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Background: Information about the anxiety and depression of students in rural areas of India is scant. We evaluated stress, coping strategies, quality of life (QOL), and well-being of students along with the dimensional and categorical distribution of anxiety and depression in a cross-sectional study in a rural college. Materials and Methods: It was an online questionnaire-based survey using the Patient Health Questionnaire-9 for depression, general anxiety disorder-7 for anxiety, and the WHO-5 Well-Being scale for well-being. Stress in the previous month, nature of stress, coping strategies, and QOL on a scale of 1 (worst) to 10 (best) were also assessed. Results: The dimensional distribution of anxiety and depression suggested the pervasiveness of these problems among students. Categorically, a considerable proportion of students had clinical levels of anxiety (32.2%), depression (40.3%); and 24.8% of students had both of them. Stress in the past month was reported by 34.2% of students, which was linked significantly with the severity of anxiety and depression. Common stressor were financial problems, family-, career-, and job-related issues. Stress, anxiety, and depression were negatively correlated with well-being and QOL. Many coping strategies were reported; more than half of the students found helping others, creative hobbies, hoping for the best, music, talking to others, yoga and exercises, prayer, and religious activities helpful. Conclusions: The results highlight the pervasive presence of anxiety and depression in college students, which are linked to stress, and have an impact on their well-being and QOL. These require specific attention for management. [ABSTRACT FROM AUTHOR]

Self-Help Groups (SHGs), the credit based voluntary groups in India are widely known for their potential to alleviate poverty and empower women. This research article explores a lesser-known theme. It tries to analyze the possibility of utilizing the current SHG model of the Indian Government to build and strengthen resilience of the SHG members in case of an external shock like financial stress, food insecurity, dispute in home for joining SHG, and difficulty to repay loan amidst lockdown due to the COVID-19 pandemic. This article also focuses on their coping mechanisms and attitude towards these crises. By utilizing primary data collected from 320 SHG members in one of the aspirational districts in West Bengal, India, the present paper tries to fulfill its objective. It provides a comprehensive understanding of the problems faced by the SHG members by combining both quantitative and qualitative techniques. The findings reveal that from organizing vocational trainings to relaxing loan repayment, SHGs and its women members overcame various adversities with tenacity, especially during the COVID-19 pandemic. Based on the study findings, it is reasonable to conclude that the current SHG model in India presents a promising avenue for enhancing the resilience of its members in the face of external shocks. Article Highlights: Idiosyncratic stress like financial stress and systemic stress like the COVID-19 pandemic were ranked the top two crises faced by the SHG members. Recognizing financial stress and stress due to the COVID-19 pandemic as the top challenges faced by SHG members implies the need for immediate support (that includes access to financial resources, and assistance in adapting livelihood strategies to withstand external shocks), resilience-building efforts (by providing members with skills to diversify their income sources, creating emergency funds, and fostering community solidarity to collectively address crises), and policy attention (implementing policies that provide targeted assistance, such as social safety nets, healthcare access, and economic stimulus). The SHG members mostly had an active attitude towards the crises faced demonstrating their remarkable resilience and adaptive capacity. This highlights the most dominant role of SHGs in their ability to foster a sense of solidarity and collective problem-solving. Members often share experiences, skills, and resources, which can be invaluable during times of crisis. Additionally, the group dynamic encourages mutual support and encourages members to take proactive steps to address challenges rather than feeling overwhelmed by them. Moreover, participating in SHGs often empowers individuals to develop skills, build confidence, and access resources that enable them to better cope with crises. Thus, it implies the importance of community-based approaches like the SHGs to resilience-building. The primary role of SHGs in strengthening resilience among its members, particularly during challenging times like the COVID-19 pandemic was preventive measures (organizing COVID awareness programs), followed by promotional measures (organizing vocational trainings) and protective measures (distribution of food grains). By engaging in these preventive, promotional, and protective measures, SHGs bolstered the resilience of their members by equipping them with knowledge, skills, and resources to navigate challenges effectively. Overall, the implication is that SHGs have played a multifaceted role in supporting their members through the COVID-19 crisis, by focusing on prevention, promotion, and protection measures to enhance their resilience and mitigate the adverse effects of the pandemic on their well-being. [ABSTRACT FROM AUTHOR]

Background: End-stage renal disease (ESRD) poses a significant burden globally and in India. However, access to treatment remains limited due to resource and cost constraints. This study aimed to evaluate the health-related quality of life (HRQoL) and economic burden among haemodialysis patients. Methods: A descriptive cross-sectional study using European Quality of life, EQ-5D-5L, to measure health-related quality of life across 5 domains, i.e. mobility, self-care, usual activities, pain/discomfort and anxiety/depression, was administered, across three settings—government dialysis centre, private dialysis centre and charity based dialysis centre. The health utility values were also calculated. Also, the costs incurred in dialysis were done. Results: The mean (± SD) age of the participants was 55 (± 11) years, the majority of the participants were male (n = 61), 80% (n = 64) of the participants were employed before and 40% of them had lost a job, due to the morbidity of the disease. Upon analyzing the EQ-5D-5L data, it is inferred that all five domains were the same across all three setups. The direct cost incurred on the haemodialysis ranged from INR.600 to INR.3500 per month, and the indirect cost ranged fromINR.50 to INR. 3000, which is borne by the participants, in about 70% of the cases. Chief Minister Health Insurance Scheme was found to be extremely useful, wherein only 30% (n = 25) of the study participants (n=81) were insured beneficiaries. Conclusion: HRQoL was moderately impaired, and treatment posed substantial financial hardship among hemodialysis patients. Expanding access to decentralized and community-based care models could help address the challenges of regular treatment and lost productivity. [ABSTRACT FROM AUTHOR]

Most research on sex workers globally has focused on cis women sex workers vulnerabilities including violence, risk for HIV/AIDS, and stigma. Despite the plethora of studies on the topic, older sex workers are significantly underrepresented in research. We used a phenomenological approach to highlight street and home-based sex workers' experiences. Using a purposive sampling strategy, 39 cis women sex workers were recruited from Karnataka, India and data were collected using in-depth interviews and focus group discussions. Findings revealed a range of changes in sex workers' lives as they aged, financial instability, lack of alternate livelihood options, and limited access to governmental benefits and social security. Participant narratives challenged the notion of anticipated traditional familial support especially from their grown children. Findings were replete with instances of sex workers' personal agency to confront personal and professional challenges. Peer networks formed the biggest forms of support as were sex workers' connections with local community-based groups. There is an urgent need for helping professionals to recognize the ongoing marginalization faced by older sex workers. It is critical to address concerns broadly along with inequities in terms of access and power as experienced by older sex workers. Finally, examining the differential impact of ageism, structural barriers including neglect by the State, violence, and stigma that follow sex workers is vital. [ABSTRACT FROM AUTHOR]

The expectation of family members and society towards students has increased in recent years to perform well or achieve success in their life. But lack of job opportunities and increased competition among students has depressed the student community. The expectation without support has negatively impacted students which has catalysed suicide among the students in India. Students are committing suicide in Indian society due to failure in achieving families' expectations which is a matter of grave concern for social scientists. The current study has applied content analysis as a method to evaluate the cases of student suicide. The cases of student suicide have been collected from different newspapers, magazines, and news portals from July 2020 and April 2021. The study finds that most students are committed suicide due to depression. The study points out that students committed suicide due to failure to fulfil the expectations of a family member. [ABSTRACT FROM AUTHOR]

Due to the COVID-19 pandemic and the economy's general situation, many households are now financially vulnerable. It is like a vicious cycle: once a household is caught, it will remain in the trap until and unless it competently manages its finances. These problems experienced by households have drawn attention to social capital. Self-help groups (SHGs) originated in India to pull out low-income households from poverty and are now recognized as social capital, which can be defined as the action of a group cooperating to enhance all its members' benefits. This article aims to explain how SHGs have contributed to reducing various factors or determinants of household financial vulnerability through a review of several other publications, theses, newspaper articles, and reports. It was discovered that SHGs now provide much more benefits than just alleviating poverty. They have helped to reduce bad loans or non-performing assets, reduced the dependence on informal sources of finance, made households more resilient toward crises such as COVID-19, and enabled households to save money and manage their finances accurately. Organizing themselves into SHGs is the only way for rural households to overcome financial difficulties. [ABSTRACT FROM AUTHOR]

