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ntroduction: Physical inactivity and the associated health problems pose a current and growing threat to public health. People with sedentary behaviour are at higher risk of suffering from symptoms of anxiety and depression. Medical students suffer very high levels of psychiatric illness, depression, suicide, dependence on alcohol and drug abuse. Objectives: 1. To assess the level of physical activity and mental health status among medical students. 2. To compare the mental health status in relation to the adequacy level of physical activity among them. Method: Cross-sectional study was conducted among 145 undergraduate medical students. Data was collected using pre-tested and pre-designed proforma. International Physical activity Questionnaire short form (IPAQ-SF) and General Health Questionnaire-12 (GHQ-12) were used to assess level of physical activity and mental health status respectively. Statistical analysis was done using SPSS version 27.0. Descriptive statistics and chi-square test was applied. Results: Among 145 medical students, 60% and 16.55% were found to have moderate and low physical activity. Distress and psychological distress was found to be among 27.59% and 22.75% students. It was found that, 50% of the participants, who were doing low level of physical activity were found to be distressed, which was found to be statistically significant. (χ2 = 10.826, df = 4, p = 0.02859073). Conclusion: Physical activity and mental health are related proportionally. Regular physical activity has the potential to reduce anxiety, distress, and depression. Importance of physical activity, which has positive influence must be emphasised to reduce mental stress among medical students.

High maternal and neonatal mortality rates persist in Mozambique, with stillbirths remaining understudied. Most maternal and neonatal deaths in the country are due to preventable and treatable childbirth-related complications that often occur in low-resource settings. The World Health Organization introduced the Safe Childbirth Checklist (SCC) in 2015 to reduce adverse birth outcomes. The SCC, a structured list of evidence-based practices, targets the main causes of maternal and neonatal deaths and stillbirths in healthcare facilities. The SCC has been tested in over 35 countries, demonstrating its ability to improve the quality of care. However, it has not been adopted in Mozambique. This study aimed to identify potential facilitators and barriers to SCC implementation from the perspective of birth attendants, clinical administrators, and decision-makers to inform future SCC implementation in Mozambique. We conducted a qualitative study involving focus group discussions with birth attendants (n = 24) and individual interviews with clinical administrators (n = 6) and decision-makers (n = 8). The Consolidated Framework for Implementation Research guided the questions used in the interviews and focus group discussions, as well as the subsequent data analysis. A deductive thematic analysis of Portuguese-to-English translated transcripts was performed. In Mozambique, most barriers to potential SCC implementation stem from the challenges within a weak health system, including underfunded maternal care, lack of infrastructure and human resources, and low provider motivation. The simplicity of the SCC and the commitment of healthcare providers to better childbirth practices, combined with their willingness to adopt the SCC, were identified as major facilitators. To improve the feasibility of SCC implementation and increase compatibility with current childbirth routines for birth attendants, the SCC should be tailored to context-specific needs. Future research should prioritize conducting pre-implementation assessments to align the SCC more effectively with local contexts and facilitate sustainable enhancements in childbirth practices.

Abstract Objective: Data evaluating timeliness of antibiotic therapy in Clostridioides difficile infections (CDI) are not well established. The study’s purpose was to evaluate the impact of time-to-CDI treatment on disease progression. Methods: A case–control study was performed among hospitalized patients with CDI from 1/2018 to 2/2022. Inclusion criteria were age ≥65 years, first occurrence, non-severe CDI at symptom onset, and CDI treatment for ≥72 hours. Cases included patients who progressed to severe or fulminant CDI; controls were patients without CDI progression. Time to CDI treatment was evaluated in three ways: a classification and regression tree (CART)-defined threshold, time as a continuous variable, and time as a categorical variable. Results: 272 patients were included; 136 with CDI progression, 136 patients without. The median (IQR) age was 74 (69–81) years, 167 (61%) were women, and 108 (40%) were immunosuppressed. CDI progression patients more commonly were toxin positive (66 [49%] vs 52 [38%], P = .087) with hospital-acquired disease (57 [42%] vs 29 [21%], P < 0.001). A CART-derived breakpoint for optimal time-to-CDI treatment of 64 hours established early (184, 68%) and delayed treatment (88, 32%). When accounting for confounding variables, delayed CDI treatment was associated with disease progression (adjOR, 4.6; 95%CI, 2.6–8.2); this was observed regardless of how time-to-CDI-active therapy was evaluated (continuous adjOR, 1.02; categorical adjOR, 2.11). Conclusion: Delayed CDI treatment was associated with disease progression and could represent an important antimicrobial stewardship measure with future evaluation.

Background: QOL is defined as “individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.” Pregnancy is a physiological state associated with several emotional and physical changes, and the antenatal period is the moment of preparation of the woman for the childbirth and maternity. Thus, poor quality of life can have adverse effects on mother and the fetus. In order to develop methods to improve the quality of life of pregnant women, the factors affecting it should be understood; and our study aims at providing such understanding. Methodology: A hospital based Cross-sectional study of the pregnant women seeking antenatal health care in Government Lady Goschen Hospital and KMC, Attavar. The data collection was done from 14-03-16 to 31-03-16 using a questionnaire consisting of 4 parts-participant details, WHO QOL- BREF, QIDS and modified Kuppuswamy scale. Results: The study was done among 195 pregnant women, and the mean QOL-BREF score was found to be 73.60. 60.5% participants belonged to lower socioeconomic status, and had a lower QOL in physical, psychological and environmental domains. 54.6% participants showed symptoms of depression and had a lower QOL in physical domain. Other factors like parity, history of abortion and complications in the current pregnancy did not show a significant association with QOL score. Conclusion: The QOL of antenatal women seeking health care in tertiary health care setup was found to be good. The factors that significantly affected the quality of life were depression and lower socio-economic status. They had a negative impact on the quality of life.

