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Covid-induced lockdowns have increased the importance of technology in education. Though access to technology as well as availability of the internet remain a major concern for a lot of children in the global south, children with intellectual disabilities are disadvantaged even more as most of the e-content is developed keeping in mind the average learner. Unstructured interviews were conducted with children with intellectual disabilities studying in government schools in Haryana as well as their teachers and parents. Thematic analysis of the interviews was conducted to understand the use-patterns of mobile phones by children with intellectual disabilities. Findings suggest that these children are learning to use mobile phones on their own or with some support and are able to navigate the complexities of these smartphones quite well. They use these devices mostly for their entertainment. This paper then reflects on the need and strategies to develop these technologies in ways that they can be used as effective tools for teaching children with intellectual disabilities, especially in the inclusive education system in developing countries. The paper reflects on the need to develop technology and tools using flexible and exploratory designs to enhance the learning processes for children with intellectual disabilities from the lower income strata. This study highlights the importance of being able to use mobile phones by children with intellectual disabilities belonging to low income families. Following this, the article argues for designing of mobile phones suitable for use by children with intellectual disabilities using playfulness and explorations, and Building e-content keeping the elements of playfulness and exploration which can enhance the learnings of this group of students which is often ignored. [ABSTRACT FROM AUTHOR]

This paper explores the different insider employee-led cyber frauds (IECF) based on the recent large-scale fraud events of prominent Indian banking institutions. Examining the different types of fraud and appropriate control measures will protect the banking industry from fraudsters. In this study, we identify and classify Cyber Fraud (CF), map the severity of the fraud on a scale of priority, test the mitigation effectiveness, and propose optimal mitigation measures. The identification and classification of CF losses were based on a literature review and focus group discussions with risk and vigilance officers and cyber cell experts. The CF was analyzed using secondary data. We predicted and prioritized CF based on machine learning-derived Random Forest (RF). An efficient fraud mitigation model was developed based on an offender-victim-centric approach. Mitigation is advised both before and after fraud occurs. Through the findings of this research, banks and fraud investigators can prevent CF by detecting it quickly and controlling it on time. This study proposes a structured, sustainable CF mitigation plan that protects banks, employees, regulators, customers, and the economy, thus saving time, resources, and money. Further, these mitigation measures will improve the reputation of the Indian banking industry and ensure its survival. [ABSTRACT FROM AUTHOR]

In this paper, we contend that urban middle-class older Indians engaged in "serious leisure" as a way to reimagine and reconfigure the structure of everyday life during the pandemic-led epochal downtime. In particular, we heuristically show that leisure activity patterns and constraint negotiation strategies among older Indians followed conceptual semblances with the dominant leisure-based typology of Serious Leisure Perspective. By thematically analysing household surveys (n = 71), time-use diaries and in-depth interviews (n = 15) of middle to upper middle-class individuals (55–80 years), we show how both men and women distinguished between serious leisure that is marked by motivation, agency and perseverance with that of unstructured, routinized free-time (or causal leisure). Time-use diaries suggested that despite the changed realities of heightened domestic time available to both genders due to the pandemic, women recorded higher proportion of their daily hours in household management and caregiving. Although women were governed by moral-cultural self-descriptions in their engagement with leisure, it was often associated with an enhanced sense of self-actualisation, self-management and identity. Overall, we show how the social codes of age and gender were inextricably linked with the practice of leisure during the pandemic. [ABSTRACT FROM AUTHOR]

