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Several hepatitis A outbreaks have recently been reported in Kerala state, India. To inform coverage decision of hepatitis A vaccine in Kerala, this study aimed to examine the cost-effectiveness of 1) hepatitis A vaccination among children aged 1 year and individuals aged 15 years, and 2) serological screening of individuals aged 15 years and vaccination of susceptible as compared to no vaccination or vaccination without serological screening. Both live attenuated hepatitis A vaccine and inactivated hepatitis A vaccine were considered in the analysis. A combination of decision tree and Markov models with a cycle length of one year was employed to estimate costs and benefits of different vaccination strategies. Analysis were based on both societal and payer perspectives. The lifetime costs and outcomes were discounted by 3%. Our findings indicated that all strategies were cost-saving for both societal and payer perspectives. Moreover, budget impact analysis revealed that vaccination without screening among individuals aged 15 years could save the government's budget by reducing treatment cost of hepatitis A. Our cost-effectiveness evidence supports the inclusion of hepatitis A vaccination into the vaccination program for children aged 1 year and individuals aged 15 years in Kerala state, India. [ABSTRACT FROM AUTHOR]

Background: The live-attenuated Japanese encephalitis (JE) vaccine (JE-CV; IMOJEV) induces a protective response in children. A shift in circulating JE virus strains suggests that a genotype shift phenomenon may occur throughout Southeast Asia. We assessed the neutralization of wild-type (WT) JE virus isolates at distal time points after vaccination.Methods: We analyzed serum samples from a subset of 47 children who had received a JE-CV booster after an inactivated JE vaccine primary immunization. We measured antibody titers (50% plaque reduction neutralization test) using a panel of WT JE strains at baseline, then after the booster at 28 days and 6 months in all subjects present at the time points and in a subset at year 5. Three additional recent isolates were tested at year 5.Results: Of 47 subjects, 43 (91.5%) subjects had JE neutralizing antibody titers ≥10 (reciprocal serum dilution) against the homologous strain before JE-CV boost; all were seroprotected up to year 5 after the JE-CV boost. Baseline WT seroprotection ranged between 78.7% and 87.2%; all subjects were seroprotected against the 4 WT strains at 28 days and 6 months; year 5 seroprotection ranged between 95.7% and 97.9%. Similar rates of protection against 3 additional WT isolates were observed at year 5.Conclusions: The long-term immune responses induced after a JE-CV booster dose in toddlers were able to neutralize WT viruses from various genotypes circulating in Southeast Asia and India.Clinical Trials Registration: NCT00621764. [ABSTRACT FROM AUTHOR]

India has been historically challenged by an insufficient and heterogeneously clustered distribution of healthcare infrastructure. While resource-limited healthcare settings, such as major parts of India, require multidisciplinary approaches for improvement, one key approach is the recruitment and training of a healthcare workforce representative of its population. This requires overcoming barriers to equity and representation in Indian medical education that are multi-faceted, historical, and rooted in inequality. However, literature is lacking regarding the financial or economic barriers, and their implications on equity and representation in the Indian allopathic physician workforce, which this review sought to describe. Keyword-based searches were carried out in PubMed, Google Scholar, and Scopus in order to identify relevant literature published till November 2023. This state-of-the-art narrative review describes the existing multi-pronged economic barriers, recent and forthcoming changes deepening these barriers, and how these may limit opportunities for having a diverse workforce. Three sets of major economic barriers exist to becoming a specialized medical practitioner in India - resources required to get selected into an Indian medical school, resources required to pursue medical school, and resources required to get a residency position. The resources in this endeavor have historically included substantial efforts, finances, and privilege, but rising barriers in the medical education system have worsened the state of inequity. Preparation costs for medical school and residency entrance tests have risen steadily, which may be further exacerbated by recent major policy changes regarding licensing and residency selection. Additionally, considerable increases in direct and indirect costs of medical education have recently occurred. Urgent action in these areas may help the Indian population get access to a diverse and representative healthcare workforce and also help alleviate the shortage of primary care physicians in the country. Discussed are the reasons for rural healthcare disparities in India and potential solutions related to medical education.