The effects of COVID-19-associated restrictions on youth sexual and reproductive health (SRH) care during the pandemic remain unclear, particularly in sub-Saharan Africa. This study uses interrupted time series analyses to assess changes in SRH care utilisation (including visits for HIV testing and treatment, family planning, and antenatal care) adolescent girls’ and young women’s (AGYW; aged 15–24 years old) in eSwatini following COVID-19 lockdown beginning in March 2020. SRH utilisation data from 32 clinics in the Manzini region that remained open throughout the 2020 COVID-19 period were extracted from eSwatini’s electronic health record system. We tabulated and graphed monthly visits (both overall and by visit type) by AGYW during the two-year period between January 2019 and December 2020. Despite the March to September 2020 lockdown, we did not detect significant changes in monthly visit trends from 2019 to 2020. Our findings suggest little change to AGYW’s SRH utilisation in eSwatini during the 2020 COVID-19 lockdown period.

Background Organizational culture has been widely recognized as predictive of health system performance and improved outcomes across various healthcare settings. Research on organizational culture in healthcare has been largely conducted in high-income settings, and validated scales to measure this concept in primary healthcare systems in lowand middle-income country (LMIC) settings are lacking. Our study aimed to validate a tool to measure organizational culture in the context of the Ethiopian Primary Healthcare Transformation Initiative (PTI), a collaborative of the Federal Ministry of Health (FMoH) and the Yale Global Health Leadership Initiative to strengthen primary healthcare system performance in Ethiopia.Methods Following established survey development and adaptation guidelines, we adapted a 31-item US-based organizational culture scale using (1) cognitive interviewing, (2) testing with 1176 district and zonal health officials from four regions in Ethiopia, and (3) exploratory factor analysis (EFA).Results Based on the results of cognitive interviewing, an adapted 30-item survey was piloted. The factor analyses of 1034 complete surveys (88% complete responses) identified five constructs of the scale which demonstrated strong validity and internal consistency: learning and problem solving, psychological safety, resistance to change, time for improvement, and commitment to the organization. Of the 30 a priori items, 26 items loaded well on the five constructs (loading values 0.40-0.86), and 4 items failed to load. Cronbach alpha coefficients were 0.86 for the scale as a whole and ranged from 0.65 to 0.90 for the subscales. The five-factor solution accounted for 62% of total variance in culture scores across respondents.Conclusion Through validation and factor analyses, we generated a 26-item scale for measuring organizational culture in public primary healthcare systems in LMIC settings. This validated tool can be useful for managers, implementers, policy-makers, and researchers to assess and improve organizational culture in support of improved primary healthcare system performance.

Background: Menopause is a normal physiological change and an important transition in women’s life. Onset of menopause has important implications on women’s fertility and health. Menopausal symptoms vary in severity and may decrease quality of life Thise is, because the majority of women still do not take treatment for these symptoms as most Indian women have a history of self-denial and neglect. This study is conducted to find the prevalence of postmenopausal symptoms among women resisting in urban slums Methods: This was a community based, cross-sectional study conducted among 334 postmenopausal women (45-60) residing in urban slums by systematic random sampling. Menopause Rating Scale (MRS) was used to assess postmenopausal symptoms Pre-designed, pre-tested proforma was used for collecting data to identify the factors affecting it. General physical examination was carried out and anthropometric measurements were recorded. Data were analysed using SPSS software version 20. Results were expressed as descriptive statistics (Mean (SD), Frequency (%)) and Chi-square test was used to find the association between two attributes. Results: 69.76% of participants had mild symptoms, 23.95% moderate symptoms and only 2.1% suffered from severe symptoms. Prevalence of somatic symptoms was 93.11%, psychological symptoms 85.33% and urogenital symptoms was 33.53%. 44.31% of women from class 4 of SES suffered from mild to severe symptoms, followed by class 3 with 20.06% (p= 0.00005). 73.86% from nuclear families and 66.67% for three generations in their families suffered from mild symptoms (p=0.0001) Conclusion: The prevalence of somatic postmenopausal symptoms was high compared to psychological and urogenital using MRS. Factors like age, poor socio-economic status, marital and educational status played a role in postmenopausal symptoms. Measures should be taken for early recognition of symptoms and treatment. To achieve this, the government, private, and voluntary organizations can establish postmenopausal clinics as soon as possible at the earliest at all levels of healthcare.