India has approximately 23 million children without parental care, who need alternative forms of care (MOSPI, 2018). Udayan Care, an NGO, designed an innovative group care model for children and youth in need of care and protection, implementing the indigenously developed LIFE (Living in Family Environment) strategy in 17 Udayan Ghars. (Sunshine Homes). With child participation as a core pillar, Udayan Care developed a Questionnaire to Assess the Needs of Children in Care (QANCC) in 2011, which is to be filled up by children annually, as a longitudinal study. The tool is conceived to ascertain whether children in the Ghars perceived if their rights were being fulfilled and that their needs were being addressed. With "meaningful participation" of children stipulated by the United Nations Convention on the Rights of the Child (UNCRC), the objective was to develop an evidence-based tool to assess the views of children on the services meted out to them, from their standpoint, and inform actual care practices annually. The self-assessment tool consists of questions, assessing the four dimensions of basic/fundamental, emotional, educational, and interpersonal needs, on a four-point Likert rating scale. A convenient purposive sampling is done on children, aged 10 to 18 years, who receive care and protection at the Ghars, and have resided there for a minimum of 6 months. This paper has two objectives, where at one end, the deductions of the previous years' data are made (2011–12 to 2016–17) with demarcating the differences with year 2018–19 data and at the second level, there is an update on the efforts made to establish the reliability and validity of the tool and create a standardized tool that can be implemented by other child care organizations in India. The paper illustrates how listening to direct voices of children and incorporating their inputs into actual care practice, can go a long way in improving the holistic wellness of children living in an alternative care setting. The results indicate that all needs of the majority of the children in Udayan Ghars. [ABSTRACT FROM AUTHOR]

Background: Contemporary society has led to the increasing use of electronic equipment that is very much responsible for the burden of electronic waste (e-waste). E-waste contains very hazardous substance that harms health and environmental conditions. There is no delicate mechanism for the management of e-waste in Lucknow city, Uttar Pradesh. This study assessed knowledge, practice, and awareness of e-waste management among residents of this city. Material and methods: The study was conducted amongst users of electronic equipment living in the Lucknow City of Uttar Pradesh. The study was a cross-sectional descriptive study. Multi-stage random sampling was done for the selection of participants for the study. A predesigned and pretested questionnaire was administered in a single setting for all phases. The total optimum sample size is 700 individuals who participated in the study. Data were entered in MS Excel 2016 and descriptive statistics such as frequencies and percentages were calculated, applying the chi-square test for association using R-4.2.1 Statistical software. Aim and objectives: To assess the knowledge, attitude and practices regarding the management of electronic waste among users of electronic equipment residing in Lucknow city. Results: Only 37% of users are aware that e-waste adversely affects health. Only 34.3% of users knew that e-waste should be given to the seller or manufacturer for recycling while rest told that it should be stored at home, sold to a scrap dealer, or disposed with normal waste. 87.3% users are not aware about e-waste govt guidelines. In the current study electronic and print media like television, radio and news paper were not found to be source of information for e-waste disposal. Conclusion: Education regarding the ill effects of e-waste is essential for people and awareness of proper disposal of e-waste is the need of the hour. Electronic and print media as well as companies producing electronic equipment should play a significant role to awaken the respondent about the disposal of e-waste. [ABSTRACT FROM AUTHOR]

Dissociative/conversion disorders affect almost 31% of children and adolescents in a clinical setting. These children experience significant impairments in their academics, and daily functioning, with high chances of developing other psychiatric comorbidities such as anxiety and depression. However, there are no studies that explore the experiences of suffering from dissociative/conversion disorders from perspective of the sufferer. Therefore, the paper has aimed at exploring the subjective experiences of dissociative and conversion disorders among adolescents in the Indian context by examining their understanding about the illness and the reason they ascribe to the cause of their illness. The study used a qualitative semi-structured interview to understand their illness. In total, 10 adolescents of age group between 12 and 16 years participated. Eight out of the 10 participants were female and the mean age was 12 years. All of them were in-patients in the department of Child and Adolescent Psychiatry, NIMHANS, which is the tertiary mental health care Institute India and pioneer Institute of mental health in Asia. All participants have had at least one or more consultation history either with a traditional healer or/and physician. Thematic analysis identified vital themes such as (1) Adolescents' attributing factors of the illness, (2) Cognitive and emotional appraisal of stressful situation/s, (3) Adolescents' appraisal of different explanatory model, (4) Living with the Impact of the illness. This analysis about dissociative/conversion disorders from adolescents' perspective has a major contribution in enhancing the clinical knowledge and practice in planning and managing children/adolescents diagnosed with dissociative/conversion disorders. [ABSTRACT FROM AUTHOR]