There is little evidence on optimizing the effectiveness and implementation of evidence-based early childhood development (ECD) interventions when task-shifted to frontline workers. In this Methods Forum paper, we describe our adaptation of the International Guide for Monitoring Child Development (GMCD) for task-shifting to frontline workers in Guatemala and India. In 2021-2022, implementers, trainers, frontline workers, caregivers, and international GMCD experts collaborated to adapt the GMCD for a task shifted implementation by frontline workers. We used an eight-step co-creating process: assembling a multidisciplinary team, training on the existing package, working groups to begin modifications, revision of draft modifications, tailoring of visual materials and language, train-the-trainers activities, pilot frontline worker trainings, final review and feedback. Preliminary effectiveness of adaptations was evaluated through narrative notes and group-based qualitative feedback following pilot trainings with 16 frontline workers in India and 6 in Guatemala. Final adaptations included: refining training techniques to match skill levels and learning styles of frontline workers; tailoring all visual materials to local languages and contexts; design of job aids for providing developmental support messages; modification of referral and triage processes for children in need of enhanced support and speciality referral; and creation of post-training support procedures. Feedback from pilot trainings included: (1) group consensus that training improved ECD skills and knowledge across multiple domains; and (2) feedback on ongoing needed adjustments to pacing, use of video-based vs. role-playing materials, and time allocated to small group work. We use the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) framework to document our adaptations. The co-creating approach we use, as well as systematic documentation of adaptation decisions will be of use to other community-based early childhood interventions and implementation strategies.

The utilization of digital health in India is playing a crucial role in enhancing healthcare services by transitioning from the current inadequate public health structure to a more efficient and patient-centric system. Digital health includes various digital tools, such as electronic health records (EHRs), telemedicine, mobile health applications, health information exchange systems, and other technological advancements to improve access, efficiency, and quality of healthcare delivery. This study investigates the prospects and challenges encountered by the newly-digitized Maharashtra Emergency Medical Services (MEMS). Utilizing the 38,823 MEMS calls from November 2022, this study investigates the current status of emergency service delivery mechanisms in Maharashtra. Through spatial analyses, this study also explores the causes behind calls. The findings of the study show that calls for 108 ambulance services were distributed across the districts and had variable service delivery time periods. Current challenges to the system arise from various urban and healthcare infrastructure problems, as well as socio-cultural challenges. Implementation of the digitized MEMS system reveals key factors that influence the service's success, assisting the policymakers and health administrators in identifying and further improving the service.

Waste is one of the major urban challenges faced globally today, and the severity of the challenge is further exacerbated by rapid urbanisation, growing populations and increasing per capita waste generation. As one of the largest urban agglomerations in the world, Delhi collects 11,352 t of waste every day. Without adequate segregation, most of this waste is sent to dumpsites and waste-to-energy plants, often associated with significant capital costs and environmental externalities. This paper conducts a life cycle assessment of the current waste management system and a comparative analysis with a suggested alternative scenario, where the share of recyclables and compostables going to landfills and waste-to-energy plants is reduced through adequate segregation. Our results revealed that landfills and waste-to-energy plants are associated with significant adverse environmental impacts such as climate change, soil and water acidification, freshwater eutrophication, human toxicity, and respiratory health. In comparison, compost plants showed negligible emissions per tonne of waste. The alternative scenario (i.e. reduce waste to landfill through adequate segregation) can help reduce the negative impact on all environmental indicators by an average of 23 %. We posit that the prevailing narrative of addressing the waste issue through waste-to-energy plants in Delhi goes against the country's climate neutrality targets. Instead, the circular economy approach offers simpler, faster, and more cost-effective solutions that policymakers should consider to reduce the financial and environmental load of the current and future waste management issue., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Vaccines for diarrhoea could have the ancillary benefit of preventing antibiotic use. We aimed to quantify and compare the expected impact of enteric vaccines on antibiotic use via Monte Carlo simulations., Methods: We analysed data from