Background District management is emerging as a lynchpin for primary healthcare system performance. However, delivery of district-level interventions at scale is challenging, and overlooks the potential role of management at other subnational levels. From 2015-2019, Ethiopia’s Primary Healthcare Transformation Initiative (PTI), aimed to build a culture of performance management and accountability at the zonal level. This paper aims to evaluate the longitudinal change in management practice and performance in the 19 zones participating in PTI, which included 315 districts and 1617 health centers.Methods Using data from PTI intervention (2018 to 2019), we employed quantitative measures of management capacity at health center, district, and zonal levels, and quantified primary healthcare service performance using a summary score based on antenatal care coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. We used multiple generalized linear regression models accounting for clustering of health centers within zones to quantify (1) change in management and performance during the two-year intervention, (2) associations between the changes in management capacity at the zonal, district, and health facility level.Results Adherence to management standards at the zonal, district, and health facility level improved significantly over two years (37%, p

BackgroundDespite a wide range of interventions to improve district health management capacity in low-income settings, evidence of the impact of these investments on system-wide management capacity and primary healthcare systems performance is limited. To address this gap, we conducted a longitudinal study of the 36 rural districts (woredas), including 229 health centers, participating in the Primary Healthcare Transformation Initiative (PTI) in Ethiopia. MethodsBetween 2015 and 2017, we collected quantitative measures of management capacity at the district and health center levels and a primary healthcare key performance indicator (KPI) summary score based on antenatal care (ANC) coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. We conducted repeated measures analysis of variance (ANOVA) to assess (1) changes in management capacities at the district health office level and health center level, (2) changes in health systems performance, and (3) the differential effects of more vs less intensive intervention models. ResultsAdherence to management standards at both district and health center levels improved during the intervention, and the most prominent improvement was achieved during district managers’ exposure to intensive mentorship and education. We did not observe similar patterns of change in KPI summary score. ConclusionThe district health office is a valuable entry point for primary healthcare reform, and district- and facility-level management capacity can be measured and improved in a relatively short period of time. A combination of intensive mentorship and structured team-based education can serve as boh an accelerator for change and a mechanism to inform broader reform efforts.

Background: Antibiotics alone are often insufficient to treat recurrent C. difficile infection (rCDI) because they have no activity against C. difficile spores that germinate within a disrupted microbiome. SER-109, an investigational, oral, microbiome therapeutic comprised of purified Firmicutes spores, was designed to reduce rCDI through microbiome repair. We report an integrated efficacy analysis through week 24 for SER-109 from phase 3 studies, ECOSPOR III and ECOSPOR IV. Methods: ECOSPOR III was a randomized, placebo-controlled phase 3 trial conducted at 56 US or Canadian sites that included 182 participants with ≥2 CDI recurrences, confirmed via toxin EIA testing. Participants were stratified by age (

Objective: Covid-19 is a highly infectious viral disease, and our understanding of the impact of this virus on the nervous system is limited. Therefore, we aimed to do a systematic analysis of the neurological manifestations. Methods: We retrospectively studied the clinical, laboratory, and radiological findings of patients with major neurological syndromes (MNS) in Covid-19 over 6 months. Results: We had 39 patients with major neurological syndromes (MNS). The most common MNS was cerebrovascular disease (CVD) (61.53%), in which ischemic stroke (83.33%), cortical sinus thrombosis (12.50%), and haemorrhagic stroke (4.16%) were seen. Among ischemic stroke patients, 50% had a large vessel occlusion, and 66.66% of patients with CVD had a significant residual disability. Cranial neuropathy (15.38%), GBS (10.26%), encephalitis (7.26%), and myelitis (5.12%) were the other MNS. Among the three encephalitis cases, two had CSF-Covid-19 PCR positivity and had severe manifestations and a poor outcome. Associated comorbidities included hypertension (30.76%), diabetes mellitus (12.82%), chronic kidney diseases (7.69%), and polycythaemia vera (2.56%). Lung involvement was seen in 64.1% of patients. Mortality was 17.94% in MNS with Covid-19. Conclusions: The most common major neurological syndrome associated with Covid-19 is CVD with increased frequency of large vessel occlusion causing significant morbidity and mortality. Simultaneous lung and other systemic involvement in MNS results in a deleterious outcome. Doi: 10.28991/SciMedJ-2022-0401-02 Full Text: PDF

Introduction: India is facing a dual burden of malnutrition with high prevalence of underweight and increasing prevalence of overweight/obesity. Methodology: This study reports anthropometric findings (body mass index, waist circumference [WC], and waist–hip ratio [WHR]) from the screening of 3296 students admitted during 2018–2019. Results: Majority of the students were male (70%), with a mean age of 18.57 years. About 31% and 19% of students were underweight and overweight, respectively. Given sex-specific cutoffs for WC and WHR, about 5% and 21% of students were at substantially increased risk of metabolic complications. About 14.5% of normal and underweight students were also found to be at substantially increased risk of metabolic complications. Multivariate analysis found increasing age (odds ratio [OR] = 0.92; 95% confidence interval [CI]: 0.88–0.98) and being male (OR = 0.74; 95% CI: 0.62–0.88) to be protective factors against underweight. We did not find any statistically significant correlation for overweight, for WHR among males, and WC and WHR among females. Conclusion: It has been noted that the college environment increases the risk of weight gain. Hence, it makes a case to periodically study changes in anthropometric measures through a longitudinal study, and accordingly develop life cycle-based interventions for prevention/management of undernutrition, obesity, and related complications.

