gamut of services envisaged to be a part of the HWC initiative are added, the costs are likely to increase. More research with additional data points would be required to confirm these tentative findings, but the results could be used as a baseline for future such studies. [ABSTRACT FROM AUTHOR]

Emotional intelligence (EI) is possibly one of the most studied psychological factors of the twenty-first century. EI is very much relevant in service industry particularly in management, academics, life sciences or psychology. The purpose of the empirical study is to test the relationship between the defined constructs of EI and job satisfaction (JS) amongst health care professionals of Delhi NCR region of India. It further tried to understand whether gender moderates the EI and JS relationship. Structured survey was used to solicit response from 260 health care professionals comprising doctors and nurses belonging to different hospitals of Delhi NCR region. Standardised instruments were used to assess the data. Linear and moderated regression were used to test hypotheses developed. The findings suggest that EI constructs significantly impact the level of JS among health care professionals. The result of moderated regression suggested that the relationship of EI and JS is significantly moderated by gender. The construct of EI is relevant in providing high quality health care service delivery to the patients. [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: Healthcare workers (HCWs) are at a high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to the increased likelihood of clinical exposure during patient management. The study objective was to determine the seroprevalence of antibodies to SARS-CoV-2 and its predictors among hospital employees. Methods: The cross-sectional study was conducted at a teaching hospital from August 2020 to September 2020 among 1,401 employees, including 1,217 HCWs, in New Delhi, India. The serum samples were examined for immunoglobulin G (IgG) antibodies to SARS-CoV-2 using the COVID Kavach-Anti-SARS-CoV-2 IgG Antibody Detection enzyme-linked immunosorbent assay kit. Data were collected electronically using the EpiCollect mobile platform. A p<0.05 was considered to indicate statistical significance. Results: A total of 169 participants (12.1%) had detectable IgG antibodies to SARS-CoV-2. The highest seropositivity rate was observed in the administrative staff (20.1%), while it was lowest among medical doctors (5.5%, p<0.001). Male sex and ever having lived in a containment zone were independently associated with past infection with SARS-CoV-2. Conclusion: The seroprevalence of SARS-CoV-2 infection in health workers may be lower than in the general population in New Delhi. However, nonpharmaceutical interventions were not associated with a reduction in the risk of acquisition of SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Background: Fixed-dose combinations (FDCs) are being widely prescribed for the treatment of various disorders in India. However, not all FDCs are rational. To know the awareness of physicians in prescribing rational FDCs was the need of the hour in order to assess the prescribing trends and rationality of FDCs. Eventually, this will help to formulate the guideline for rational use of FDCs. Methods: This was a prospective observational study conducted in All India Institute of Medical Sciences Bhopal, MP, India. Prescriptions were collected over a period of 2 months by the convenience sampling method from hospital pharmacy. The data were subjected to descriptive analysis using Microsoft Excel and Graph Pad Prism. Results were expressed in mean ± standard deviation (SD), percentages and 95% confidence interval. Results: A total of 2496 drugs were prescribed in 1008 prescriptions, of which 945 (37.82%) were FDCs with an average of 0.93 ± 0.94 (mean ± SD) per prescription. Of 945, 67 (7.09%) were included in National List of Essential Medicine 2015 considered as rational. The number of prescriptions containing one or more FDCs was 629 (62.40%). FDCs were more frequently prescribed to male patients (54.92%) and in the age group of 18–30 years (33.44%). FDCs containing a proton pump inhibitor were prescribed most frequently (16.29%) followed by nonsteroidal anti-inflammatory drugs (13.96%) and multivitamins (7.83%). Conclusions: Prescribing irrational FDCs was very common, and hence there is an obvious need to update our prescribers about the irrationality of FDC and motivate them to develop a habit of rational prescribing. [ABSTRACT FROM AUTHOR]