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

Introduction: Medullary thyroid carcinoma (MTC) is a rare type of thyroid cancer and the main treatment is surgery. The extent of surgery depends on the spread of tumour and often involves thyroidectomy and neck dissection. Recurrent or metastasis tumour can be detected with raising calcitoninand there are various options of treatment. Methods: This was a retrospective study of MTC over seven years in a tertiary cancer centre which evaluated the treatment outcome and the non-surgical options available in recurrent and metastatic tumours. Results: Among the 601 thyroid cancers, 34 patients (5.3%) were MTC, of which 29 were studied. Majority were women, below 60 years, were diagnosed with fine needle aspiration cytology of thyroid nodule or nodes and had raised calcitonin value (Ctn). The value of Ctn was correlated with tumour burden rather than extent (p=0.7). Recurrence was seen in 35% and all patients with locoregional recurrence had curative surgery whereas metastatic patients were offered palliative treatment. Acceptance of palliative treatment was less due to financial burden. The five year overall survival for nonmetastatic disease was 89.4 % and for patients with metastatic disease at presentation was 54.7 %. Conclusion: The incidence of medullary thyroid carcinoma is low compared to the differentiated thyroid carcinoma. The main treatment is surgery and other treatment options are limited. [ABSTRACT FROM AUTHOR]

With time, the law and economics of insurance have advanced from considering it solely as a security measure to recognising it as an asset class. Numerous companies now offer loans against these life insurance policies, accepting the 'property' nature of life insurance behind the veil (Doherty & Singer, 2003; Mancini & Murphy, 2012; Mazonas, Stallard & Graham, 2011). Recently the world witnessed sudden deaths at large scale during the COVID-19 pandemic. A study indicates that financial crisis is a major reason of acute stress and instability in adults' lives (Karim & Shetu, 2023; PK, TK & PK 2021) In such crisis situations, the secondary market assignment of life insurance policies could have been a boon for any person facing financial difficulty or not having a living family member/nominee. The market for life settlements flourished during HIVAIDS crisis in the USA and has shown steady growth since then in various jurisdictions of the world. However, in India, the doors for secondary market trading were closed in 2015 through a statutory amendment to the Insurance Act, 1938 presently in force in India. Contemporary academia is divided on necessity of the requirement of insurable interest on the secondary market assignment of insurance policies. Other legal issues such as moral hazard, and ethics of trading on life are debatable as well. The preliminary investigation revealed a scarcity of papers discussing these legal considerations around life settlements. However, among the top 10 countries in the global life insurance ranking, five are emerging markets including India having immense potential for life settlements market (Anon, 2021). Consequently, the researcher conducted a scientific SLR using PRISMA Method, along with reviewing selected papers in full, focusing on the legal and related economic considerations, to produce valuable insights for the emerging market. This paper presents the sole effort to pursue SLR on legal issues and put them in a place with the aim to ignite the discussion on legal considerations of life settlements. Importantly, this paper considers India as an emerging market for reference and the USA as a benchmark for established market. This paper adopted a theoretical approach to fulfill the need for legal analysis complimented with secondary data analysis. [ABSTRACT FROM AUTHOR]

Purpose: Financial satisfaction is a potential ambition of individuals' lives that requires well-strategized economic behaviors. The authors examine the impact of various factors on the financial behavior (FB) and financial satisfaction (FIS) of individuals in India's National Capital Region (NCR). Design/methodology/approach: Through a literature review, a survey questionnaire was formulated using existing scales on FIS. For more in-depth insights, data are obtained from 427 respondents in the NCR region using self-administered questionnaires. This article used "partial least square structural equation modeling (PLS-SEM)" to inspect the hypothesized model of individuals' FIS. Findings: According to the study results, financial attitude (FA), financial self-efficacy (FSE), financial knowledge (FK) and demographic characteristics (DC) significantly influence FB. Conversely, financial stress (FS) negatively impacts FB. It also highlights that FA, FSE, FK and FB all significantly impact FIS. Nevertheless, FS and DC insignificantly influence FIS. Originality/value: To the best knowledge of the authors, this article is an initial attempt to offer a novel perspective of individuals' FB and FIS in India. It would help the government and stakeholders by providing various pioneering economic schemes and making policies that help increase individuals' FIS. Peer review: The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-03-2023-0239 [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has exhibit deep stress all over the world. Despite recent speculative suggestions of poorer psychological state in all age in India, since the beginning of the pandemic, there are no systematic efforts to help consequences. This research tried to report on the content of effect of lockdown on individual economy in Luck now city, those who could also be notably liable to negative emotions alongside news on the impact of corona virus on their lives. These impacts consecutively related to negative have an effect on. Participants' high worries centred on economy attainments, social and recreational activities, and physical health. A lot of females than males disturbed regarding educational attainment and physical health whereas a lot of males disturbed regarding economical, social and recreational activities. Thus, Indian individuals report important impact of the pandemic on varied aspects of their life and area unit notably disturbed regarding economical and educational attainments, social and recreational activities and physical health. During pandemic and lockdown people lost their jobs, their business were closed, they have had no option for their livelihood They were suffered from more stress. They were panic to thought about how to move their family life. How to secure their family. Thus Pandemics are extremely impactful and endangering the protection and traditional functioning of the community. [ABSTRACT FROM AUTHOR]

Background: Mental health illnesses are becoming a prime cause of concern among young adults. Many individuals with mental disorders do not get the necessary health care. Objectives: To assess the attitude towards seeking professional psychological help and stigma of mental illness among the students of a health science institute, to assess the association between stigma and attitude towards seeking psychological help with select socio demographic variables and to determine the correlation between attitude towards seeking professional psychological help and stigma of mental illness. Methods: A cross-sectional study was done on 215 students in Karnataka. The study tool consisted of questionnaires on socio-demographic profile and two sets of validated scales (Attitude Toward Seeking Professional Psychological Help Scale and Perceived Devaluation Discrimination Scale). Results: The study showed males had more positive attitude towards seeking professional psychological help than females. Individuals with history of present/past illness were more open towards seeking professional psychological help. Pearson correlation test between ATSPPHS and PDDS showed a negative correlation. Conclusions: Psychological help seeking attitude needs to be improved among the students. Educational institutes need to incorporate mental health awareness and stigma reduction program in their curriculum. [ABSTRACT FROM AUTHOR]

The aim of the systematic review and meta‐analysis is to determine the stress and stressors experienced by the parents of high‐risk neonates admitted to the neonatal intensive care unit (NICU) in India. We included both quantitative and qualitative studies. The Joanna Briggs Institute Critical Appraisal Checklist and Critical Appraisal Skill Programme checklist were used to assess the quality of included studies. A systematic search was conducted in PubMed, EMBASE, SCOPUS, EBSCOhost, Web of Science, ProQuest, Microsoft Academic, DOAJ, Indian Citation Index, and J‐Gate to identify relevant studies. Additionally, online hand searching was performed on Indian websites of relevant institutions, women and child health departments, repositories, registries, and paediatric journals. Twelve of the 21 quantitative studies found that maternal stress was higher than fathers due to the separation from their babies and the medical condition of the neonate. One qualitative study reported that financial burden, alterations in the parenting role, and concern over domestic issues are significant causes of fathers' stress. A meta‐analysis of the included studies assessed the prevalence of maternal, paternal, and parental stress and reported that mothers experienced higher stress levels than fathers across all subscales. The most typical stressors for parents were changes in neonatal looks, behaviour, and altered parental roles. Beyond the immediate NICU care and interactions, other triggering factors of stress among parents must be considered to design multicomponent interventions in a local (Indian) context. Moreover, parental psychological support and regular counselling can be incorporated into the standard neonatal intensive care policy. [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]