Abstract Background Government-sponsored health insurance schemes (GSHIS) aim to improve access to and utilization of healthcare services and offer financial protection to the population. India’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one such GSHIS. This paper aims to understand how the processes put in place to manage hospital-based transactions, from the time a beneficiary arrives at the hospital to discharge are being implemented in PM-JAY and how to improve them to strengthen the scheme’s operation. Methods Guidelines were reviewed for the processes associated with hospital-based transactions, namely, beneficiary authentication, treatment package selection, preauthorization, discharge, and claims payments. Across 14 hospitals in Gujarat and Madhya Pradesh states, the above-mentioned processes were observed, and using a semi-structured interview guide fifty-three respondents were interviewed. The study was carried out from March 2019 to August 2019. Results Average turn-around time for claim reimbursement is two to six times higher than that proposed in guidelines and tender. As opposed to the guidelines, beneficiaries are incurring out-of-pocket expenditure while availing healthcare services. The training provided to the front-line workers is software-centric. Hospital-based processes are relatively more efficient in hospitals where frontline workers have a medical/paramedical/managerial background. Conclusions There is a need to broaden capacity-building efforts from enabling frontline staff to operate the scheme’s IT platform to developing the technical, managerial, and leadership skills required for them. At the hospital level, an empowered frontline worker is the key to efficient hospital-based processes. There is a need to streamline back-end processes to eliminate the causes for delay in the processing of claim payment requests. For policymakers, the most important and urgent need is to reduce out-of-pocket expenses. To that end, there is a need to both revisit and streamline the existing guidelines and ensure adherence to the guidelines.

Abstract GDC‐0334 is a novel small molecule inhibitor of transient receptor potential cation channel member A1 (TRPA1), a promising therapeutic target for many nervous system and respiratory diseases. The pharmacokinetic (PK) profile and pharmacodynamic (PD) effects of GDC‐0334 were evaluated in this first‐in‐human (FIH) study. A starting single dose of 25 mg was selected based on integrated preclinical PK, PD, and toxicology data following oral administration of GDC‐0334 in guinea pigs, rats, dogs, and monkeys. Human PK and PK‐PD of GDC‐0334 were characterized after single and multiple oral dosing using a population modeling approach. The ability of GDC‐0334 to inhibit dermal blood flow (DBF) induced by topical administration of allyl isothiocyanate (AITC) was evaluated as a target‐engagement biomarker. Quantitative models were developed iteratively to refine the parameter estimates of the dose‐concentration‐effect relationships through stepwise estimation and extrapolation. Human PK analyses revealed that bioavailability, absorption rate constant, and lag time increase when GDC‐0334 was administered with food. The inhibitory effect of GDC‐0334 on the AITC‐induced DBF biomarker exhibited a clear sigmoid‐Emax relationship with GDC‐0334 plasma concentrations in humans. This study leveraged emerging preclinical and clinical data to enable iterative refinement of GDC‐0334 mathematical models throughout the FIH study for dose selection in subsequent cohorts throughout the study. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC? GDC‐0334 is a novel, small molecule TRPA1 inhibitor and a pharmacokinetic‐pharmacodynamic (PK‐PD) modeling strategy could be implemented in a systematic and step‐wise manner to build and learn from emerging data for early clinical development. WHAT QUESTION DID THIS STUDY ADDRESS? Can noncompartmental and population‐based analyses be used to describe the PK and PD characteristics of GDC‐0334 in preclinical and clinical studies? WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE? GDC‐0334 exposure generally increased with dose in rats, dogs, and monkeys. The starting dose (25 mg) in the clinical study was determined based on the preclinical data. GDC‐0334 exhibited linear PK in humans and the bioavailability was increased with food. The inhibitory effect of GDC‐0334 on dermal blood flow induced by the TRPA1 agonist allyl isothiocyanate in humans indicates a clear PK‐PD relationship. HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE? The models developed based on TRPA1 agonist‐induced dermal blood flow inhibition data can be used to predict PK‐PD relationships in future preclinical and clinical studies evaluating new drug entities that target TRPA1.

BackgroundDuring the second wave of the COVID-19 pandemic in India, the Ministry of Ayush conducted a community study to provide therapeutic care to patients with asymptomatic, mild, and moderate COVID-19 in home isolation based on the empirical evidence generated on the efficacy of AYUSH-64 in COVID-19.ObjectiveTo document disease characteristics, care-seeking behavior, and outcomes in patients with asymptomatic, mild, or moderate COVID-19 in home isolation who used AYUSH-64 for COVID-19.MethodsCross-sectional analysis of the data generated through a community study conducted in India from 08 May to 31 August 2021 was performed to study the disease characteristics, care-seeking behavior during home isolation, clinical outcomes, adverse events, and the association between various risk factors and clinical recovery during the study period. The data were collected through semi-structured questionnaires, available in electronic data collection format at the baseline, 7, 14, and 21 days. A logistic regression was performed to explore the relationship between relevant variables and clinical recovery.ResultsData from 64,642 participants were analyzed for baseline assessment, and final analysis was done for 49,770 participants. The mean age of the enrolled participants was 38.8 ± 11.7 years, and 8.4% had co-morbidities. AYUSH-64 was utilized as an add-on to the standard care by 58.3% of participants. Comparable clinical outcomes were observed in participants utilizing AYUSH-64 either as a standalone or as an add-on to standard care, in terms of clinical recovery, disease progression, the requirement for oxygen supplementation, hospitalization, ICU admission, and need for ventilator support. Younger age, having no co-morbidities or substance abuse, and having been vaccinated were associated with early clinical recovery than those who were older and not vaccinated.ConclusionsThe study findings suggest that AYUSH-64 use, either standalone or as an adjunct to standard care, in asymptomatic, mild, or moderate COVID-19 is associated with good clinical outcomes. Ayush services and interventions can be effectively integrated into the mainstream public health architecture to serve public health goals.