Introduction: Prosocial behaviour is one of the key features of the development of school-going adolescents. Therefore, the current paper focuses on the prosocial behaviour of school-going adolescents in Kollam District, Kerala. Methodology: A cross-sectional descriptive study where 600 school-going adolescents, their parents and 60 class teachers were selected through cluster sampling method. English and Malayalam version of the Strength and Difficulties Questionnaire (SDQ) was administered among respondents. Chi-square and multiple linear regression models were used for analysing the data. Results: Self-report of prosocial behaviour predictors were significantly associated with gender (P < 0.01), urban-rural settings (P < 0.001) and government-private schools (P < 0.001). Parents' report shows highly significant relationship with gender (P < 0.001) whereas teachers' report is significantly related to urban-rural settings (P < 0.01). Conclusion: The current study found that one-fifth of school-going adolescents had borderline to abnormal (self – 17.4%; parents' – 16.9%; teachers' report – 20.8%) prosocial behaviour. School-going adolescents should involve in volunteer activities and campaigns for better development in society. [ABSTRACT FROM AUTHOR]

Background: The occurrence of workplace hazards, occupational diseases, and deaths contribute significantly to the increase in the global burden of diseases. The Municipal Solid Waste (MSW) workers experience occupational stressors throughout the process of waste management that affects their well-being and results in high rates of occupational health problems. It is vital to understand the workplace practices and occupational morbidities of the MSW workers to ensure their safety and well-being. In this context, the study aimed to explore the occupational health and safety practices at the place of work among the MSW workers in Karimnagar and Hyderabad in Telangana, India. Methodology: A cross-sectional study was conducted in two cities of Telangana. A total of 394 MSW workers were surveyed. The number of MSW workers in Karimnagar and Hyderabad were 152 and 194, respectively. A pre-tested questionnaire was administered to the MSW workers to study the occupational morbidities and workplace safety practices. Focused group discussions were conducted among the MSW workers in both cities. In-depth interviews of sanitary supervisors in Karimnagar were conducted. Semi-structured questionnaires and interview guides were used with questions on sociodemographic characteristics, health status, work environment, protection strategy, and healthcare utilization. MS Excel and NVivo-12 were used for data analysis. Results: Musculoskeletal problem was the major reported morbidity among the MSW workers (76.6%). Injuries were reported more among the MSW workers in Hyderabad (39.7%) along with a fear of being hit by vehicles while working on the main roads. About 88.7% of the MSW workers had less than secondary education. There was a wage difference between the contract and permanent MSW workers. There was a lack of provision of personal protective equipment and poor working conditions, overall. Lack of basic amenities such as the provision of drinking water and toilets apart from inadequate social security and healthcare facilities was reported. Conclusion: This paper highlights the unsatisfactory working environment and high-occupational morbidities among the MSW workers in Telangana. There was a lack of basic amenities at the workplace making it difficult for the MSW workers. A comprehensive approach which focuses on the health and safety with social security for the MSW workers is required. [ABSTRACT FROM AUTHOR]