Purpose: The predominant mode of human communication is speech, and whenever it is hindered, humans resort to the tactile-kinaesthetic mode. Use of sign language by persons with speech-hearing impairments is a classic example of such adaptation. The Demonstration School at the Regional Institute of Education in Mysuru, South India, undertook training of typically-developing students in Indian Sign Language (ISL), so as to facilitate communication and instruction of students with hearing impairment who are in mainstream learning environments. Method: Training in ISL was imparted to 140 typically-developing students in higher primary classes. Twenty-four 40-minute sessions were conducted over a month. After theoretical orientation in logical bases of manual communication, practical training commenced with elementary manual alphabets, progressed through essential daily-life vocabulary necessary to construct simple sentences and carry out general conversations, and culminated in signing the Indian National Anthem. Results: Typically-developing students gained primary benefits such as improved awareness about non-verbal communication modes, mastery of basic skills in ISL, and positive attitudes towards sign languages. Conclusion: The UNCRPD 2006 authorises sign language as the linguistic identity of the Deaf, and encourages the use of sign language in learning environments. Future research should add to the findings on secondary benefits in the form of scholastic and sociometric advantages derived by students with hearing impairments who receive instructions in sign language in mainstream learning environments. [ABSTRACT FROM AUTHOR]

There are various individual factors that impact child diarrhoea-related behaviours among primary care seekers. Behavioural factors, social norms, economic considerations, access to healthcare, gender, etc., are some of the factors that can impact the treatment-seeking behaviour of the parents for their children who are suffering from diarrhoea. This article also establishes the relationship between open defaecation as a social behaviour and the incidence of child diarrhoea. Other than this, the relationship between open defaecation and child nutritional indicators is also established through substantive evidence. Open defaecation is known to have significant health impact, especially on children. Children from ODF distrcits are also significantly less wasted and under weighing than children from Non-ODF districts. However, the open defaecation free (ODF) status showed no significant impact on stunting in the current study. [ABSTRACT FROM AUTHOR]

Introduction: Public health programmes work to improve the health and well-being of communities by identifying the risks affecting people at different stages of life and finding best ways to minimize them. This article attempts to map the public health jobs available in India and contribute towards providing new insights in recruitment strategies for public health professionals (PHPs). Methods: A total of 427 public health jobs advertised in recruitment portals, newspapers and websites of organizations during 2012–2015 were analysed for title, qualification, location and job disciplines. Results: Higher qualification in public health and/or social sciences is much preferred followed by MBBS and management. The largest group of vacancies consisted of programme management responsibilities followed by profiles in RMNCH. Delhi, Orissa, Madhya Pradesh and Bihar had the highest number of jobs. Recommendations: A dedicated public health jobs web portal can be a rich resource for employers for easy access to profiles of PHPs. It will also give due emphasis to public health as a profession. Building a public health cadre in state health services shall be a desirable step to ensure creation of enough job opportunities. Conclusion: Research should be undertaken to understand the changing trends in public health employment. Such studies can be beneficial for public health workforce planning and monitoring. [ABSTRACT FROM AUTHOR]

BACKGROUND: Children with cystic fibrosis may have a deficiency of micronutrients, including zinc, which may affect their susceptibility to infections. There is a paucity of data on zinc supplementation among children with cystic fibrosis. We hypothesized that a pharmacologic dose of zinc administered daily for 12 months would reduce the need for antibiotics by 50%. METHODS: This double-blind randomized placebo-controlled trial was conducted among children with cystic fibrosis to assess the effect of zinc supplementation on the need for antibiotics and pulmonary function tests. The children, age 5-15 y, of either sex, received either 30-mg zinc tablets or similar looking placebo tablets daily in addition to standard care. They were followed up every month for a period of 12 months and whenever they had pulmonary exacerbations. Their serum zinc was estimated at baseline and at 12 months of enrollment. During each visit, the children underwent a pulmonary function test and sputum culture. RESULTS: Of a total of 43 children screened, 40 were enrolled, and of them, 37 completed the study. The median (interquartile range) number of days of the administration of antibiotics over 12 months of follow-up among the children receiving zinc was 42 (14-97) d. In the placebo group, it was 38 (15-70) d (P = .79). There were no significant differences in the percent-of-predicted FEV, or change in FEVX values at 12 months (P = .44). The number of children in whose respiratory specimens Pseudomonas was isolated was similar for the 2 groups at different time intervals. The adverse events reported were similar in the 2 groups. CONCLUSION: We did not find any significant difference in the need for antibiotics, pulmonary function tests, hospitalization, colonization with Pseudomonas, or the need for antibiotics for children with cystic fibrosis receiving zinc supplementation of 30 mg/d. [ABSTRACT FROM AUTHOR]