Abstract Background South Africa is home to 7.7 million people living with HIV and supports the largest antiretroviral therapy (ART) program worldwide. Despite global investment in HIV service delivery and the parallel challenge of non-communicable diseases (NCDs), there are few examples of integrated programs addressing both HIV and NCDs through differentiated service delivery. In 2014, the National Department of Health (NDoH) of South Africa launched the Central Chronic Medicines Dispensing and Distribution (CCMDD) program to provide patients who have chronic diseases, including HIV, with alternative access to medications via community-based pick-up points. This study describes the expansion of CCMDD toward national scale. Methods Yale monitors CCMDD expansion as part of its mixed methods evaluation of Project Last Mile, a national technical support partner for CCMDD since 2016. From March 2016 through October 2019, cumulative weekly data on CCMDD uptake [patients enrolled, facilities registered, pick-up points contracted], type of medication provided [ART only; NCD only; and ART-NCD] and collection sites preferred by patients [external pick-up points; adherence/outreach clubs; or facility-based fast lanes], were extracted for descriptive, longitudinal analysis. Results As of October 2019, 3,436 health facilities were registered with CCMDD across 46 health districts (88 % of South Africa’s districts), and 2,037 external pick-up points had been contracted by the NDoH. A total of 2,069,039 patients were actively serviced through CCMDD, a significant increase since 2018 (p

Recurrent and acute bleeding from intestinal tract angioectasia (AEC) presents a major challenge for clinical intervention. Current treatments are empiric, with frequent poor clinical outcomes. Improvements in understanding the pathophysiology of these lesions will help guide treatment. Using data from the US Food and Drug Administration (FDA)’s Adverse Event Reporting System (FAERS), we analyzed 12 million patient reports to identify drugs inversely correlated with gastrointestinal bleeding and potentially limiting AEC severity. FAERS analysis revealed that drugs used in patients with diabetes and those targeting PPARγ‐related mechanisms were associated with decreased AEC phenotypes (P

Background: The prevalence and pattern of skin diseases are influenced by the overall ecosystem of the region. There is a dearth of research about prevalence, health-care seeking, compliance, and treatment outcome in skin diseases among scheduled tribes. Objectives: The aim of this study is to understand the magnitude of skin diseases in tribal area of Dahod, Gujarat using a simple “Store and Forward” technique of teledermatology. Materials and Methods: A cross-sectional study was conducted in 10 randomly selected villages of Dahod and Jhalod blocks of Dahod district of Gujarat during June–August 2017. Trained surveyors visited households randomly in different localities (called Faliya) of each village ensuring representativeness. Survey responses were captured on mobile-based MAGPI portal, and images of skin conditions were capture on smart phones, and de-identified images were transferred over WhatsApp. Results: A total of 781 households were approached in 10 villages and 2214 participants consented. Among them, 549 were identified with suspected skin diseases, but 520 consented for photograph. The skin diseases were more prevalent among males, children, and elderly. Of 520, 44 (8.5%) could not be assess due to poor quality photograph and 35 (6.7%) did not have any clinically significant condition. Thus, of 2214 participants, 441 (20%) had skin diseases, and infections and eczema were major conditions constituting two-third of the skin diseases in the study population. The treatment-seeking behavior and compliance to treatment was poor. Conclusion: Considering the high prevalence of skin diseases in tribal villages of Dahod, Gujarat coupled with limited availability of trained dermatologist, new innovative avenues like teledermatology should be explored.

Background: Considering the impact of lockdown on older adults, there is a need for some online option to maintain the physical and mental well-being of this vulnerable population in the current pandemic situation. Generally, In the Indian context, elderly are not well acquainted with online platforms for different purposes of shopping, health or for being socially active. However with adequate training they are willing to learn new technologies and adapt to online platforms. Objectives: To find the satisfaction of Online group exercise program for older adult’s population to maintain their physical and mental well-being. Methodology: It was a web-based intervention study where 40 participants were invited to fill the patient satisfaction questionnaire and feedback form using Google Forms. Participants who have attended the online group exercise class at least for a period of 1 month (20 Sessions) were included in the study. Out of 40, 34 participants responded to the questionnaire. Results: As per descriptive statistical analysis, results showed that 100% of study population was satisfied in all aspects of online exercise program. Conclusion: With adequate training and constant technical support; elderly population can be encouraged to participate in online group exercise program which is well appreciated by this population as an alternative option in changing health care delivery models.

Abstract Background Opioid overdoses are at an epidemic in the United States causing the deaths of thousands each year. Project DAWN (Deaths Avoided with Naloxone) is an opioid overdose education and naloxone distribution program in Ohio that distributes naloxone rescue kits at clinics and in the emergency departments of a single hospital system. Methods We performed a retrospective analytic cohort study comparing heroin overdose survivors who presented to the emergency department and were subsequently discharged. We compared those who received a naloxone rescue kit at discharge with those who did not. Our composite outcome was repeat opioid overdose related emergency department visit(s), hospitalization and death at 0–3 months and at 3–6 months following emergency department overdose. Heroin overdose encounters were identified by ICD- 9 or 10 codes and data was abstracted from the electronic medical record for emergency department patients who presented for heroin overdose and were discharged over a 31- month period between 2013 and 2016. Patients were excluded for previous naloxone access, incarceration, suicidal ideation, admission to the hospital or death from acute overdose on initial emergency department presentation. Data was analyzed with the Chi- square statistical test. Results We identified 291emergency department heroin overdose encounters by ICD-9 or 10 codes and were analyzed. A total of 71% of heroin overdose survivors received a naloxone rescue kit at emergency department discharge. Between the patients who did not receive a naloxone rescue kit at discharge, no overdose deaths occurred and 10.8% reached the composite outcome. Of the patients who received a naloxone rescue kit, 14.4% reached the composite endpoint and 7 opioid overdose deaths occurred in this cohort. No difference in mortality at 3 or 6 months was detected, p = 0.15 and 0.36 respectively. No difference in the composite outcome was detected at 3 or 6 months either, p = 0.9 and 0.99 respectively. Conclusions Of our emergency department patients receiving a naloxone rescue kit we did not find a benefit in the reduction of repeat emergency department visits hospitalizations, or deaths following a non-fatal heroin overdose.