Purpose: In the present era of modernization, the social group members interact with each other with selfish and unselfish intents. However, the unselfish means and ends build a long term relationship among people. On the other hand, selfish ends bud out unethical means such as abuses, violence and fights. The situation becomes tough when the same becomes evident among the family relationship and as a consequence the elderly are being treated unfairly. Out of such cases, some are reported and the majority of them remain unreported, which eventually becomes the cause of concern for the social welfare agencies. Thus, this paper aims to examine the elder abuse (EA) tendency in metro, non-metro and religious cities. Design/methodology/approach: For this study, a mixed-method approach is used to develop survey instruments, validate findings using qualitative and quantitative data sources for better generalization of results. The present study explored and confirmed the related factors using exploratory factor analysis and confirmatory factor analysis for the establishment of a valid scale of EA. Further, the difference of perceptions among the elders for abuse across the metro, non-metro and religious cities was statistically checked using the ANOVA and post hoc techniques. Findings: The present study identified the traces of EA and created a comprehensive understanding of it. The present study manifests the prevailing practices of EA in society by discussing the demerits of dependency and modernization. Moreover, the present study assesses the pervasiveness and the repercussion of dependency and the impact of modernization on EA followed by a discussion on how the victim elders may handle the situation. In the present study, a scale is developed to identify EA because of the dependency of the elderly and the modernization of society. Originality/value: Some exclaiming thoughts such as the dependency of elders elevate the chances of EA on one side, while modernization of society hampers the social/family bonding leading to EA. The inconsistent development across the region has created modernization as a significant factor for EA. The level and depth of modernization across locations such as metro, non-metro and religious cities are the cause for varying degrees of EA. Based on the literature review, the present study has sensed the presence of EA in society at large by developing a scale for the aforesaid purpose. [ABSTRACT FROM AUTHOR]

Adolescent girls vulnerable to early marriage and school dropout in rural India may be at elevated risk of psychosocial problems. However, few screening instruments have been culturally adapted and validated to measure this risk. This paper describes the process by which the Primary Health Questionnaire PHQ-9, a screening instrument for depression, was tested for cultural validity as part of the Samata evaluation – an intervention to support low caste adolescent girls in rural south India to attend and complete secondary school and to delay marriage until adulthood. Three focus groups discussions (FGDs) were held with 20 adolescent girls and six outreach workers of the Samata programme in rural north Karnataka, south India. The FGDs were used to explore local expressions of psychosocial problems and to understand the acceptability and appropriateness of PHQ-9 items. A thematic content analysis was conducted on the transcripts of the FGDs. Descriptions of local expressions of psychosocial problems generally matched the items on the PHQ-9. However, not all representations of psychological symptoms were captured by this tool. Persistent worry, loneliness and isolation, and externalised behaviours were also described by participants as common expressions of psychosocial distress. Based on the limitations of translation methods, local stakeholders must be involved in evaluating the cultural appropriateness of mental health screening tools. The current research demonstrates a strategy by which to assess the cultural validity of Western psychiatric instruments with key stakeholders in low- and middle-income settings. [ABSTRACT FROM AUTHOR]