Background: The aim was to study and compare knowledge, attitude and practices regarding self-medication in healthcare and nonhealthcare university students. Methods: Suitably constructed, structured and pretested questionnaires were distributed to 350 students in each group; data were documented in SPSS software version 20.0 and analyzed using χ2-test and multivariate logistic regression analysis. Results: Completed questionnaires only were analyzed, which were 314 and 310 in healthcare and nonhealthcare groups, respectively. The majority of students practiced self-medication (84.4% vs. 68.1%; p < 0.001) with the most common indications being fever (46.4% vs. 37.9%; p < 0.001) and cough and common cold (30.9% vs. 37%; p = 0.004). Most commonly self-medicated drugs were antipyretics (67.9% vs. 52.6%; p = 0.03) and multivitamins (28.7% vs. 16.8%; p < 0.001). A few of them experienced adverse drug reactions due to self-medication (6.8% vs. 1.9%; p < 0.001). Independent risk factors for self-medication were younger age group (OR = 2.93, CI 95% 1.09-7.85), storage of medicines at home (OR = 2.49, CI 95% 1.21-5.12), healthcare students (OR = 2.54, CI 95% 1.72-3.74), higher knowledge scores (OR = 1.65, CI 95% 1.08-2.52), those consuming homeopathic preparations (OR = 9.19, CI 95% 1.24-68.11), multivitamins (OR = 6.7, CI 95% 2.88-15.6) or health supplements (OR = 6, CI 95% 2.15-16.74), participants who strongly agreed that self-medication is a part of self-care (OR = 3.97, CI 95% 1.56-10.09), and those self-medicating with an old prescription for same illness (OR = 0.04, CI 95% 0.01-0.15) or over advice from home (OR = 0.11, CI 95% 0.04-0.3). Conclusions: Though self-medication is common in university students, there is a dearth in their knowledge regarding the same. This highlights the need for increasing awareness among students regarding hazards of self-medication. [ABSTRACT FROM AUTHOR]

Introduction The potential impact of concomitant iron deficiency on hemoglobin A2 (HbA2)-based identification of β-thalassemia trait (β TT) is a worrisome issue for screening laboratories. This is especially true for resource-constrained settings where iron deficiency is widespread and molecular confirmatory tests for borderline low HbA2 values may be unavailable. Methods Obligate β TT carrier individuals ( n = 752) were identified during screening studies on the parents of thalassemia major patients. HbA2%, complete blood counts and serum iron, ferritin and transferrin saturation were studied. Iron-deficient individuals ( n = 135) with normal range HbA2% were taken as controls. Results Concomitant iron deficiency (defined as ferritin ≤15 ng/mL and/or transferrin saturation ≤15%) was present in 20.7% (156/752) βTT cases, that is, 33.3% females (122/366) and 8.8% males with βTT (34/386). Mean HbA2 in iron-replete βTT was 5.4 ± 0.8 (range 3.1-7.9) and in iron-deficient βTT was 5.4 ± 0.9 (range 3.3-7.6). HbA2 < 4.0% was found in 23/752 (3.1%) βTT: 13/595 iron-replete (2.2%) and 10/157 (6.4%) iron-deficient βTT individuals. However, five of the 10 iron-deficient βTT cases carried the silent CAP+1 (A>C) β-thalassemia allele accounting for the borderline HbA2%. On a separate analysis, all five severely anemic βTT (Hb < 80 g/L) and 16/17 βTT with severe hypoferritinemia (<5 ng/mL) had HbA2 > 4.5%. The single case with serum ferritin 4.8 ng/mL and HbA2 3.3% showed a CAP+1 (A>C) mutation. Conclusions Iron deficiency was prevalent among north Indian β TT individuals, especially women. After adjusting for other causes of low HbA2 in β TT, iron deficiency, even when very severe, was very unlikely to interfere significantly with HbA2-based identification of β TT. [ABSTRACT FROM AUTHOR]