Background: People with disabilities (PWDs) often face higher risk of financial burden towards healthcare. Higher out-of-pocket expenditure (OOPE) is a barrier towards accessing medical services, resulting in healthcare inequities between men and women. There is a lack of studies on gender disparities in healthcare burden among PWD in India. The present study examines gender inequality towards healthcare expenditure among PWDs in India. Methods: Unit level data from the Persons with Disabilities in India Survey under the National Sample Survey, 76th round that covered 118,152 households involving 576,569 individuals of whom 106,894 had at least one disability was used. We performed secondary analysis using descriptive statistics, bivariate estimates, Blinder–Oaxaca decomposition and multilevel log-linear regression to meet the objective of the study. Results: OOPE as a percent of monthly per capita expenditure was higher among males across all states of India except in Puducherry, Dadra and Nagar Haveli, Lakshadweep and Mizoram. This varied from 0.6% in Jammu and Kashmir to 20% in Nagaland. Multilevel analysis confirms that OOPE was significantly lesser among females (β = –0.070, 95% confidence interval = – 0.129 to 0.01) compared to males after controlling demographic and disability-related predictors. PWDs reported higher healthcare burden as a percent of total household expenditure in India, and relatively less amount was spent on female healthcare compared to male healthcare. Conclusion: A substantial gender inequality for healthcare expenditure is found among PWDs in India. This makes for an urgent call to health researchers and policymakers towards gender-sensitive research, policy formulation and program implementation for PWDs in India. [ABSTRACT FROM AUTHOR]

Introduction: Suicide has become a societal crisis owing to the recent increasing trends globally. Of the total suicide deaths globally, two-thirds occur in the developing countries including India. The available data on suicide in India reflect a rate of 11% (according to the National Crime Records Bureau 2013) with the highest rates in older adult males and an increasing trend of suicide deaths in younger age groups. Much of the literature is from the southern part of India with a relatively sparse data from North India. Aim and Methodology: The aim was to examine the 15-year (2004-2019) trend of suicide (age and gender distribution, methods used, and reasons) in an urban city in North India. Information was collected from the leading newspapers (English, Hindi, and Punjabi) of the area. Duplication of information was avoided, and statistical analysis was done using SPSS version 20. Results: Fluctuations in the total number of suicide cases over the 15-year period were observed with nearly 63% of people committing suicide being younger than 30 years of age, of whom 53% were male. More females in the younger age group and more males in the older age group were suicide victims. Of all the methods used, hanging was the most common (70%), followed by consuming poisonous substance, jumping from height, shooting self, and stabbing in the descending order. A ceiling fan was used for hanging by 32% of victims who hanged themselves, of whom 65% were male. Among the cited reasons, stress/depression was experienced by 19% of victims. Discussion and Conclusion: The trends with respect to age distribution, gender, and method used that is reported in the current study are in line with the trends reported globally. The preventive measures, especially using technological advances in designing fans not suitable for tying noose around it, can be explored. [ABSTRACT FROM AUTHOR]

Background: Adolescents are vulnerable to stressors because of the rapid physical and mental changes that they go through during this life period. Young people residing in slum communities experience additional stressors due to living conditions, financial stress, and limited access to healthcare and social support services. The Adolescents' Resilience and Treatment nEeds for Mental Health in Indian Slums (ARTEMIS) study, is testing an intervention intended to improve mental health outcomes for adolescents living in urban slums in India combining an anti-stigma campaign with a digital health intervention to identify and manage depression, self-harm/suicide risk or other significant emotional complaints. Methods: In the formative phase, we developed tools and processes for the ARTEMIS intervention. The two intervention components (anti-stigma and digital health) were implemented in purposively selected slums from the two study sites of New Delhi and Vijayawada. A mixed methods formative evaluation was undertaken to improve the understanding of site-specific context, assess feasibility and acceptability of the two components and identify required improvements to be made in the intervention. In-depth interviews and focus groups with key stakeholders (adolescents, parents, community health workers, doctors, and peer leaders), along with quantitative data from the digital health platform, were analysed. Results: The anti-stigma campaign methods and materials were found to be acceptable and received overall positive feedback from adolescents. A total of 2752 adolescents were screened using the PHQ9 embedded into a digital application, 133 (4.8%) of whom were identified as at high-risk of depression and/or suicide. 57% (n = 75) of those at high risk were diagnosed and treated by primary health care (PHC) doctors, who were guided by an electronic decision support tool based on WHO's mhGAP algorithm, built into the digital health application. Conclusion: The formative evaluation of the intervention strategy led to enhanced understanding of the context, acceptability, and feasibility of the intervention. Feedback from stakeholders helped to identify key areas for improvement in the intervention; strategies to improve implementation included engaging with parents, organising health camps in the sites and formation of peer groups. Trial Registration: The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries, Reference number: CTRI/2022/02/040307. Registered 18 February 2022. [ABSTRACT FROM AUTHOR]

The article focuses on the World Health Organization's conceptualization of mental well-being, emphasizing its relevance in the workplace and how certain factors like shift work and stress can impact employees' mental health. It discusses the societal and economic implications, with poor mental health leading to lower productivity and increased indirect costs, and provides insights into the sociodemographics of the workforce in India based on a recent labor force survey.

Purpose: Consumers can spend their disposable income on hedonic consumption or save for the future. Their preferences were altered by the prolonged life and livelihood-threatening experiences of the pandemic. This paper aims to study the spillover effect of the pandemic experience on consumer savings attitudes and hedonic purchase preferences in the new normal. Design/methodology/approach: The authors conducted 35 in-depth interviews with consumers in India. The data were analysed thematically. Findings: The results showed that when fear of life and negative emotions of the pandemic persisted, consumers became short-term focused, moved towards materialism and increased hedonic spending. Alternatively, individuals who faced substantial financial hardships resorted to an increased preference for savings. The relationship between changes in savings orientation and hedonic consumption was found to be moderated by consumer's individual differences in financial vulnerability and life history strategies. Practical implications: As the trend towards increased hedonic consumption and preference for luxury products continues, the study findings can be used to devise effective marketing strategies to tap the emerging segment of mass luxury consumption. Originality/value: Despite ample work being conducted in the hedonic consumption domain, it has not been studied in conjunction with savings orientation, a significant determinant. This research links personal savings orientation with hedonic spending and substantiates that purchase decisions are cognitively weighted as a choice of discretionary spending against the opportunity to save. [ABSTRACT FROM AUTHOR]

Background: Drug addiction is a social problem that affects people all over the world, Increased manufacturing, distribution, promotion, availability, and social values contribute to this issue. Aims and Objectives: The aim of this study was to explore the causes of substance abuse among users and its impacts. Materials and Methods: The study's findings were derived through primary research. In-depth interviews with substance users undergoing treatment at a de-addiction center in Srinagar were carried out in June 2022-July 2022. This study included a thematic analysis of the stories of 20 participants. Results: Data gathered through participant narratives revealed personal experiences as well as common themes. A total of 3 themes emerged from the codes, the themes include (1) Initiation of substance abuse (2) Causes associated with substance abuse (3) Consequences of substance abuse. Conclusion: We conclude that the problem of substance abuse in Kashmir has assumed rising dimensions: curiosity, academic pressure, increasing economic stress, and easy accessibility are leading to initiation into substance abuse. It also reveals the harmful effects of substance abuse. Heroin is mostly used substance by abusers for the first time; substance abuse is on the rise, which is highly concerning for every member of society. [ABSTRACT FROM AUTHOR]

Background: Families with children diagnosed with ADHD often experience elevated levels of stress compared to families with typically developing children. This stress manifests in various forms including family conflicts, disciplinary challenges, financial strain, parental depression, and difficulties in marital relationships. Objectives: The objective was to assess parenting stress, coping, and resilience among parents of children with ADHD, as well as the psychosocial problems of children with ADHD as reported by parents. Method and Materials: his descriptive cross-sectional study was conducted at the Child Guidance Clinic, Psychiatry Department, Government Medical College & Hospital, Chandigarh. It included 40 consecutive mothers of children diagnosed with ADHD according to DSM-5 criteria, aged 6 to 14 years, fluent in Hindi or English, and residing with their child. Exclusion criteria comprised major medical or psychiatric illnesses, specific learning disabilities (SLD), and comorbid disabilities in children, as well as significant psychiatric or medical illnesses, disabilities, or substance dependencies (excluding nicotine) in mothers, and multiple family members with major disabilities. Assessment tools used were the Socio-demographic and Clinical Data Sheet, Chandigarh Parent Related Stress Scale (CPRSS), Bref-COPE, The Connor-Davidson Resilience Scale (CD-RISC), Screening Tool for Assessment of Psychosocial Problems (STAPP), and Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS). Result: The study revealed high levels of stress among mothers of children with ADHD, who employed a range of coping strategies including instrumental support, active coping, and planning, as well as emotional support, acceptance, positive reframing, and religious coping. Some also used maladaptive strategies like behavioural disengagement, venting, and self-blame. Participants showed a moderate level of resilience, with mild overall problems noted. Issues related to financial resources and high expressed emotion were most prevalent, followed by challenges with medication/treatment compliance and social support. Conclusion: This study underscores the need for increased focus on supporting parents in ADHD management, informing the development of comprehensive psychosocial intervention programs. [ABSTRACT FROM AUTHOR]