Religious-spiritual (R/S) education helps medical students cope with caregiving stress and gain skills in interpersonal empathy needed for clinical care. Such R/S education has been introduced into K-12 and college curricula in some developed nations and has been found to positively impact student’s mental health. Such a move has not yet been seen in the Indian education system. This paper aimed to examine perspectives of teachers and parents in India on appropriateness, benefits, and challenges of including R/S education into the school curriculum and also to gather their impressions on how a R/S curriculum might promote students’ health. A cross-sectional study of religiously stratified sample of teachers and parents was initiated in three preselected schools in India and the required sample size (N = 300) was reached through snowballing technique. A semi-structured questionnaire, with questions crafted from “Religion and Spirituality in Medicine, Physicians Perspective” (RSMPP) and “American Academy of Religion’s (AAR) Guidelines for Religious Literacy,” was used to determine participants’ perspectives. Findings revealed that teachers’ and parents’ “comfort in integrating R/S into school curriculum” was associated with their gender (OR 1.68), education status (OR 1.05), and intrinsic religiosity (OR 1.05). Intrinsic religiosity was significantly (p = 0.025) high among parents while “intrinsic spirituality” was high (p = 0.020) among teachers. How participants’ R/S characteristics influence their support of R/S education in school is discussed. In conclusion, participants believe R/S education will fosters students’ emotional health and interpersonal skills needed for social leadership. A curriculum that incorporates R/S education, which is based on AAR guidelines and clinically validated interpersonal spiritual care tools would be acceptable to both teachers and parents. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies using the WHOQOL measures have demonstrated that the relationship between individual items and the underlying quality of life (QoL) construct may differ between cultures. If unaccounted for, these differing relationships can lead to measurement bias which, in turn, can undermine the reliability of results.Methods: We used item response theory (IRT) to assess differential item functioning (DIF) in WHOQOL data from diverse language versions collected in UK, Zimbabwe, Russia, and India (total N = 1332). Data were fitted to the partial credit 'Rasch' model. We used four item banks previously derived from the WHOQOL-100 measure, which provided excellent measurement for physical, psychological, social, and environmental quality of life domains (40 items overall). Cross-cultural differential item functioning was assessed using analysis of variance for item residuals and post hoc Tukey tests. Simulated computer-adaptive tests (CATs) were conducted to assess the efficiency and precision of the four items banks.Results: Splitting item parameters by DIF results in four linked item banks without DIF or other breaches of IRT model assumptions. Simulated CATs were more precise and efficient than longer paper-based alternatives.Discussion: Assessing differential item functioning using item response theory can identify measurement invariance between cultures which, if uncontrolled, may undermine accurate comparisons in computer-adaptive testing assessments of QoL. We demonstrate how compensating for DIF using item anchoring allowed data from all four countries to be compared on a common metric, thus facilitating assessments which were both sensitive to cultural nuance and comparable between countries. [ABSTRACT FROM AUTHOR]

Introduction: Promotion and support of breastfeeding is a global priority and an important child-survival intervention. Accredited Social Health Activists (ASHAs) can play a significant role in the promotion of breast-feeding. Present research paper reviews their knowledge & practices with respect to Infant and Young Child Feeding (IYCF) issues. Further, it also analyzes difficulties being faced by them in promoting positive IYCF practices so that necessary support can be provided for carrying out their desired role. Material and Methods: It was a descriptive, cross-sectional study conducted in the block Doiwala of Dehradun district, Uttarakhand. All 168 ASHAs were included in the study for the assessment of knowledge and practices by interview technique based on predesigned and pre-tested questionnaire. Results: 98% ASHAs had complete and correct information about exclusive breast feeding, however only 38% ASHAs were aware that breastfeeding should be started within 4 hours in children delivered by caesarean section. Only 18% ASHAs reported to be able to motivate mothers to practice exclusive breast feeding. Insufficient mother's milk (55.4%), Caesarean sections (20.2%), coercion from elders in the family to start top milk were among the important factors attributed for failure of exclusive breastfeeding. Regarding complementary feeding, only 45% ASHAs knew the correct timing of initiation of complementary feeding; however 58% ASHAs had introduced the complementary feeding at 7th month in their children. 83.9% ASHAs knew that complementary food should be semisolid in consistency, while 87.5% and 32.7% ASHAs were aware that egg and non-vegetarian food items can be given as complementary food to the child. Bottle feeding had been practiced by about 33% of ASHAs in the past; however no ASHA had reported bottle feeding currently. Conclusion: Present research paper concludes that although knowledge level of ASHAs is high regarding IYCF practices but it does not match with the actual practices. They require skill building especially in the area of breastfeeding options for working women as well as complementary feeding. [ABSTRACT FROM AUTHOR]