a longitudinal birth cohort, which enrolled children from 2009 to 2012 from Bangladesh, India, Nepal, Pakistan, and Tanzania. We used Monte Carlo simulations to estimate hypothetical vaccine impact in nine vaccination scenarios (including six single vaccines and three combination vaccines) on antibiotic- treated diarrhoea, overall antibiotic courses, and antibiotic exposures to bystander pathogens. For each vaccine scenario, we randomly selected target pathogen-specific diarrhoea episodes to be prevented according to the specified vaccine efficacy and estimated the absolute and relative differences in incidence of antibiotic use outcomes between vaccine and no vaccine scenarios., Findings: Among 1119 children, there were 3029 (135·3 courses per 100 child-years) antibiotic-treated diarrhoea episodes. Based on simulated results, a Shigella vaccine would cause the greatest reductions compared with the other single pathogen vaccines in antibiotic courses for all-cause diarrhoea (6·1% relative reduction; -8·2 courses per 100 child-years [95% CI -9·4 to -7·2]), antibiotic courses overall (1·0% relative reduction; -8·2 courses per 100 child-years [-9·4 to -7·2]), and antibiotic exposures to bystander pathogens (1·2% relative reduction; -15·9 courses per 100 child-years [-18·5 to -13·8]). An adenovirus-norovirus-rotavirus vaccine would cause the greatest reductions in antibiotic use (12·2 courses per 100 child-years [-13·7 to -11·0]) compared with the other combination vaccines. However, projected vaccine effects on antibiotic use in 2021 were 45-74% smaller than those estimated in 2009-12 accounting for reductions in diarrhoea incidence in the past decade., Interpretation: Vaccines for enteric pathogens could result in up to 8-12 prevented courses of antibiotics per 100 vaccinated children per year. Combination vaccines will probably be necessary to achieve greater than 1% reductions in total antibiotic use among children in similar low-resource settings., Funding: Wellcome Trust and Bill & Melinda Gates Foundation., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Happiness has been shown to influence many health-related outcomes in older adults. Identifying correlates and brain substrates of happiness across countries and cultures is an important goal, as the global older adult population continues to increase., Methods: We used univariate and multiple regression to examine associations between happiness and several demographic, health, and lifestyle variables in 665 older adults (39% female) from Kerala, India. We also used Bayesian regression to examine associations between cortical thickness and happiness in a subsample of 188 participants that completed MRI scanning., Results: Happiness was significantly associated with several variables. In our multiple regression model, which included all significant univariate predictors, self-rated health, depression, anxiety, apathy, social network size, social network diversity, and social support significantly predicted happiness. Demographic indicators (age, sex, education, marital status, residence, and employment status/type), cognitive impairment, comorbidities, and leisure activities were not significantly associated with happiness in the multiple regression model. Cortical thickness in several brain regions was positively associated with happiness scores, including frontal, temporal, parietal, occipital, and cingulate regions., Discussion: Understanding the key correlates is critical for identifying both modifiable factors that can be targeted in well-being interventions and fixed characteristics that identify those at-risk for reduced happiness. The widespread pattern of brain regions associated with happiness is consistent with the multifactorial nature of happiness and, given that the regions identified do not overlap with those vulnerable to cortical thinning, can help explain why subjective well-being, unlike other cognitive functions, is largely resistant to age-related decline., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The present study investigated the effect of low vs high-dietary-Advanced Glycation End products-based diets on oral disposition index-(DIo)-a marker of islet β-cell function and cardiometabolic risks factors in 38-overweight and obese Asian Indian-adults (aged 25-45 years with body-mass-index (BMI) ≥23kg/m 2 ) through 12-week isocaloric crossover feeding trial. Biochemical-measures included-glucose tolerance test (GTT), Insulin assay (0,30 and 120 min), lipid-profile, serum-adiponectin, serum-AGE and serum-Thiobarbituric acid reactive substances-(TBARS) assessed both at baseline and end of each intervention. Generalised linear models showed that low-dAGE diet significantly improved in oral disposition index [Least Square Mean (SE), +0.3 (0.1); p =  0.03] compared to high-dAGE diet. The low-dAGE diet also showed a significant reduction in 30-minutes plasmapost-glucose-challenge-value:(-8.1[3.8] (mg/dl) vs 3.8 [3.8] (mg/dl); p  = 0.01), serum-AGEs-(-3.2 [0.2] (μg/ml) vs -0.8 [0.2] (μg/ml); p = <0.0001) compared to high-dAGE diet. In summary, low-dAGE diets exhibited improvement in the insulin-sensitivity and reduction in the inflammatory levels compared to high-dAGE diets. Hence, study first time in India revealed that low dAGE diets could be a potential strategy to reduce diabetes risk.