As India's elderly population grows rapidly, there is a demand for robust policy tools for geriatric health management. This study focuses on unveiling the impact of financial stress and insecurity in diverse economic sectors on adult malnutrition in India. Further, we explore the connections of adult malnourishment with mental and physical health outcomes. Analysis has been done using data of 59,764 respondents aged 45 years and above from the Longitudinal Ageing Study in India (LASI- Wave I) (2017-19). A modified Malnutrition Universal Screening Tool (MUST) has been used to assess the risk of adult malnutrition. It categorizes malnutrition into Low Risk, High Risk Group 1 (HRG1-undernourished), and High Risk Group 2 (HRG2-over-nourished). Approximately 26% of adults were classified in HRG1, characterized by low body mass index, recent hospital admissions, and affiliation with food-insecure households. Around 25% adults belonged to HRG2 characterized by high body mass index and waist-to-hip ratio. The relative risk ratios from the multinomial logit generalized structural equation model indicate that the risk of being in HRG1 was 20–40% higher among respondents not presently working or receiving pension benefits, as well as those involved in agricultural work. The risk of being in HRG2 doubles if the respondent was diagnosed with some chronic disease during the last 12 months. A higher composite cognition score reduces the risk of being in HRG1 by 4%, while it increases the risk of being in HRG2 by 3%. Additionally, experiencing episodic depression raises the risk of being in HRG1 by 10%. Financial insecurity, particularly in the informal and agricultural sectors, coupled with poor mental health, hinders positive nutritional outcomes. Extending universal pro-poor policies to fortify food security in resource poor households and integrating mental health variables in nutrition policies can be beneficial to address adult malnourishment in India. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity is defined as the coexistence of two or more chronic health conditions in the same individual. It is associated with an increased number of hospital visits, polypharmacy, adverse drug events, increased treatment costs, increased burden on the families, poor functional status, poor quality of life, and an increased risk of death. Objective: The objective of the study is to determine the prevalence of multimorbidity and associated sociodemographic factors among elderly population in a rural area in south Kerala. Materials and Methods: This cross-sectional study was conducted among elderly population residing in the field practice area of a rural health training center of a medical college in South Kerala for a duration of 3 months from October 2019 to December 2019. Data were collected by interview of the subjects by the investigator. Charlson comorbidity index was used to assess the morbidity status of the subjects. Results: The self-reported prevalence of multimorbidity among the study participants was 86.4% (95% confidence interval: 82.5-90.3). In this, 42.8% had mild, 22.4% had severe, and 21.4% had moderate multimorbidity. Hypertension was the most common (53.1%) morbidity among the participants, followed by rheumatic diseases (42.7%) and diabetes mellitus (41%). Multimorbidity among the study participants was found to be significantly associated with their age, occupation status, and smoking habit among them. Conclusion: Multimorbidity among elderly population deserves much more attention than it has at present, and hence, there is an urgent need to focus on it with emphasis on the need to strengthen the health-care facilities for them, with respect to early identification and holistic management of their morbidities under one roof. [ABSTRACT FROM AUTHOR]

Healthcare is one of the most important issues in India, but often overlooked and not discussed during election campaigns. Poor medical infrastructure, insufficient public health services, and unmet healthcare needs persist in the country. Though people do want the right, high quality, and cost-effective medical treatment when they fall sick, this is put on the backseat when they are healthy, thereby the demand and struggle for health care in the future remains un-articulated by both the people and the administration. India has a heavy disease burden especially in children under 5 years and women and of lifestyle diseases like stroke, ischemic heart disease, hypertension, diabetes and cancer, now affecting younger adults. Increased dependence on private health care result in high out of pocket expenditure and a huge economic burden. Budgetary allocation for health consistently remains low and has not achieved 2.5% of GDP as recommended under the National Health Policy 2017 and 15th Finance Commission. Improving the public healthcare infrastructure and access, as well as addressing private healthcare costs, is the need of the hour especially during formation of a new democratic order in our country. [ABSTRACT FROM AUTHOR]

Purpose: This exploratory study aims to explore the operational and financial constraints faced by small and medium enterprises (SMEs) in India during the COVID-19 pandemic. The paper highlights the role of supply chain finance (SCF) in the uncertain business environment caused by the pandemic. Design/methodology/approach: The study adopts an inductive approach and conducts convergent interviews with 32 SME owners and bank officials who are associated with SME-related financial transactions. The analysis of the interview data has been done through a grounded theory approach. Findings: The findings portray four key themes representing the operational and financial constraints faced by SMEs during the pandemic. Further, the study identifies four drivers of SCF adoption among SMEs, including capital constraints, high inventory turnover cycle time, high order fulfilment cycle time and long debtors' collection period. Practical implications: The study provides various insights to the managers and owners of SMEs to deal with the economic crisis and eliminate the financial pressure created by the pandemic. The study enlightens the policymakers about the struggles of the SMEs during the economic turmoil created by the pandemic and guides them to introduce the relevant policies to resolve their problems. Originality/value: To the best of the authors' knowledge, this is the first study to identify the factors driving the SMEs to adopt SCF due to the economic chaos created by the pandemic. Also, the study theoretically contributes to the literature by developing a theoretical framework for SCF adoption based on grounded theory. [ABSTRACT FROM AUTHOR]

Background: Pediatric intensive care unit (PICU) admissions can have significant repercussions on families, including financial burdens and psychological distress. Not only do they face the overwhelming concern for their child's health and well-being, but they are also confronted with a range of practical and financial difficulties. Coping strategies play a vital role in mitigating the negative impact of PICU admissions on families. Various coping mechanisms, such as seeking social support, engaging in problem-solving, and utilizing emotional regulation techniques, can help families navigate the challenges they face. The objectives of the study are to understand the array of financial implications in the form of out-of-pocket expenses (OOPE) and to quantify with a better understanding of the composition of out-of-pocket expenses in the form of medical and non-medical expenses. It also aimed to determine the loss of productive hours in a family and to understand the burden of OOPE in relation to the income of the family. Methods: This prospective observational study was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital over a period of 6 months after obtaining permission from the institutional ethics committee. Data pertaining to financial burden was collected with the help of Structured questionnaires which included the following categories travel, meals, accommodation, and incidental expenses were considered as non-medical expenses while all medicine costs and investigations were considered as medical expenses. The quantitative data were presented as the means ± SD as median with 25th and 75th percentiles (interquartile range) and were analyzed using ANOVA (for more than two groups) and independent t test (for two groups). Results: More than half of the children (39(55.71%)) were not enrolled under any government scheme. The mean value of total medical and non-medical costs was 2525 ± 4035.28 and 2234.29 ± 846.84 Indian rupees. The mean value of total out-of-pocket expenses incurred per day (Indian rupees) on day 1, day 2, day 3, day 4, and day 5 were 1304 ± 587.2, 1208.86 ± 3773.84, 814.57 ± 565.03, 807.71 ± 522.76, and 699.86 ± 807.02 respectively. Conclusion: Families of children admitted to the pediatric intensive care unit incurred catastrophic health expenditure with the cost of medicine contributing a major share. The lowest income brackets had much higher, more than twice the financial burden compared to the higher income group. Almost all families experienced a high loss of productivity in the form of a number of days lost due to the PICU admission of a child. Enrolment in government schemes helped to reduce OOPEs though better coverage of these schemes is needed. [ABSTRACT FROM AUTHOR]