Background: Murraya koenigii (Rutaceae) (curry patta: Hindi) of the family Rutaceae is used in the traditional Indian system of medicine for its immunomodulatory properties. The essential oil of the leaves of M. koenigii possesses antimicrobial, antifungal, and pesticidal activities and is used for the treatment of amebiasis, diabetes, and hepatitis. The present study was performed to evaluate the effect of M. koenigii on humoral and cell-mediated immune responses in rats. Methods: Aqueous extract of M. koenigii leaves was administered orally in a dose of 350 mg/kg. Cell-mediated immunity was assessed by measuring foot pad thickness following sensitization by injection of keyhole limpet hemocyanin and subsequent challenge by the same. Humoral immunity was assessed by measurement of hemagglutination titer to sheep red blood cells (SRBCs). Results: In the humoral immune response, the administration of M. koenigii [350 mg/kg per os (p.o.)] from day 1 to day 7 after sensitization with SRBC on day 0 caused a significant increase in the primary anti-SRBC titer. However, the secondary immune response was decreased significantly (p<0.05) as shown by a decrease in secondary anti-SRBC titer measured on day 11 following a booster dose of antigen on day 8. In the delayed-type hypersensitivity test, M. koenigii (350 mg/kg, p.o.), when administered for 14 days, produced a significant (p<0.05) decrease in foot pad thickness when compared with the control group. Conclusions: Thus, these results suggest that oral administration of M. koenigii augments primary humoral immune response and decreases cell-mediated immunity. [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]

In the absence of a well implemented Drug Policy, paucities in access, affordability, efficiency, quality and effectiveness of health services and limited resources continue to handicap the functioning of the health system. Higher accessibility and quality was taken to be synonymous with higher costs. The main objective of the study was to study the impact of a drug policy on availability of essential drugs and cost containment in a tertiary care hospital from 1996 through 2007. The interventions consisted of selection of list of essential drugs and procurement through centralized pooled system in 1996–1997, followed by setting up of Drugs & Therapeutic Committee (1997). Average drug expenditure increased slightly from 3.63 per cent to 5.16 per cent while there was 5 fold rise in hospital patient attendance. Drug expenditure reduced by 47 per cent, without any compromise on key drug availability which increased to 94.6 per cent. Despite high expenditure on key drugs (75.89 per cent) mean availability was 67.48 per cent but after intervention with the same expenditure (77.68 per cent) it increased to 95.28 per cent. Number of drugs out-of-stock decreased from 27.57 per cent to 19.57 per cent of minor duration only and no stock out of vital drugs. ABC analysis revealed 3.33 drugs only in category A consuming 74 per cent budget which increased markedly to 9.63 drugs consuming 79.53 per cent budget after intervention along with reversal of previous trend of non-essential among top 10 drugs where only vital drugs represented top 10 drugs. The present study showed cost-containment accompanied by increased availability of essential drugs is possible and optimizes the value of limited government funds and thereby empower and support government in making basic medicines available to all. Managerial interventions such as limited list of essential drugs, efficient procurement, through Drugs and Therapeutic Committee (DTCs) have a vital role in improving day-to-day care of patients and can serve as an effective strategy in curtailing inappropriate drug use, reducing drug expenditures and served to increased availability and accessibility to essential medicines thus optimizing the value of limited government funds. [ABSTRACT FROM PUBLISHER]