Introduction: Facilities in austere environments may consider emergency care beyond their scope. Often patients with high-acuity conditions have no other choice than to present to these facilities. The disconnect between the intent of health systems planners and the reality faced by providers manifests as facilities unable to manage such cases.The Indian Health Service, with a range of stakeholders, developed an emergency care delivery assessment tool for facilities in austere environments, designed to identify deficiencies in facility readiness for emergency care delivery across four areas: 1. Procedural2. Human resources3. Non-pharmacologic material resources4. Pharmacologic material resources., Methods: The tool's underlying architecture is a resource matrix similar to hospital-based tools, using the "Facility" component of the WHO Emergency Care Systems Framework as the Y-axis and undifferentiated presentations taught by the WHO basic emergency care course, advanced trauma life support, and advanced life support in obstetrics as the X-axis. The tool was piloted at a remote frontier clinic., Results: We found 48 deficiencies: 7 procedural, 1 human resources, 31 non-pharmacologic materials, and 9 pharmacologic materials. We aggregated deficiencies by facility function to assess the capacity to perform each. We also aggregated deficiencies by clinical presentation to identify targets for educational interventions., Conclusion: We successfully created a novel emergency care capacity assessment tool for use in austere environments using materials with broad international consensus. The successful pilot found deficiencies across all 4 areas. This tool may be useful in many other remote domestic facilities and rural health posts in low- and middle-income countries., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: In India, 85% of organ donations are from living donors and 15% are from deceased donors. One-third of living donors were rejected because of ABO or HLA incompatibility. Kidney exchange transplantation (KET) is a cost-effective and legal strategy to increase living donor kidney transplantation (LDKT) by 25%-35%., Methods: We report our experience with 539 KET cases and the evolution of a single-centre program to increase the use of LDKT., Results: Between January 2000 and 13 March, 2024, 1382 deceased donor kidney transplantations and 5346 LDKT were performed at our centre, including 10% (n = 539) from KET. Of the 539 KET, 80.9% (n = 436) were ABO incompatible pairs, 11.1% (n = 60) were compatible pairs, and 8% (n = 43) were sensitized pairs. There were 75% 2-way (n = 2 × 202 = 404), 16.2% 3-way (n = 3 × 29 = 87), 3% 4-way (n = 4 × 4 = 16), 1.8% 5-way (n = 5 × 2 = 10), 2.2% 6-way (n = 6 × 2 = 12), and 1.8% 10-way KET (n = 10 × 1 = 10). Of the recipients 81.2% (n = 438) were male and 18.8% (n = 101) were female, while of the donors, 78.5% (n = 423) were female and 21.5% (n = 116) were male. All donors were near relatives; wives (54%, n = 291) and mothers (20%, n = 108) were the most common donors. At a median follow-up of 8.2 years, patient survival, death censored graft survival, acute rejection, and median serum creatinine levels of functioning grafts were 81.63% (n = 440), 91% (n = 494), 9.8% (n = 53) and 1.3 mg/dL respectively. We credited the success to maintaining a registry of incompatible pairs, high-volume LDKT programs, non-anonymous allocation and teamwork., Conclusion: This is the largest single-centre KET program in Asia. We report the challenges and solutions to replicate our success in other KET programs., (© 2024 Asian Pacific Society of Nephrology.)

Dr. Harish Chandra Pant was Chief of the Section on Neuronal Cytoskeletal Protein Regulation within the National Institute of Neurological Disorders and Stroke at the NIH. A main focus of his group was understanding the mechanisms regulating neuronal cytoskeletal phosphorylation. Phosphorylation of neurofilaments can increase filament stability and confer resistance to proteolysis, but aberrant hyperphosphorylation of neurofilaments can be found in the neurofibrillary tangles that are seen with neurodegenerative diseases like Alzheimer disease (AD). Through his work, Harish would inevitably come across cyclin dependent kinase 5 (Cdk5), a key kinase that can phosphorylate neurofilaments at KSPXK motifs. Cdk5 differs from other Cdks in that its activity is mainly in post-mitotic neurons rather than being involved in the cell cycle in dividing cells. With continued interest in Cdk5, Harish and his group were instrumental in identifying important roles for this neuronal kinase in not only neuronal cytoskeleton phosphorylation but also in neuronal development, synaptogenesis, and neuronal survival. Here, we review the accomplishments of Harish in characterizing the functions of Cdk5 and its involvement in neuronal health and disease., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Prevention of neonatal bilirubin injury exemplifies success of systems approach to avert adverse neonatal and childhood outcomes that rely on strategies including prenatal identification of Rhesus sensitization, universal maternal blood typing, risk assessment for neonatal extreme hyperbilirubinemia (EHB), unfettered access to safe, effective phototherapy, and application of patient safety principles. India's diverse landscape suggests varied real-time experiences of neonatal hyperbilirubinemia and consequent infant mortality rates (IMR). Utilizing Global Burden of Disease (GBD) database, the authors examined national and subnational trends, infant mortality timing, and the disease burden from hemolytic and perinatal jaundice over 30 y (1999 to 2019). They also assessed the correlation of EHB-IMR with socio-demographic index and health expenditure per capita, estimating economic losses from EHB-related infant mortality to guide policy decisions at national and state domains. From 1990 to 2019, India delivered 811,078,415 livebirths of which, 1,189,856 infant deaths were due to EHB. EHB-related deaths decreased from 57,773 in 1990 to 19,664 in 2019, a 60% reduction vs. 40% in overall IMR. Early (0-6 d), late (7-27 d), and post-neonatal (28-364 d) deaths accounted for 61%, 34%, and 5% of mortality, respectively. Uttar Pradesh and Bihar contributed to 38% of all EHB deaths. Economic analysis estimate losses between US $7.2 and 11.7 billion for the year 2019 secondary to EHB-related mortality. The present analysis reveals consistent declines across all states to reach current EHB-IMR of 0.8 per 1,000 live-births in India by 2019. Significant economic impact of lost human productivity highlight ongoing need for targeted life-saving public health strategies., Competing Interests: Declarations Conflict of Interest None., (© 2024. The Author(s), under exclusive licence to Dr. K C Chaudhuri Foundation.)