Background: In the past few decades, there has been a significant increase in healthcare expenditure due to the prevalence of health issues across the globe. This is primarily seen among white-collar employees due to the sedentary nature of their jobs, which affects their current earnings (Purchasing Power) directly due to the reallocation of their real income towards healthcare expenditure (Economic Burden) and indirectly by impacting work productivity through sick leaves. Aim: To measure the economic burden of disease(s) among white-collar employees, and to study the same across different socio-demographic variables. Methods: A cross-sectional study has been conducted in the region of Delhi-NCR among 357 white-collar employees. A random sampling method was adopted using a structured questionnaire. The questionnaire collected information regarding the direct and indirect costs of health conditions with a recall period of one month. The cumulative score of these monthly costs was converted to annual data to estimate the economic burden of the health conditions among the employees over a year. Results: As compared to Communicable diseases (16.24%), Non-communicable diseases (27.17%) were more prevalent among the respondents. Compared to other diseases, the employees suffering from Heart diseases (INR 7,62,237.50), Spinal health issues (INR 1,73,625.00), and Diabetes (INR 1,64,535.71) incurred more economic burden. At a 5% significance level, no significant difference was observed in economic burden for Gender and BMI. However, the economic burden was significantly different across the categories of Age and Monthly income. A positive association can be observed in economic burden with the increasing categories of age and monthly income. Conclusion: With the nature of sedentary work (desk jobs), white-collar employees are at a greater risk of exposure to various NCDs than CDs and incur a significant amount of out-of-pocket expenditure to manage their health status. [ABSTRACT FROM AUTHOR]

Objectives: Access to palliative care is limited, especially in rural India. Children needing care by palliative teams may themselves be patients, or siblings and children of patients. Armed forces families face characteristic lifestyle challenges -- frequent transfers, living in difficult and remote areas, serving personnel staying apart from families for long periods -- very different from issues faced by civilians. Military service increases the risk of psychosocial burden for serving personnel as well as families. Most depend on private and state medical services for palliative care so it is important for the palliative community to understand their issues. This study aimed to explore the issues related to children -- faced by armed forces families when caring for patients in palliative care. Material and Methods: Qualitative study based on thematic analysis of semi-structured interviews with caregivers -- either serving personnel or their dependents, in three centres. Results: Analysis of the 15 interviews showed that armed forces families face complex challenges related to children when caring for the palliative patient due to frequent movement, lack of paediatric palliative services in far-flung areas, disruption of the continuity of care, social isolation, language, and cultural barriers when living in non-native areas, inability to build and access family and community support and financial burden due to restrictive reimbursement policies. Conclusion: Although medical and administrative support within the organisation provides a cushion, wives have to manage alone in the father's prolonged absence, and safety is a concern for children when living outside the campuses and serving personnel report guilt, anger, and helplessness at not being present when needed. Awareness of these issues can enable palliative workers to provide more meaningful support tailored to the needs of service families. [ABSTRACT FROM AUTHOR]

BACKGROUND: During the unexpected lockdown implemented in early 2020 in reaction to the coronavirus 2019 (COVID-19) pandemic, a considerable section of India's population of migrant construction-site workers were stuck. OBJECTIVE: Our objective was to explore the lived experiences and consequent perceptions of migrant workers related to the COVID-19 lockdown and the consequences on their lives. METHODS: We conducted structured in-depth interviews (IDIs) with twelve migrant construction-site workers in Bhavnagar, Western India, from November to December 2020, using qualitative research methods. All IDIs were conducted with participant's consent, audio-recorded, transcribed in English, inductively coded, and thematically analyzed. RESULTS: The primary financial challenges mentioned by the migrant workers in the interviews were unemployment, monetary issues, and a difficult sustenance. The social concerns were described as anxious migrant exodus, discrimination, mistreatment, lack of social assistance, inability to fulfil their family's expectations, lack of safe transportation arrangements by the authorities during the exodus, inadequacies in the public distribution system, law and order, and apathy of their employers. The psychological repercussions were described using terms like "fear," "worry," "loneliness," "boredom," "helplessness," and "trapped." Monetary compensation, job opportunities at the native place, and a well-managed migrant exodus were reportedly their key expectations from the government. Healthcare issues mentioned during the lockdown included a lack of facilities to treat common ailments, substandard care, and repeated COVID-19 testing prior to departure. CONCLUSION: The study highlights the need to have rehabilitation mechanisms such as targeted cash transfers, ration kits, and safe transportation services for migrant workers through inter-sectoral coordination for mitigating hardship. [ABSTRACT FROM AUTHOR]

India aims to provide universal health coverage to all individuals and communities thus ensuring accessibility, promotive, curative, preventive, rehabilitative, and palliative health services to all. Healthcare technologies play a critical role in ensuring eliminating healthcare disparities and encouraging quality healthcare at all levels. Technology solutions such as indigenous medical devices and diagnostic products, telemedicine, artificial intelligence, and drone technology can best integrate rural needs, improve health outcomes, patient safety, and healthcare quality and experience for patients' values and strengths and can therefore be important contributors to advancing rural health equity. These technologies can transform India's healthcare system by providing quality care and mitigating the risk of catastrophic financial hardship. [ABSTRACT FROM AUTHOR]

Purpose: As Covid-19 became a pandemic, numerous people were forced to stay at home, leading to increased intimate partner violence (IPV) in many countries, particularly in developing and least-developed ones. This paper aims to highlight the IPV based on 15 different cases formed from the practical evidence of five developing countries. Design/methodology/approach: The authors interviewed 15 women from five countries who were the victims of IPV during the early periods of Covid-19 outbreak. Due to geographical remoteness, the authors conducted informal telephone interviews to collect the participants' personal experiences. The conversations were recorded with participants' permission; afterwards, the authors summarized participants' experiences into 15 different cases without revealing their original identities (instead, disguised names were used). Findings: It was revealed that the women were the primary victims of such violence, particularly from their intimate partners (husbands). In most cases, such IPV, as reported by the interviewees, originated or increased after the pandemic when they were forced to stay at home, losing their partners' jobs or income sources. Originality/value: The authors summarized the causes of IPV and put forward a few action recommendations based on the interviewees' practical experience and existing literature. This paper will open a new window for research investigations on IPV during emergencies such as Covid-19 outbreak. [ABSTRACT FROM AUTHOR]

This article studies the impact of the COVID-19 pandemic on the gendered dimensions of employment and mental health among urban informal-sector workers in Delhi, India. First, the study finds that men's employment declined by 84 percentage points during the pandemic relative to pre-pandemic employment, while their monthly earnings fell by 89 percent relative to the baseline mean. In contrast, women did not experience any significant impact on employment during pandemic. Second, the study documents very high levels of pandemic-induced mental stress, with wives reporting greater stress than husbands. Third, this gendered pattern in pandemic-induced mental stress is partly explained by men's employment losses, which affected wives more than husbands. In contrast, women staying employed during the pandemic is associated with worse mental health for them and their (unemployed) husbands. Fourth, pre-existing social networks are associated with higher mental stress for women, possibly due to the "home-based" nature of women's networks. HIGHLIGHTS In India, men suffered larger employment losses than women during the pandemic. Women reported greater mental stress than men, although both reported high stress. Men's employment losses affected their wives' mental health more than their own. Having many peers is correlated with worse stress for women, but not men. [ABSTRACT FROM AUTHOR]

The present paper studied the impact of educational inequality on child mortality in the states of southern region of India during the period 1991 to 2019. The study applied the Gini coefficient technique to investigate the education inequality in each state of the region. The paper observed the highest educational inequality in Andhra Pradesh while the lowest in Kerala among the states. However, such educational inequality is highest in the rural areas as compared to the urban areas in each state. The improvement of the average years of schooling contributed to the reduction of education inequality in the region. The study observed that the reduction of education inequality leads to the growth of per capita NSDP in each state of the region. Similarly, the expansion of education sector leads to reduction of child mortality rate in each state of the region. [ABSTRACT FROM AUTHOR]