Context: In India, people residing in slum are not able to get safe food, drinking water, and shelter. Special vulnerable group such as women and children are at higher risk for infectious- and nutritional-related problems. Because of the dual responsibility of working women for her family and job, chances are always higher that the reproductive and child health (RCH) of such families are compromised. Aims: The aim of this study is to assess RCH profile of working women residing in slums. Subjects and Methods: A community-based cross-sectional observational study was carried out among slums of Rajkot city. With the usage of simple random sampling technique and informed verbal consent for the study, a total of 480 working and nonworking women were enrolled in this study. Semi-closed prestandardized questionnaire was used to capture their sociodemographic, reproductive health, and child health parameters. The World Health Organization growth standard was used to categorize the nutritional status of their children. Results: Age of marriage and first conception were significantly delayed among working women. Only 37.8%working women had adequate birth spacing between two children. About 33.3% had received adequate antenatal care (ANC) services during pregnancy. Higher prevalence of malnutrition (65.2%) and lower prevalence of full immunization (39.4%) were found among children of working women. Conclusions: Low birth spacing, lower utilization of ANC care services, higher malnutrition, and poor immunization coverage among working women had indicated underutilization of RCH services by working women of slum.

Background: Central obesity is the important risk factor in metabolic syndrome which is in turn cardiovascular risk factor which will increase the morbidity and mortality. The study was conducted to assess the anthropometric indices in predicting metabolic syndrome among obese adults. Methods: Cross sectional study was done among 264 adults having BMI more than 35 and visiting our hospital for a period of three months were included. A predesigned and pretested proforma was used to collect data. Anthropometric measurements, Blood pressure and diabetic profile was measured. Data was analysed using SPSS. Results: Among 264 adults, 118 (44.69%) had metabolic syndrome; Majority belonged to 30- 39 years (40.15%); educated up to PUC (32.58%) and belonged to class II socio-economic status (38.64%). There was significant mean difference between waist circumference, diastolic blood pressure, HDL levels and FBS levels among the study participants who had and who didn’t have metabolic syndrome. Area under curve (AUC) for waist: height ratio was 0.969, whereas for waist circumference and BMI it was 0.956 and 0.689 respectively. Conclusion: Waist: height ratio can predict metabolic syndrome better than waist circumference and BMI. Central obesity should be identified at the earliest than general obesity. So that lifestyle modifications can be advised in early life to avoid further morbidity leading to further permanent disabilities and life threatening events in future.

Background: India contributes 20% global maternal deaths every year. An important reason of such maternal mortality is due to cost of maternity services which makes it in accessible to the poor. Knowledge of maternity-related expense and its determinants is useful for health authorities to focus public resources and target financial assistance or exemption guidelines toward the “neediest.” Methodology: It was a cross-sectional descriptive study conducted amongst 180 women living in urban slums and who had delivered a baby within 1 year of the interview date. Results: The mean cost of delivery was around Rs. 8880. The average delivery cost of private institutions was significantly higher than that of government hospitals or home delivery. Around 75% of women delivered in private institution had health expenditure of more than 10% of total annual family income – catastrophic expenditure. Conclusion: In spite of significantly higher maternity care-related costs in private institutes than government hospitals, majority of mothers had utilized services from private clinics and had suffered catastrophic expenditures during utilization of maternity care services. This study highlights the need for birth preparedness counseling as well as effective implementation of maternity benefit schemes to prevent families from pushing downward to the poverty line.

Abstract Background Community health workers are essential personnel in resource-limited settings. In Uganda, they are organized into Village Health Teams (VHTs) and are focused on infectious diseases and maternal-child health; however, their skills could potentially be utilized in national efforts to reduce the growing burden of non-communicable diseases (NCDs). We sought to assess the knowledge of, and attitudes toward NCDs and NCD care among VHTs in Uganda as a step toward identifying their potential role in community NCD prevention and management. Methods We administered a knowledge, attitudes and practices questionnaire to 68 VHT members from Iganga and Mayuge districts in Eastern Uganda. In addition, we conducted four focus group discussions with 33 VHT members. Discussions focused on NCD knowledge and facilitators of and barriers to incorporating NCD prevention and care into their role. A thematic qualitative analysis was conducted to identify salient themes in the data. Results VHT members possessed some knowledge and awareness of NCDs but identified a lack of knowledge about NCDs in the communities they served. They were enthusiastic about incorporating NCD care into their role and thought that they could serve as effective conduits of knowledge about NCDs to their communities if empowered through NCD education, the availability of proper reporting and referral tools, and visible collaborations with medical personnel. The lack of financial remuneration for their role did not emerge as a major barrier to providing NCD services. Conclusions Ugandan VHTs saw themselves as having the potential to play an important role in improving community awareness of NCDs as well as monitoring and referral of community members for NCD-related health issues. In order to accomplish this, they anticipated requiring context-specific and culturally adapted training as well as strong partnerships with facility-based medical personnel. A lack of financial incentivization was not identified to be a major barrier to such role expansion. Developing a role for VHTs in NCD prevention and management should be a key consideration as local and national NCD initiatives are developed.