Background: Living donor liver transplant (LDLT) is based on the principle of double equipoise. Organ shortage in Asian countries has led to development of high-volume LDLT programs with good outcomes. Safety of live liver donor is the Achilles heel of LDLT program and every effort should be made to achieve low morbidity and near zero mortality rates., Methods: We retrospectively analyzed our prospectively maintained donor morbidity data (outcomes) of 177 donors in a new transplant program setup in western India by an experienced surgeon. The primary end point was to analyze the morbidity rates and the factors associated with it., Results: None of the donors in our cohort of 177 donors developed grade IV or V complication (Clavien-Dindo classification). One-fourth (1/4th) of the donors developed complications ranging from grade I to grade III(b). The rate of complications according to modified Clavien-Dindo classification is as follows: (1) grade I in 5.6% (n = 10), (2) grade II in 14.6% (n = 26), (3) grade III(a) in 3.9% (n = 7), (4) grade III(b) in 2.2% (n = 4). Three donors (1.6%) developed post-hepatectomy intra-abdominal bleeding and required re-exploration (grade IIIb). All of them recovered well post-surgery and are doing well in follow-up. The mean follow-up of the entire cohort was 2871 ± 521 days (range 1926-3736 days)., Conclusion: Donor safety (outcome) is determined by meticulous donor surgery and good-quality remnant., (© 2024. Indian Society of Gastroenterology.)

Although the need to train clinicians to provide effective mental health care to individuals from diverse backgrounds has been recognized worldwide, a bulk of what we know about training in cultural competence (CC) is based on research conducted in the United States. Research on CC in mental health training from different world populations is needed due to the context-dependent nature of CC. Focusing on India and USA, two diverse countries that provide complementary contexts to examine CC, we explored graduate students', practicing clinicians', and faculty members' perspectives regarding CC training they received/provided and future training needs using mixed-methods. The data were collected using focus groups (n = 25 groups total: 15 in India, 11 in USA), and a survey (n = 800: 450 in India, 350 in USA). Our data highlight the salient social identities in these countries, and the corresponding constituents of CC training. Participants in India described a practical emphasis to their CC training (e.g., learning about CC through life experiences and clinical practice experiences) more so than through coursework, whereas participants in USA described varying levels of coursework related to CC along with practice. Participants in both countries considered enormity of CC as a challenge, while those in the US also identified CC training limited to a white, straight, male perspective, hesitancy in engaging with diversity topics, and limited time and competence of the faculty. Strengths of CC training in India and USA are mutually informative in generating recommendations for enhancing the training in both countries., Competing Interests: Declarations Conflict of interest On behalf of all authors, the corresponding author states that there is no conflict of interest. Ethical Approval This study was approved by the Institutional Review Board at the first author’s academic institution in USA (Approval Protocol Numbers: 01172r and 01475r). The application and approval were reviewed by the ethics committee at the second author’s academic institution in India, and the study was approved. Informed Consent All participants provided informed consent., (© 2024. The Author(s).)