Purpose: The current study aims to identify the impact of financial literacy, financial risk-tolerance, financial socialization, financial stress, socio-demographic factors and financial behavior on the individual financial wellbeing residing in India's National Capital Region (NCR) region. Understanding financial wellbeing is crucial as it helps individuals understand personal finance better and develop a more favorable financial attitude. The information can depict individuals' financial skills, knowledge and attitudes toward achieving financial wellbeing in emerging economies. Design/methodology/approach: Through self-administered survey questionnaires, data are obtained using convenience sampling from 420 (394) respondents regarding individual financial wellbeing levels in India. The survey responses were collected between May 2022 and July 2022. The authors use the "partial least squares structural equation modeling" (PLS-SEM) technique to test the research hypotheses. Findings: The present study's outcome confirms that five determinants, such as financial literacy, financial risk-tolerance, financial socialization, financial stress and socio-demographic factors, significantly influence the financial behavior of individuals. Further, financial behavior, financial literacy, financial risk-tolerance and financial socialization significantly influence financial wellbeing. However, financial stress and socio-demographic factors have statistically insignificant impacts on financial wellbeing. Originality/value: The present study is exclusive in which an effort is being made to acquire relative importance on financial behavior and an individual's financial wellbeing. The present paper will help the government, financial services providers, and policymakers in offering innovative economic schemes and designing policies that may enhance the financial wellbeing of individuals. Finally, this article provides the road map for future research in this field. [ABSTRACT FROM AUTHOR]

Objective: Institutional deliveries have been promoted in India to reduce maternal and neonatal mortality. While the institutional deliveries have increased, they tend to involve large out of pocket expenditure (OOPE) and distress financing for households. In order to protect the families from financial hardship, publicly funded health insurance (PFHI) schemes have been implemented in India. An expanded national health insurance scheme called the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched in 2018. The current study was aimed at evaluating the performance of PFHI in reducing the OOPE and distress financing for the caesarean and non-caesarean institutional deliveries after the launch of PMJAY. This study analysed the nationally representative dataset of the National Family Health Survey (NFHS-5) conducted in 2019-21. Results: Enrollment under PMJAY or other PFHI was not associated with any reduction in out of pocket expenditure or distress financing for caesarean or non-caesarean institutional deliveries across India. Irrespective of the PFHI coverage, the average OOPE in private hospitals was five times larger than public hospitals. Private hospitals showed an excessive rate of using caesarean-section. Utilization of private hospitals was significantly associated with incurring larger OOPE and occurrence of distress financing. [ABSTRACT FROM AUTHOR]

Since students must take theory, clinical, and practical courses in a range of subjects, including anatomy, physiology, biochemistry, community medicine, etc., the MBBS curriculum is more demanding and challenging. In a brief period of time. Students often experience stress as they discover novel ideas and theories that are used in clinical settings. Since they are fresh to the subject, first-year MBBS students are undoubtedly a little stressed. One hundred first-year MBBS students were chosen for the study using a survey. Students studying medicine completed a survey. In this study, we looked at how much more stress female students take on in terms of academic stressors, interpersonal and intrapersonal stressors, teaching and learning stressors, and social stressors. [ABSTRACT FROM AUTHOR]

Objectives: Primary objective -- Phase I: The primary objective of this study was as follows: (1) To identify common protective resilient factors that enabled the adult female cancer survivors to cope with the cancer experience. (2) To identify potential barriers to the resilience of adult female cancer survivors. Secondary objective -- Phase II: The secondary objective of this study was to develop and validate a resilience tool for cancer survivorship. Material and Methods: A mixed approach using sequential exploratory design was used in the study. A qualitative approach using phenomenology design was used in the first phase followed by a quantitative approach in the second phase. In the first phase, in-depth interviews were conducted until data saturation with 14 female breast cancer survivors chosen by purposive and maximum variation sampling methods based on inclusion criteria. The researcher used Colaizzi's data analysis framework to analyse the transcripts. Findings were configured as protective resilience factors and barriers to resilience. Based on the analysis of the qualitative phase, the researcher developed a 35-item resilience tool for cancer survivorship. Content validity, criterion validity and reliability of the newly developed instrument were assessed. Results: In the qualitative phase, the mean age of the participants was 57.07 years and the mean age at diagnosis was 55.5 years. The majority 11 (78.57%) of them were homemakers. All 14 (100%) of them had undergone surgery. The majority 11 (78.57%) of them had all three modes of therapy, that is, surgery, chemotherapy and radiation therapy. The categories of themes identified are presented under two main headings, that is, protective resilience factors and barriers to resilience. The theme categories identified under protective resilience factors were personal, social, spiritual, physical, economic and psychological factors. The barriers to resilience identified were lack of awareness, medical/biological barriers, social, financial and psychological barriers. The developed resilience tool had a content validity index of 0.98, a criterion validity of 0.67, internal consistency of 0.88 and stability of 0.99 at a 95% confidence interval. Principle component analysis (PCA) was used to validate the domains. PCA of protective resilience factors (Q1-Q23) and barriers to resilience (Q24-Q35) had Eigenvalues of 7.65 and 4.49, respectively. The resilience tool for cancer survivorship was found to have good construct validity. Conclusion: The present study has identified the protective resilience factors and barriers to resilience among adult female cancer survivors. The developed resilience tool for cancer survivorship was found to have good validity and reliability. It will be useful for nurses and all other healthcare professionals to assess the resilience needs of cancer survivors and to provide need-based quality cancer care [ABSTRACT FROM AUTHOR]

Majority of people in low- and middle-income countries with mental illness do not receive healthcare, leading to chronicity, suffering and increased costs of care. This study estimated the out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE), and poverty impact due to mental illness in India. Data was acquired from the 76th round data of the National Sample Survey (NSS) on the theme 'Persons with Disabilities in India Survey', July–December 2018. Data of 6,679 persons who reported mental illness during the survey was included for analysis. OOPE, CHE, poverty impact and state differentials of healthcare expenditure on mental illness were analysed using standard methods. In total, 18.1% of the household's monthly consumption expenditure was spent on healthcare on mental illness. About 59.5% and 32.5% of the households were exposed to CHE based on 10% and 20% thresholds, respectively. About 20.7% of the households were forced to become poor from non-poor due to treatment care expenditure on mental illness. Our study suggests the critical need to accelerate on various measures for early diagnosis and management of mental health issues along with financial risk protection for reducing financial impact of healthcare expenditure on mental illness among households in India. [ABSTRACT FROM AUTHOR]

Aims: The primary objective of the present study was to evaluate the economic burden of limited English proficiency (LEP) by estimating its direct, indirect, and intangible costs. A secondary objective was to assess the impact of variables on the economic burden. Design and Setting: A cross-sectional single-arm descriptive study conducted in a learning disability clinic in a public medical college in Mumbai. Subjects and Methods: The study cases (aged ≥8 years and ≤18 years) were recruited by non-probability sampling. A structured questionnaire was used to interview the parent to collect data related to direct and indirect costs. Intangible cost data were collected by documenting the willingness-to-pay value using the contingent valuation technique. Statistical Analysis Used: A multivariate regression model was used to assess the impact of predictor variables on the costs. Results: The direct, indirect, and intangible costs due to LEP were Indian Rupees (INR) 826,736, 3,828,220, and 1,906,300, respectively. Indirect costs comprised 82.2% of the total costs. Expenditure on tuition and remedial education comprised 39.86% and 14.08% of the indirect and direct costs, respectively. The average annual learning disability clinic costs were INR 2,169,146. The average annual total costs per student were INR 42,102. Higher socioeconomic status was predictive of increased "indirect costs", "total costs", and "intangible costs." Conclusion: LEP is a cost-intensive condition (indirect > intangible > direct costs). Non-medical costs are the costliest component of direct costs. Parental loss of earnings is the costliest component of indirect costs. [ABSTRACT FROM AUTHOR]