BACKGROUND:Case management in children with cutaneous leishmaniasis (CL) is mainly based on studies performed in adults. We aimed to determine the efficacy and harms of interventions to treat CL in children. METHODS:We conducted a systematic review of clinical trials and cohort studies, assessing treatments of CL in children (≤12 years old). We performed structured searches in PubMed, CENTRAL, LILACS, SciELO, Scopus, the International Clinical Trials Registry Platform (ICTRP), clinicaltrials.gov and Google Scholar. No restrictions regarding ethnicity, country, sex or year of publication were applied. Languages were limited to English, Spanish and Portuguese. Two reviewers screened articles, completed the data extraction and assessment of risk of bias. A qualitative summary of the included studies was performed. RESULTS:We identified 1092 records, and included 8 manuscripts (6 Randomized Clinical Trials [RCT] and 2 non-randomized studies). Most of the articles excluded in full-text review did not report outcomes separately for children. In American CL (ACL), 5 studies evaluated miltefosine and/or meglumine antimoniate (MA). Their efficacy varied from 68-83% and 17-69%, respectively. In Old-World CL (OWCL), two studies evaluated systemic therapies: rifampicin and MA; and one study assessed efficacy of cryotherapy (42%, Per Protocol [PP]) vs intralesional MA (72%, PP). Few studies (4) provided information on adverse events (AEs) for children, and no serious AEs were reported in participants. Risk of bias was generally low to unclear in ACL studies, and unclear to high in OWCL studies. CONCLUSION:Information on efficacy of treatment for CL in children is scarce. There is an unmet need to develop specific formulations, surveillance of AEs, and guidelines both for the management of CL and clinical trials involving the pediatric population. REGISTRATION:The protocol of this review was registered in the PROSPERO International register of systematic reviews, number CRD42017062164.

Background: Utilization of postnatal services is the right of every woman and can be affected by socio-demographic factors and in turn with the availability of services. This research was undertaken to study the pattern of utilization of postnatal care services and factors affecting it among postnatal women of urban slums Methods: Cross sectional study was done and data was collected by house to house survey after taking consent, using a pre- designed and pre-tested proforma. Results: Majority 54.21% women belonged to 21-25years of age, 56.84% were educated till high school and 88.95% belonged to lower class. 69.47% and 21.58% utilized ANC and PNC services. Literates and primi mothers had utilized PNC services compared to illiterates and multipara. Lower socioeconomic status women had used PNC adequately when compared to higher class (p

Background: Household air pollution (HAP) resulting from the use of solid cooking fuels is a leading contributor to the burden of disease in India. Advanced combustion cookstoves that reduce emissions from biomass fuels have been considered potential interventions to reduce this burden. Relatively little effort has been directed, however, to assessing the concentration and exposure changes associated with the introduction of such devices in households. Objectives: The aim of this study was to describe HAP exposure patterns in pregnant women receiving a forced-draft advanced combustion cookstove (Philips model HD 4012) in the SOMAARTH Demographic Development & Environmental Surveillance Site (DDESS) Palwal District, Haryana, India. The monitoring was performed as part of a feasibility study to inform a potential large-scale HAP intervention (Newborn Stove trial) directed at pregnant women and newborns. Methods: This was a paired comparison exercise study with measurements of 24-hour personal exposures and kitchen area concentrations of carbon monoxide (CO) and particulate matter less than 2.5 μm in aerodynamic diameter (PM2.5), before and after the cookstove intervention. Women (N = 65) were recruited from 4 villages of SOMAARTH DDESS. Measurements were performed between December 2011 and March 2013. Ambient measurements of PM2.5 were also performed throughout the study period. Findings: Measurements showed modest improvements in 24-hour average concentrations and exposures for PM2.5 and CO (ranging from 16% to 57%) with the use of the new stoves. Only those for CO showed statistically significant reductions. Conclusion: Results from the present study did not support the widespread use of this type of stove in this population as a means to reliably provide health-relevant reductions in HAP exposures for pregnant women compared with open biomass cookstoves. The feasibility assessment identified multiple factors related to user requirements and scale of adoption within communities that affect the field efficacy of advanced combustion cookstoves as well as their potential performance in HAP intervention studies.

Introduction: Sleep disorder is a common and complicated health problem, which cause morbidity, mortality, decreasing functional capacity and quality of life. Working women are at increased risk for developing sleep disorders due to work-life imbalance added with family responsibilities. The study was conducted to assess the quality of sleep and factors affecting it among working women using Pittsburgh Sleep Quality Index (PSQI). Methodology: Community based cross sectional study was conducted among 234 working women aged 18 years and above. Data was collected and PSQI was used to assess quality of sleep. Results: 41.5% working women were in the age-group of 30-39 years, 53.4% belonging to Class I SES, 83.3% married and 85.9% working between 4-8 hours. Poor sleep quality was seen in 72.6% working women with mean PSQI score of 5.24 (SD ± 1.408).90.6% married women had poor sleep quality compared to 35.9% unmarried, who had normal sleep [χ2=23.55, df=1, p8 hours [χ2=6.007, df=1, p=0.0143]. Conclusions: PSQI can be used as a screening tool for early diagnosis. Counselling and health education sessions can be initiated at the earliest at work place.