Objectives: The COVID-19 pandemic may have influenced alcohol and tobacco consumption in low-income and middle-income countries, yet the effects are relatively unknown. In this study, we estimated the medium-term effects of the pandemic on tobacco and alcohol consumption in India., Methods: We used data from the fifth round of the National Family Health Survey 2019-2021, a nationally representative survey conducted between June 2019 and April 2021. We employed propensity score matching to evaluate the change in tobacco and alcohol consumption patterns by exploiting the gap in survey activities due to the pandemic lockdown-no data collection took place from April to October 2020. Individuals surveyed after the lockdown were considered COVID-19-affected, while those surveyed before were considered as unaffected., Results: The tobacco use rate was 1.4% lower and alcohol consumption was 0.3% lower for COVID-19-affected individuals relative to non-affected individuals. By tobacco product, there was a 0.9%, 0.6% and 0.4% decrease in the use of smokeless tobacco, cigarettes and bidi, respectively. Recent initiation decreased by 2.3%, 1.6% and 1.4%, for cigarettes, smokeless tobacco and alcohol, respectively. Tobacco use declined to a greater extent in low-wealth and rural populations, and in male and older subsamples. Alcohol use decreased in urban households, and among male and young subsamples, relative to their counterparts. Secondhand smoke exposure decreased by 4.6%., Conclusion: Tobacco and alcohol consumption, including recent initiation, decreased during the pandemic in India. Varying effects by subgroups suggest the need for targeted future control policies that support cessation and limit consumption., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objective: This study critically examined the adaptation and normative processes of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV)India., Method: WAIS-IV U.K. Edition Administration and Scoring Manual, WAIS-IVIndia Administration and Scoring Manual, and WAIS-IV Administration and Scoring Manual and Technical and Interpretive Manuals were used to extract test development and adaptation process data. The analyses were descriptive and qualitative., Results: A review of the manuals showed that the normative sample were fluent English speakers with high education levels, which is not representative of India's multilingual and educational diversity. The study identified minimal cultural and linguistic adaptations in subtests, which raised concern about potential biases in the test adaptation process across cultures. The lack of clarity in item selection, demographic data, sample selection, and psychometric properties raised questions about the test's reliability and validity. Issues related to education, age, gender, and regional distribution are discussed, emphasizing the test's limitations in capturing the diverse characteristics of the heterogeneous Indian population., Conclusions: WAIS-IV India may not adequately represent India's population. More careful consideration of socioecological and psychometric factors when adapting intelligence (IQ) tests and use of advanced data harmonization methods can provide robust cross-national statistical harmonization in the future along with more ecologically valid local test development efforts. This can allow consideration of social determinants of health and other factors that can inform a more nuanced approach to IQ test development in non-western contexts., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: This special series of exploratory studies compared WAIS-IV performances in five Asian countries: Japan, South Korea, Taiwan, India, and Indonesia with the U.S. The studies examined cognitive profiles across age groups to develop hypotheses on how culture can impact cognition. This summary article integrates the findings from each study to determine similarities and differences across Asian countries and proposes possible underlying cultural factors impacting cognition., Methods: In each study, raw scores corresponding to a subscale score of 10 were scored with U.S. norms across all age groups. Index scores were calculated with the adjusted scale scores. The impact of education on test performances was determined by correlating WAIS-IV scores with a ratio of educational attainment for each country with the U.S. for each age group. Findings from each country were then integrated to develop hypotheses on cultural factors that impacted cognitive profiles., Results: East Asian countries (Japan, South Korea, Taiwan) demonstrated weaker Verbal Comprehension Index scores and stronger Processing Speed Index scores than the U.S. sample, although the latter was moderated by age. East Asian countries demonstrated stronger performances on Perceptual Reasoning versus Verbal Comprehension tests. East Asians and the Java subset of the Indonesian sample demonstrated a pattern of stronger performances in younger versus older cohorts which was significantly correlated with educational attainment., Discussion: Cultural factors impacting cognition were proposed. Clinical implications of the findings were discussed and directions for future studies to examine the relationship between culture and cognition were recommended., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: The objective of this study is to examine the trends in geographical inequality of opportunity in maternal health services in India considering the Every Newborn Action Plan (ENAP) 2025 coverage targets., Setting: India., Participants: Women in the National Family Health Survey (NFHS)-NFHS-4 (2014-2015) and NFHS-5 (2019-2021)., Primary and Secondary Measures: District-level coverages of 4+antenatal care (ANC) visits, institutional delivery with skilled birth attendant, postnatal care (PNC) services within 48 hours of delivery, continuum of care (CoC) services for women with most recent live births were considered. Human Opportunity Index (HOI) documented the opportunities for equitable access to these services, ranging from 0 (high inequality) to 100 (universal access). HOI was compared between the survey