Background: Waiting lists for treatment are common in outpatient and community services, Existing methods for managing access and triage to these services can lead to inequities in service delivery, inefficiencies and divert resources from frontline care. Evidence from two controlled studies indicates that an alternative to the traditional "waitlist and triage" model known as STAT (Specific Timely Appointments for Triage) may be successful in reducing waiting times without adversely affecting other aspects of patient care. This trial aims to test whether the model is cost effective in reducing waiting time across multiple services, and to measure the impact on service provision, health-related quality of life and patient satisfaction.Methods/design: A stepped wedge cluster randomised controlled trial has been designed to evaluate the impact of the STAT model in 8 community health and outpatient services. The primary outcome will be waiting time from referral to first appointment. Secondary outcomes will be nature and quantity of service received (collected from all patients attending the service during the study period and health-related quality of life (AQOL-8D), patient satisfaction, health care utilisation and cost data (collected from a subgroup of patients at initial assessment and after 12 weeks). Data will be analysed with a multiple multi-level random-effects regression model that allows for cluster effects. An economic evaluation will be undertaken alongside the clinical trial.Discussion: This paper outlines the study protocol for a fully powered prospective stepped wedge cluster randomised controlled trial (SWCRCT) to establish whether the STAT model of access and triage can reduce waiting times applied across multiple settings, without increasing health service costs or adversely impacting on other aspects of patient care. If successful, it will provide evidence for the effectiveness of a practical model of access that can substantially reduce waiting time for outpatient and community services with subsequent benefits for both efficiency of health systems and patient care.Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12615001016527 . Approved 15/9/2015. [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: Rates of perinatal depression (antenatal and postnatal depression) in South Asia are among the highest in the world. The delivery of effective psychological treatments for perinatal depression through existing health systems is a challenge due to a lack of human resources. This paper reports on a trial protocol that aims to evaluate the effectiveness and cost-effectiveness of the Thinking Healthy Programme delivered by peers (Thinking Healthy Programme Peer-delivered; THPP), for women with moderate to severe perinatal depression in rural and urban settings in Pakistan and India.Methods/design: THPP is evaluated with two randomised controlled trials: a cluster trial in Rawalpindi, Pakistan, and an individually randomised trial in Goa, India. Trial participants are pregnant women who are registered with the lady health workers in the study area in Pakistan and pregnant women attending outpatient antenatal clinics in India. They will be screened using the patient health questionnaire-9 (PHQ-9) for depression symptoms and will be eligible if their PHQ-9 is equal to or greater than 10 (PHQ-9 ≥ 10). The sample size will be 560 and 280 women in Pakistan and India, respectively. Women in the intervention arm (THPP) will be offered ten individual and four group sessions (Pakistan) or 6-14 individual sessions (India) delivered by a peer (defined as a mother from the same community who is trained and supervised in delivering the intervention). Women in the control arm (enhanced usual care) will receive health care as usual, enhanced by providing the gynaecologist or primary-health facilities with adapted WHO mhGAP guidelines for depression treatment, and providing the woman with her diagnosis and information on how to seek help for herself. The primary outcomes are remission and severity of depression symptoms at the 6-month postnatal follow-up. Secondary outcomes include remission and severity of depression symptoms at the 3-month postnatal follow-up, functional disability, perceived social support, breastfeeding rates, infant height and weight, and costs of health care at the 3- and 6-month postnatal follow-ups. The primary analysis will be intention-to-treat.Discussion: The trials have the potential to strengthen the evidence on the effectiveness and cost-effectiveness of an evidence-based psychological treatment recommended by the World Health Organisation and delivered by peers for perinatal depression. The trials have the unique opportunity to overcome the shortage of human resources in global mental health and may advance our understanding about the use of peers who work in partnership with the existing health systems in low-resource settings.Trial Registration: Pakistan Trial: ClinicalTrials.gov Identifier: NCT02111915 (9 April 2014) India Trial: ClinicalTrials.gov Identifier: NCT02104232 (1 April 2014). [ABSTRACT FROM AUTHOR]