The determinants of parasite persistence or elimination after treatment and clinical resolution of cutaneous leishmaniasis (CL) are unknown. We investigated clinical and parasitological parameters associated with the presence and viability of Leishmania after treatment and resolution of CL caused by L. Viannia.Seventy patients who were treated with meglumine antimoniate (n = 38) or miltefosine (n = 32) and cured, were included in this study. Leishmania persistence and viability were determined by detection of kDNA and 7SLRNA transcripts, respectively, before, at the end of treatment (EoT), and 13 weeks after initiation of treatment in lesions and swabs of nasal and tonsillar mucosa.Sixty percent of patients (42/70) had evidence of Leishmania persistence at EoT and 30% (9/30) 13 weeks after treatment initiation. A previous episode of CL was found to be a protective factor for detectable Leishmania persistence (OR: 0.16, 95%CI: 0.03-0.92). kDNA genotyping could not discern differences between parasite populations that persisted and those isolated at diagnosis.Leishmania persist in skin and mucosal tissues in a high proportion of patients who achieved therapeutic cure of CL. This finding prompts assessment of the contribution of persistent infection in transmission and endemicity of CL, and in disease reactivation and protective immunity.

Introduction: Medical education and healthcare are inherently stressful and demanding. Optimal level of stress enhances learning while excess of stress can lead to health problems. If untreated can lead to multiple disorders like sleeping disturbances, insomnia and further may lead to burnout. Objectives: To assess the level of stress among postgraduates and to know risk factors leading to burnout. Methodology: Cross sectional study was conducted among 120 postgraduates in a medical college. Data was collected using pre-designed questionnaire. Perceived stress scale-14 was used to assess stress and Maslach Burnout Inventory was used to assess burnout. Results: Mean age of the study participants was 27.39±2.84 years. 53.33% were males and 46.67% females. Prevalence of stress was 91.67%. Among them, 37.50% had mild stress and 22.50% had severe stress. Prevalence of burnout was 45.0%. Stress levels were higher among 93.75% males, 94.73% second year, 92.11% clinical postgraduates and all married postgraduates (p>0.05). Burnout was significantly more among third year postgraduates compared to others (p=0.016). 51.56% males, 54.55% clinical and 60.71% married postgraduates had burnout (p>0.05). Conclusions: PSS-14 and MBI-SS can be used as screening tools for early diagnosis and preventive measures like counselling can be initiated at the earliest to all.

Millions of Indians fall into poverty because of the private high Out of Pocket pattern of health financing, due to the absence of insurance coverage. Conditions like HIV and AIDS also influence poverty due to a lifelong treatment requirement. Access to insurance coverage (commercial or voluntary) has been denied to People Living with HIV (PLHIV) through various clauses. However lately, there have been certain experiments on inclusion of HIV into new or existing schemes. This paper provides a systematic review of coverage, managerial and financial systems of selected cases of HIV insurance pilots in India with an objective to explore its sustainability and ability to be replicated. A cross-sectional descriptive analysis of existing literature and in-depth case studies of relevant health insurance schemes were used for the review. Data was compiled using qualitative data collection tools such as in-depth interviews with officials. The schemes were analysed using two frameworks viz. managerial ability and coverage ability. The managerial ability was analysed through a Strength-Weakness-Opportunity-Threat (SWOT) analysis. The coverage ability was analysed through three dimensions viz. a) breadth b) depth and c) height. In India, there are two types of insurance policies vis-à-vis HIV coverage. These were categorised as HIV-specific and HIV-sensitive policies. Of the seven pilot schemes reviewed, the small-scale health insurance schemes show limited success owing to smaller pool and limited managerial capabilities. The large schemes offer avenues for mainstreaming but pose issues of governance as well as marketing among PLHIVs. The findings of the research identify a specific set of issues and challenges for sustainability and replication from three perspectives viz. a) market, b) cost recovery and sustainability and c) equitable coverage. Abbreviations: AIDS – Acquired Immune Deficient Syndrome; ART - Anti-retroviral Therapy; BPL – Below Poverty Line; FF-HIP – Freedom Foundation Health Insurance Policy; HIV – Human Immunodeficiency Virus; IRDA – Insurance Regulatory and Development Authority; NGO – Non Government Organisation; PLHIV – People Living with HIV; OI – Opportunistic Infections; OOP – Out of Pocket; RSBY – Rashtriya Swasthya Bima Yojana; STI – Sexually Transmitted Infection; SWOT – Strengths, Weaknesses, Opportunities, Threats; UHC – Universal Health Coverage; UNDP – United Nations Development Program.

Background: In India, approximately 66% of households rely on dung or woody biomass as fuels for cooking. These fuels are burned under inefficient conditions, leading to household air pollution (HAP) and exposure to smoke containing toxic substances. Large-scale intervention efforts need to be informed by careful piloting to address multiple methodological and sociocultural issues. This exploratory study provides preliminary data for such an exercise from Palwal District, Haryana, India. Methods: Traditional cooking practices were assessed through semi-structured interviews in participating households. Philips and Oorja, two brands of commercially available advanced cookstoves with small blowers to improve combustion, were deployed in these households. Concentrations of particulate matter (PM) with a diameter