rounds and wealth index (WI) quintiles that the women belonged to., Results: Coverages of 4+ANC visits, institutional delivery, PNC and CoC in India increased by 22.8% (95% CI 22.1% to 23.5%), 12.6% (95% CI 12.2% to 12.9%), 28.5% (95% CI 28.0% to 29.0%) and 38.6% (95% CI 37.6% to 39.6%) between NFHS-4 and NFHS-5, respectively. The HOI for 4+ANC visits was 48.4 in NFHS-5, ranging from 11.3 to 92.4 in states and from 31.1 to 70.5 for WI I-V. The HOI for institutional delivery was 80.4 in NFHS-5, ranging from 37.4 to 99.7 in the states and from 21.0 to 100 for WI I-V. The HOI for PNC services was 73.5 in NFHS-5, ranging from 37.5 to 95.6 in the states and from 61.2 to 88.3 for WI I-V. The HOI for CoC was 37.1, ranging from 6.5 to 88.8 in the states and from 19.8 to 62.7 for WI I-V for CoC in NFHS-5., Conclusion: Though significant improvements in the geographical inequity of maternal health services have been made in India, the geographical inequity for 4+ANC visits coverage lags significantly behind resulting in CoC coverage inequity to achieve the ENAP targets for these services., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

In this study, we use an integrative taxonomic approach to redescribe Schyzocotyle nayarensis (Malhotra, 1983) (Cestoda: Bothriocephalidae), based on newly collected specimens from the type-host Raiamas bola (Hamilton, 1822) (Cypriniformes: Danionidae) in Fulbari, Siliguri, West Bengal, India. The detailed morphological assessment, from whole mounts, histology and scanning electron microscopy, offers additional insights into the scolex structure, vitelline follicles, and egg morphology. Molecular data from this and previous studies corroborate the identity and systematics of S. nayarensis as a bothriocephalid closely related to the Asian Fish Tapeworm, Schyzocotyle acheilognathi (Yamaguti, 1934). This study elucidates the historical context and taxonomic ambiguities surrounding S. nayarensis , emphasizing the key role of the scolex in both generic and species identification. Amendments to the diagnosis of Schyzocotyle Akhmerov, 1960 are proposed. A differential diagnosis of the two valid species within the genus, namely S. acheilognathi and S. nayarensis , is also provided. An evaluation of the taxonomic status of Bothriocephalus teleostei Malhotra, 1984, and Capooria barilii Malhotra, 1985 suggests that they may be S. nayarensis. Finally, we posit that none of the ten species of Ptychobothrium Lönnberg, 1889 described from Indian freshwater teleosts belong to this genus but instead appear to be a mix of species belonging to Schyzocotyle , Senga Dollfus, 1934, and possibly even Proteocephalidae La Rue, 1911; all require further study based on newly collected, properly fixed specimens and an integrated taxonomic approach. Finally, future survey studies may reveal hidden diversity of Schyzocotyle species in Indian cyprinoids.

Objectives: There is limited information about the stability and predictability of Bayley Scales of Infant and Toddler Development (BSID) assessing child development in low- and middle-income settings. The objective of the present study was to analyse stability and predictive validity of BSID using an existing birth cohort., Design: Prospective birth cohort follow-up study., Setting and Participants: A community-based birth cohort of 251 newborns was recruited and followed-up in urban Vellore, South India, until 9 years of age. Using BSID-III, child development was measured at 6, 15, 24 and 36 months. Cognition was assessed using the Wechsler Preschool Primary Scales of Intelligence at 5 years, and the Malin's Intelligence Scale for Indian Children scale at 7 and 9 years of age. The stability of BSID measurements across time points was expressed by intraclass correlation (ICC) and concordance correlation coefficients. Linear regression was used to describe the predictability of BSID-III of cognition at 5, 7 and 9 years., Results: The ICC for domain-wise BSID scores between time points of measurement suggested a weak correlation. The BSID scores at 36 months correlated best with Full-Scale Intelligence Quotient (FSIQ) at 5 years (r: 0.40-0.49), 7 years (r: 0.35-0.48) and 9 years (r: 0.36-0.38). BSID scores at 36 months predicted FSIQ better at 5, 7 and 9 years with R 2 ranging from 23.3% to 28.6%, when compared with 24 months BSID scores (R 2 - 16.0% to 25.9%)., Conclusion: Poor stability and predictability of BSID warrant caution in the predictive projection of early childhood assessments. Better predictability of future cognition of 36 months' BSID scores highlights its advantage over the 24 months' assessment., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Residual blood specimens provide a sample repository that could be analyzed to estimate and track changes in seroprevalence with fewer resources than household-based surveys. We conducted parallel facility and community-based cross-sectional serological surveys in two districts in India, Kanpur Nagar District, Uttar Pradesh, and Palghar District, Maharashtra, before and after a measles-rubella supplemental immunization activity (MR-SIA) from 2018 to 2019. Anonymized residual specimens from children 9 months to younger than 15 years of age were collected from public and private diagnostic laboratories and public hospitals and tested for IgG antibodies to measles and rubella viruses. Significant increases in seroprevalence were observed following the MR SIA using the facility-based specimens. Younger children whose specimens were tested at a public facility in Kanpur Nagar District had significantly lower rubella seroprevalence prior to the SIA compared to those attending a private hospital, but this difference was not observed following the SIA. Similar increases in rubella seroprevalence were observed in facility-based and community-based serosurveys following the MR SIA, but trends in measles seroprevalence were inconsistent between the two specimen sources. Despite challenges with representativeness and limited metadata, residual specimens can be useful in estimating seroprevalence and assessing trends through facility-based sentinel surveillance.