Background: Recognizing the need to increase access to safe abortion services to reduce maternal mortality and morbidity, the state government of Bihar, India introduced an innovative mechanism of accrediting private health care facilities. The program, Yukti Yojana ('a scheme for solution'), accredits eligible health facilities and supports them in providing abortion-related services free of charge to rural and low-income urban women. This paper describes implementation of Yukti Yojana. Methods: A descriptive analysis of abortion services provided under the Yukti Yojana program was conducted using four data sources: 1) assessment of accredited facilities over 6 months; 2) induced and incomplete abortion service registers; 3) client exit interviews and associated direct observation of client-provider interaction for a sample of accredited facilities; and 4) in-depth interviews with providers and key stakeholders responsible for providing or influencing abortion services. These analyses assessed characteristics of women receiving abortion services, quality of care and client satisfaction, and barriers and facilitating factors of a successful accreditation process. Results: Forty-nine private facilities were accredited during the first two years of the program, and 84 % had begun providing abortion services, in all 27,724 women were served. Overall, 53 % of beneficiaries reported holding a "Below Poverty Line" card, while 71 % had low living standard. The majority of women (n = 569) reported satisfaction (90 %) with their care, while 68 % perceived good quality of services. Having a government-led initiative was considered a key element of success, while stringent requirements for site approval, long waiting time for accreditation, complicated and delayed reimbursement process and low reimbursement fees for abortion services were identified as barriers to implementation. Conclusions: Yukti Yojana provides a model for successfully involving private OB/GYNs and general physicians to deliver safe abortion services to poor women on a large scale and offers additional evidence that public-private partnerships can be used to ensure availability of high-quality maternal health services to women in low-income countries. Private facility accreditation also offers a promising solution to the limited availability of safe abortion services in low resource settings such as Bihar, India. [ABSTRACT FROM AUTHOR]

This paper examines the relationships between self-reported loneliness and living arrangements. A structured questionnaire with some open-ended questions was administered face-to-face in English, Hindi or Punjabi to a sample of 161 elderly South Asian immigrants 60 or more years of age living in Edmonton, Alberta, Canada in 2003. The majority of respondents said that they never felt lonely. More than one in three (37.3%) respondents indicated that they felt lonely occasionally, frequently or all of the time. Those living alone were significantly more likely to report feeling lonely at least occasionally than were those living with others, especially those living with their spouse in an extended family. The fact that South Asian immigrant seniors typically lived with others, often in an extended family with or without their spouse, and rarely lived alone protected them to some extent from loneliness. However, our findings showed that among those living with others, it was the amount of waking time spent alone at home and the quality of family relationships rather than living arrangement per se that significantly predicted self-reported loneliness. Nevertheless, living in a larger household was associated with spending less time alone. We discuss plausible influences of culture on expectations regarding family and social relationships and on the meaning of being alone, as well as practical implications for addressing loneliness in a multi-cultural society. [ABSTRACT FROM PUBLISHER]

Manipur is a geographically isolated state of India characterised by a high HIV prevalence among people who inject drugs (PWID). A low-to-moderate lifetime rate of HIV testing has been documented amongst PWID in Manipur. Little is known about the extent of undiagnosed HIV in this setting and whether uptake of HIV testing (and knowledge of a positive diagnosis) leads HIV-positive PWID to change their risk behaviours. The cross-sectional data (n= 821) analysed for this paper were collected in 2009 for the Integrated Behavioural and Biological Assessment (IBBA) using interviewer-administered questionnaires and the collection of de-linked blood and urine samples. Almost one-third (30.7%) of the participants tested HIV positive. The majority knew where to obtain a confidential HIV test (80.7%), however, half of the HIV-positive participants had either never had an HIV test (37.7%), or had undertaken a test without collecting the result (12.7%). Almost one-quarter (23.4%) of the HIV-positive participants and 17.4% of the HIV-negative participants had shared a needle/syringe with at least one other injector during the preceding month. Encouragingly, HIV-positive participants were significantly more likely than HIV-negative participants to use condoms with their regular sexual partners, however, there was still a high proportion of HIV-positive participants who did not use a condom at last sex with their regular (47.2%) or casual (48.0%) partners. Having taken an HIV test and collected the result was associated with a reduction in HIV-risk behaviours among HIV-positive participants, but not among HIV-negative participants. In conclusion, we found that a substantial proportion of the HIV-positive PWID in Manipur were not aware of their positive status, and risky injecting and sexual practices were commonplace. However, HIV-positive PWID appear to reduce their high-risk behaviours when they become aware of their HIV status highlighting the importance of taking HIV testing coverage to scale. [ABSTRACT FROM PUBLISHER]