Background: Cardiovascular diseases are a major cause of morbidity and mortality in India, with dyslipidemia contributing significantly to the risk. There are few community-based studies that highlight the burden and risk factors associated with dyslipidemia in the Indian population. Objectives: To determine the prevalence and risk factors associated with dyslipidemia among adults ages 18 years and older in a resettlement colony located in central Delhi. Methods: A cross-sectional study that included a random sample of 200 adults was designed. A study tool based on the World Health Organization STEPwise approach to surveillance of noncommunicable diseases and their risk factors (STEPS) questionnaire was used. Fasting venous blood sample was collected to assess the lipid profile and anthropometric measures of the participants were recorded. Criteria based on the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults were used to define the cut offs for dyslipidemia. Data were analyzed with the Statistical Package for Social Sciences, version 17. Results: Of a total of 200 study subjects, 34% had increased total cholesterol levels (≥200 mg %), 38% had increased low-density lipoprotein levels (≥130 mg %), 40% had increased triglyceride levels (≥150 mg %), and 42% had low high-density lipoprotein levels (<40 mg %). Using the logistic regression model, we found age, hypertension, alcohol consumption, and abdominal obesity to be associated with increased odds of dyslipidemia. Conclusion: A high proportion of individuals in the community have dyslipidemia, often associated with modifiable risk factors. The situation demands programs aimed at risk factor reduction. A focus on behavior change and health promotion targeting the younger age group is recommended. [Copyright &y& Elsevier]

Background: As a pilot project, Indian Psychiatric Society conducted the first multicentric study involving diverse settings from teaching institutions in public and private sectors and even privately run psychiatric clinics. Aim of the Study: To study the typology of functional somatic complaints (FSC) in patients with first episode depression. Materials and Methods: A total of 741 patients from 16 centers across the country participated in the study. They were assessed on Bradford Somatic Symptom inventory for FSC, Beck Depression Inventory for severity of depression, and Comprehensive Psychopathological Rating Scale- anxiety index (CPRS-AI) for anxiety symptoms. Results: The mean age of the study sample was 38.23 years (SD-11.52). There was equal gender distribution (male - 49.8% vs. females 50.2%). Majority of the patients were married (74.5%), Hindus (57%), and from nuclear family (68.2%). A little over half of the patients were from urban background (52.9%). The mean duration of illness at the time of assessment was 25.55 months. Most of the patients (77%) had more than 10 FSCs, with 39.7% having more than 20 FSCs as assessed on Bradford Somatic Inventory. The more common FSC as assessed on Bradford Somatic Inventory were lack of energy (weakness) much of the time (76.2%), severe headache (74%) and feeling tired when not working (71%), pain in legs (64%), aware of palpitations (59.5%), head feeling heavy (59.4%), aches and pains all over the body (55.5%), mouth or throat getting dry (55.2%), pain or tension in neck and shoulder (54%), head feeling hot or burning (54%), and darkness or mist in front of the eyes (49.1%). The prevalence and typology of FSCs is to a certain extent influenced by the sociodemographic variables and severity of depression. Conclusion: Functional somatic symptoms are highly prevalent in Indian depressed patients and hence deserve more attention while diagnosing depression in Indian setting. [ABSTRACT FROM AUTHOR]

The study was conducted with the aim of investigating the effects of perception of the hospital workplace factors on the job satisfaction and psychological well-being of a sample of paramedical health care employees (N =200) from a medical college (teaching) hospital and public (non-teaching) government-run hospitals. Statistical analysis of the data revealed that despite significant differences in perceived work-place factors, the reported levels of psychological well-being and job satisfaction of the participants were nearly similar in the two types of public hospitals. Stepwise regression analysis of the data revealed that the organization’s structure-related factors, co-ordination and work autonomy were significantly predictive of job satisfaction and psychological well-being of health care employees, while the process-related workplace factors, participative decision making and intra-professional relations, emerged as significant predictors of psychological well-being and job satisfaction in both types of hospitals. Results have significant implications for public hospitals which are currently facing competition from the state-of-the-art health care technology being introduced by private hospitals, and are therefore under pressure for retention of skilled health care employees. [ABSTRACT FROM PUBLISHER]