Background: Anti-retroviral therapy (ART) for HIV has changed a highly fatal disease to a chronic manageable condition. National technical guidelines by NACO say that adherence of >95%(optimal) is required for optimal viral load suppression which is a challenge both for the patient and the health system. Objectives: This study was conducted to determine the reasons for missed and lost to follow-up (LFU) cases and to assess the impact of the COVID pandemic on ART adherence. Settings and Design: Cross-sectional study conducted at ART center, Jhansi. Methods and Material: 357 patients were administered a self-designed questionnaire after taking informed consent to enquire about the reasons for missing doses and LFU and whether they missed treatment during the lockdown. Statistical analysis used: The results were expressed in frequencies and percentages and appropriate statistical tests were applied. Results: 72% HIV patients had optimal adherence and 6.7% were on second-line treatment. Out of 357 patients, 56 had missed treatment and 10 were LFU. The main reasons for the missing were run out of pills, busy with other things and being away from home. The number of episodes of missed and LFU increased during the pandemic. The main problems faced were lack of transport (24), fear of catching the disease (7), no money to hire a vehicle (5). Conclusions: Constant monitoring and handholding of those with suboptimal adherence is required. Travel allowance to such patients and regular counseling will help to ensure adherence. Long-term solutions include vocational rehabilitation and awareness programs to reduce stigma and discrimination. [ABSTRACT FROM AUTHOR]

Purpose: The study seeks to examine the impact of the Insolvency and Bankruptcy Code, 2016 (IBC), on the publicsector banks in India. The first part investigates the effect on advances and the non-performing assets (NPA's) on the publicsector banks, the second part assesses the impact of the NPAs on the profits of the public-sector banks after the implementation of the IBC. Design/Methodology/Approach: The study is based on the secondary data, collected from the publications of the Reserve Bank of India, the annual Economic Survey, the Insolvency and Bankruptcy Board of India (IBBI), and a few relevant articles. We assessed the impact on the NPAs and recovery measures for the four public-sector banks that were merged with other banks. The Numerical Propulsion System Simulation (NPSS), correlation, and regression were used to analyse the data. The Shapiro-Wilk test, Anderson Darling (AD), D'Agostino Skewness, D'Agostino Kurtosis, and D'Agostino Omnibus tests were also used. Findings: The results show a significant impact of the enforcement of the IBC on the recovery of loans, profit, and nonperforming assets of the four public-sector banks. Limitations: The period of study was ten years--five years before the enforcement of the IBC, and five years after that, and the study was confined only to four Indian banks. Hence, the results may not probably be generalised to other public-sector banks, private banks, or foreign banks in the country. Practical Implications:India's banking sector has seen various changes over the last decade. An increase in the NPA was a major concern for the government of India. The declining rate of recovery of loans in India and the NPAs led to issues among banks, organisations, and individuals (lenders and borrowers). The introduction of the IBC by the Parliament of India was aimed at bringing down the NPAs and increasing the recovery of non-performing loans. Originality/Value: This study was conducted to assess the impact of the four Indian banks' pre- and post IBC (i.e., The NPAs crisis) and exogenous (i.e., the liquidity stress) crises. Moreover, profitability growth has been estimated for the four Indian public-sector banks. This will be of great value to the stakeholder. [ABSTRACT FROM AUTHOR]

Caregivers of people with disability experience difficulties in a variety of care domains. Understanding the predictive factors of caregiver strain is important in developing and implementing evidence-based intervention to reduce the difficulties experienced by the carers. The current study is a cross sectional comprehensive one-phase survey conducted in randomly selected sub-districts (taluks) of the Ernakulam district in Kerala. Primary caregivers (n = 851) for persons with different kinds of disability were identified with the help of ASHAs (Accredited Social Health Activities) from the selected geographical locations and were interviewed in a house-to-house survey after obtaining written informed consent. Validated tools measuring caregiver strain, financial burden, access to services and wellbeing were used to study the population. Majority of the caregivers were females (77.3%) and spouses (35.2%). Of the caregivers 27% reported high levels of caregiver strain. The major factors associated with caregiver strain were female gender (B = 1.379, p = 0.000), financial issues (B = 0.105, p = 0.000), the general health of caregivers (B = 0.467, p = 0.000) and issues relating to employment (B = 0.956, p = 0.000) and the availability of government welfare services (B = 1.138, p = 0.000). High caregiver burden and strain is experienced by almost a third of people caring for a person with a disability. Comprehensive interventions to reduce caregiver strain should be developed. The rehabilitation sector needs to be made aware of the high levels of caregiver strain (especially in carers who were female, unemployed, have health issues and lack formal support). To improve wellbeing for people with disability we firstly need to promote social inclusion and support schemes for caregiver. Co-designed systems are needed to assist carers to access formal and informal support resources, and increase social connectedness. [ABSTRACT FROM AUTHOR]

Introduction: Kidney replacement therapy in chronic kidney disease patients can result in catastrophic health costs, pushing them into poverty in lower middle‐income countries. There are only limited studies from India focusing on the financial hardship of these patients. Data on direct nonmedical and indirect cost of hemodialysis (HD) are also limited. This study aims to find the different components of cost for HD and its association with quality of life (QOL) among HD patients. Methods: Primary objective was to find the cost of HD, which include direct medical, direct nonmedical and indirect cost. Secondary objective was to study whether the ratio of out‐of‐pocket (OOP) payments for HD to household income can affect the QOL. The QOL was assessed using EQ‐5D‐5L instrument. Catastrophic health care expenditure was defined as OOP health care expenditure exceeding 40% of the household income and distress financing as borrowing money or selling assets to meet the OOP expenditure for treatment. Findings: Of the 152 patients enrolled for the study, 103 (67.8%) were males. Mean age was 60.9 ± 12.5 years. Monthly OOP expenditure for dialysis was USD 478.4 (362.6–663.6) of which direct nonmedical and indirect expenses constitute USD 115.6 (88.4–292.4). Median percentage of household income spent for dialysis was 194.5 (IQR 128–297). One hundred and forty‐two (93.4%) had catastrophic healthcare expenditure and 76 (50%) had distressing health care expenditure. On multivariable linear regression, proportion of total household income spend for dialysis was associated with poor QOL in patients undergoing HD; coefficient = −0.04 (95% CI −0.008 − 0.092), p = 0.039. Discussion Nonmedical direct and indirect cost is substantial among patients undergoing HD. Nine of 10 patients had catastrophic health care expenditure, which pushed 50% of the patients to distress financing. [ABSTRACT FROM AUTHOR]

Purpose: Aging has detrimental effects on elders due to their physical health and financial hardship. Elders face neglect, insult and abuse in society due to causes related to physical health and financial issue from caregivers. This study aims to identify the measures of physical health and financial hardship and classifies elders under neglect, insult and abuse categories. Design/methodology/approach: The propositions of existence and classifying elders under neglect, insult and abuse categories were tested by using discriminant analysis and their profiling was done by perceptual mapping technique. Findings: The elder neglect category identified as a prominent category due to physical health while elder insult and abuse were caused by physical health and financial hardship both. The present study portrays the multi-dimensional facets related to elders' ill-treatment. The elder's ill-treatment categories were profiled to imply the measure of elevating elders' dignity and care at a personal level and society at large. Originality/value: This study classifies elders under neglect, insult and abuse categories. This classification may facilitate the medical practitioners, academicians and government and non-government social welfare agencies in understanding elder abuse with new perspectives. [ABSTRACT FROM AUTHOR]