HIV epidemic in India is predominantly concentrated in subgroups of population, such as female sex workers (FSWs) and their clients, whose behavior exposes them to a higher risk of acquiring HIV infection. This paper aims to present the changing patterns of socio-demographic characteristics, behaviors, reported sexually transmitted infections (STIs), and associated factors among FSWs over 11 years. Multistage cluster sampling with probability-proportional-to-size (PPS) method was used in the surveys. A sample of 400 FSWs was studied every year. The mean age and literacy at the baseline level increased significantly over the years. House-based sex increased by 40% from 43.3% in 1997 to 83% in 2008 (p<0.001). Condom use at last sex with one-time clients; consistent condom use (CCU) with one-time and regular clients indicated increasing trends. FSWs reported low levels of condom use at last sex (14.5% in 1997 to 5% in 2008;p<0.001) and CCU (12.6% in 2004 to 3.6% in 2008;p<0.01) with regular partners. FSWs who used condom with one-time clients at last sex reported significantly less STI symptoms. A two-third reduction in genital ulcers was found from 13.1% in 1997 to 4.5% in 2008 (p<0.001). Nonliterate and hotel-based sex workers were 1.6 (1.0–2.5; 95% CI) and 2.2(1.3–3.7; 95% CI) times more likely to have reported STI symptoms. The percentage of FSWs who underwent HIV testing increased (p<0.001); similarly, a 20% increase was found in FSWs who availed counseling services from 65.2% in 1997 to 85.4% in 2008 (p<0.001). Poor, illiterate, and marginalized were more likely to get involved in risky behaviors which suggest the need for structural interventions as part of HIV prevention strategy. [ABSTRACT FROM AUTHOR]

The School Mental Health (SMH) services play critical roles fostering positive mental health and helping children with psychological problems. Despite its proven value, SMH services remain less developed in India. In this context, sensitizing teachers about child mental health issues could be considered as an important step in SMH promotion. Towards this goal, a large scale sensitization program for school teachers on SMH issues was carried out in an Indian city. This paper reports the process and the outcome of this sensitization program. [ABSTRACT FROM AUTHOR]

Background: A large state-wide tobacco survey was conducted using modified version of pretested, globally validated Global Adult Tobacco Survey (GATS) questionnaire in 2015–22016 in Tamil Nadu, India. Due to resource constrains, data collection was carrid out using paper-based questionnaires (unlike the GATS-India, 2009–2010, which used hand-held computer devices) while data entry was done using open access tools. The objective of this paper is to describe the process of data entry and assess its quality assurance and efficiency. Methods: In EpiData language, a variable is referred to as ‘field’ and a questionnaire (set of fields) as ‘record’. EpiData software was used for double data entry with adequate checks followed by validation. Teamviewer was used for remote training and trouble shooting. The EpiData databases (one each for each district and each zone in Chennai city) were housed in shared Dropbox folders, which enabled secure sharing of files and automatic back-up. Each database for a district/zone had separate file for data entry of household level and individual level questionnaire. Results: Of 32,945 households, there were 111,363 individuals aged ≥15 years. The average proportion of records with data entry errors for a district/zone in household level and individual level file was 4% and 24%, respectively. These are the errors that would have gone unnoticed if single entry was used.The median (inter-quartile range) time taken for double data entry for a single household level and individual level questionnaire was 30 (24, 40) s and 86 (64, 126) s, respectively. Conclusion: Efficient and quality-assured near-real-time data entry in a large sub-national tobacco survey was performed using innovative, resource-efficient use of open access tools. [ABSTRACT FROM PUBLISHER]