Providing social support to tuberculosis (TB) patients is a recommended strategy as households having TB patients find themselves in a spiral of poverty because of high cost, huge income loss and several other economic consequences associated with TB treatment. However, there are few examples of social support globally. The Indian government introduced the 'Nikshay Poshan Yojana' scheme in 2018 to provide nutritional support for all registered TB patients. A financial incentive of 500 Indian Rupee (6 United States Dollars) per month was proposed to be transferred directly to the registered beneficiaries' validated bank accounts. We examined the reach, timing, amount of benefit receipt and the extent to which the benefit alleviated catastrophic costs (used as a proxy to measure the impact on permanent economic welfare as catastrophic cost is the level of cost that is likely to result in a permanent negative economic impact on households) by interviewing 1482 adult drug-susceptible TB patients from 16 districts of four states during 2019 to 2023, using the methods recommended by the World Health Organization for estimating household costs of TB nationally. We also estimated the potential amount of social support required to achieve a zero catastrophic cost target. At the end of treatment, 31-54% of study participants received the benefit. In all, 34-60% of TB patients experienced catastrophic costs using different estimation methods and the benefit helped 2% of study participants to remain below the catastrophic cost threshold. A uniform benefit amount of Indian Rupee 10 000 (127 United States Dollars) for 6 months of treatment could reduce the incidence of catastrophic costs by 43%. To improve the economic welfare of TB patients, levels of benefit need to be substantially increased, which will have considerable budgetary impact on the TB programme. Hence, a targeted rather than universal approach may be considered. To maximize impact, at least half of the revised amount should be given immediately after treatment registration., (© The Author(s) 2024. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Social capital, defined as the nature of the social relationship and the resources embedded within the social network of an individual or community, influences how individuals within a group interact and collaborate within their communities or organizations. While it is acknowledged that social capital can be drawn from as a coping strategy to mitigate financial stress, there is a notable absence of the lived experience in the literature on how social capital influences households to tap resources from their social network. We have investigated the role of social capital in healthcare financing in rural Uttar Pradesh, India, highlighting the challenges faced by households in managing healthcare expenses. We took a qualitative research approach, conducting in-depth interviews with 24 households in the Hardoi District of Uttar Pradesh in August 2017 to explore participants' lived experience of accruing support from their community during their healthcare crisis. Data analysis followed a thematic content analysis approach. The study finds that households leverage social capital for both financial and non-financial support during health crises. Social networks, trust, and community cohesion play critical roles in resource acquisition. However, overreliance on social capital can be coercive, leading to inequity, privacy invasion, and dependency. Though social capital serves as a crucial resource of support in healthcare emergencies, its unequal distribution and potential for misuse highlight the need for more structured health financing policies in India. The findings underscore the importance of integrating community-driven resources into broader health financing strategies, considering local social structures and community dynamics. • Rural Indian families from Uttar Pradesh use social capital to fund health cost. • Social capital impacts equal access to community resources during a health crisis. • Community's contribution included financial, logistical, and emotional support. • Reciprocal trust catalyzes a cycle of social cohesion and continuous mutual support. • Excessive reliance on social capital may coerce or invade privacy. [ABSTRACT FROM AUTHOR]

The impact of the COVID‐19 pandemic on the overall well‐being of consumers is disastrous. However, there is limited understanding of how the COVID‐19 situation affects consumer well‐being and how subsistence consumers mitigate well‐being concerns and unique stresses. Following an exploratory, qualitative approach, 39 in‐depth semi‐structured interviews with subsistence consumers were conducted in India and Bangladesh. Findings from the thematic analysis reveal that subsistence consumers experienced unique stresses and hardships during COVID‐19, which are unforeseen transitory financial stress, psychosocial stress, and marketplace and consumption‐related stresses. Drawing on the appraisal theory of stress, our analysis of the data identifies the co‐existence of two emotion‐focused coping strategies—religiosity and social support—that interplay to overcome their well‐being concerns in the emerging countries of India and Bangladesh. Therefore, it may be of particular interest to managers and policymakers who seek to address the severe consequences of the COVID‐19 pandemic on socio‐economically subsistence consumers. [ABSTRACT FROM AUTHOR]

We conducted this study to examine the nature of treatment-seeking behavior among carpet weavers in Kashmir. We used a grounded theory approach to gain an in-depth understanding of the phenomenon. Data were collected through face-to-face interviews with 35 research participants recruited through purposive and theoretical sampling techniques. Based on the primary data, our study reveals that carpet weavers approached different agencies and used multiple methods for seeking treatment for their illness(es). The majority of the participants relied on spiritual healers, followed by traditional methods, Unani treatment, compounders and self-medication, while modern medicine was the last option for seeking treatment. We also found that participants base their choices about when and where to seek treatment on multiple socio-economic and cultural factors like financial constraints, perception towards illness, no provision for leave, costly and lengthy medical treatment, side effects of modern medicine, the nature of the disease, lack of infrastructure and insecurity due to conflict. These findings are relevant to employers and various government as well as non-government organizations. Additional implications of these findings for carpet weavers, public health, for practice and research are also discussed. [ABSTRACT FROM AUTHOR]

Background: In the west, survival following treatment of childhood acute lymphoblastic leukaemia (ALL) approaches 90%. Outcomes in India do not exceed 70%. To address this disparity, the Indian Collaborative Childhood Leukaemia group (ICiCLe) developed in 2013 a contemporary treatment protocol for uniform risk-stratified management of first presentation ALL based on cytogenetics and minimal residual disease levels (MRD). A multicentre randomised clinical trial opened in 2016 (ICiCLe-ALL-14) and examines the benefit of randomised interventions to decrease toxicity and improve outcomes.Methods: Patients 1-18 years with newly diagnosed ALL are categorised into four risk groups based on presentation features, tumour genetics and treatment response. Standard risk includes young (< 10 years) B cell precursor ALL (BCP-ALL) patients with low presentation leucocyte count (< 50 × 109/L) and no high-risk features. Intermediate risk includes BCP-ALL patients with no high-risk features but are older and have high presentation leucocyte counts and/or bulky disease. High risk includes BCP-ALL patients with any high-risk feature, including high-risk genetics, central nervous system leukaemia, poor prednisolone response at treatment day 8 and high MRD (≥ 0·01%) at the end of induction. Patients with T-lineage ALL constitute the fourth risk group. All patients receive four intensive treatment blocks (induction, consolidation, interim maintenance, delayed intensification) followed by 96 weeks of maintenance. Treatment intensity varies by risk group. Clinical data management is based on a web-based remote data capture system. The first randomisation examines the toxicity impact of a shorter induction schedule of prednisolone (3 vs 5 weeks) in young non-high-risk BCP-ALL. The second randomisation examines the survival benefit of substituting doxorubicin with mitoxantrone in delayed intensification for all patients. Primary outcome measures include event-free survival (overall, by risk groups), sepsis rates in induction (first randomisation) and event-free survival rates following second randomisation.Discussion: ICiCLe-ALL-14 is the first multicentre randomised childhood cancer clinical trial in India. The pre-trial phase allowed standardisation of risk-stratification diagnostics and established the feasibility of collaborative practice, uniform treatment, patient enrolment and data capture. Pre-trial observations confirm the impact of risk-stratified therapy in reducing treatment-related deaths and costs. Uniform practice across centres allows patients to access care locally, potentially decreasing financial hardship and dislocation.Trial Registration: Clinical Trials Registry-India (CTRI) CTRI/2015/12/006434 . Registered on 11 December 2015. [ABSTRACT FROM AUTHOR]

Background: The sudden and rapid spread of the COVID‑19 pandemic has created fear, worry and uncertainty in the student community. First‑year medical students are likely to be doubly affected, for in addition to the stress of adapting to new learning processes, they are also now faced with uncertainties due to the COVID‑19 pandemic. It was therefore decided to estimate psychological distress among the 1st‑year medical students among the COVID‑19 pandemic‑related uncertainty. Methods: A cross‑sectional study was conducted on 1st‑year medical students studying at a Medical College in western India. Demographic and COVID‑19 related data was collected from the students through Google Forms and psychological distress was measured by using the 20 point World Health Organization‑Self Reporting Questionnaire (WHO‑SRQ 20). The study was approved by the Institutional ethics committee. Informed consent was taken before administering the questionnaire to the study participants. Statistical analysis was conducted using the SPSS statistical software. Results: Prevalence of Psychological distress among the study participants by WHO‑SRQ 20 Scale with cut off 7/8 as found to be 25.5%. Worried about themselves contracting COVID‑19 Infection (odds ratio [OR]: 3.44; 95% confidence interval [CI]: 1.25–9.42), worried of the adverse financial effect on self and family due to COVID‑19 pandemic (OR: 3.01; 95% CI: 1.29–7.04), worried that online mode of learning was putting them at disadvantage compared to traditional Teaching‑Learning method (OR: 3.44; 95% CI: 1.25–9.42), and worried about adverse effects on social support due to COVID‑19 pandemic (OR: 2.63; 95% CI: 1.27–5.43), were the factors significantly associated with psychological distress among the medical students. Discussion: There is an urgent need to develop a system to render counseling/professional help to all the students in need. This would ensure better mental health and would minimize any adverse academic outcomes among the students due to the COVID‑19 Pandemic. [ABSTRACT FROM AUTHOR]