The interconnected systems of lakes of Bengaluru, India, experience tremendous stress due to unsustainable urbanisation. Traditional lake-centric research approach struggles to capture and address this issue due to the cascaded nature of impacts in interconnected lake systems. Hence, this study assesses the impact of urbanisation on a lake series scale, focusing on the Yele Mallappa Shetty Lake series (YMSLS). Land use land cover change analysis (1993-2023) showed that in 1993, the YMSLS catchment area was dominated by open spaces (53.4%) and agriculture land and vegetation (35%), with built-up areas covering only 7.2%. By 2023, the built-up area has expanded to 34.6% and became the dominant land use. This rapid urbanisation has led to increased water surface area from wastewater influx, causing significant weed growth and water pollution in the lakes. Lake water quality assessment showed that faecal coliform, total coliform, dissolved oxygen, and biochemical oxygen demand levels exceeded standard limits with spatio-temporal variations driven by interconnectivity. Pollutant flushing during monsoon reduced pollution load in upstream lakes, but high wastewater inflow made downstream lakes, particularly the end lake, highly polluted but perennial. Increased water availability expanded the user base of the end lake, but traditional uses have declined and coping strategies of users, such as wastewater lift irrigation from the lake, became unsustainable. The study indicates that spatial interdependence and cascading effects necessitate a lake series approach for assessing the impacts of urbanisation on interconnected lake system, which is crucial for enhancing water security and preparedness for future extreme events., Competing Interests: Declarations Ethical Approval and Consent to Participate Not applicable. Consent for Publication Not applicable Competing Interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Mercury (Hg), a ubiquitous atmospheric trace metal posing serious health risks, originates from natural and anthropogenic sources. India, the world's second-largest Hg emitter and a signatory to the Minamata Convention, is committed to reducing these emissions. However, critical gaps exist in our understanding of the spatial and temporal distribution of Hg across the vast Indian subcontinent due to limited observational data. This study addresses this gap by employing the GEOS-Chem model with various emission inventories (UNEP2010, WHET, EDGAR, STREETS, and UNEP2015) to simulate Hg variability across the Asian domain, with a specific focus on India from 2013 to 2017. Model performance was evaluated using ground-based GMOS observations and available literature data. Emission inventory performance varied across different observational stations. Hence, we employed ensemble results from all inventories. The maximum relative bias for Total Gaseous Mercury (TGM) and Gaseous Elemental Mercury (GEM; Hg 0 ) concentrations is about ±20%, indicating simulations with sufficient accuracy. Total Hg wet deposition fluxes are highest over the Western Ghats and the Himalayan foothills due to higher rainfall. During the monsoon, the Hg wet deposition flux is about 65.4% of the annual wet deposition flux. Moreover, westerly winds cause higher wet deposition in summer over Northern and Eastern India. Total Hg dry deposition flux accounts for 72-74% of total deposition over India. Hg 0 dry deposition fluxes are higher over Eastern India, which correlates strongly with the leaf area index. Excluding Indian anthropogenic emissions from the model simulations resulted in a substantial decrease (21.9% and 33.5%) in wet and total Hg deposition fluxes, highlighting the dominant role of human activities in Hg pollution in India.

Background: Considering the significant growth in India's aging population, it is imperative to identify factors associated with frailty among older Indians. This study examined the association between sleep quality, sleep duration, and physical frailty among older adults in India. Moreover, we examined whether the associations between sleep quality, sleep duration, and physical frailty varied by gender., Methods: In this secondary analysis, we used data from the 2015 wave 2 of the Study on Global Aging and Adult Health (WHO-SAGE) in India, comprising a sample of 6,512 older adults aged 50 years and above. Pre-frailty and frailty were assessed using the modified version of the frailty phenotype developed by Fried and colleagues. Sleep was assessed by self-reported quality and duration. Multinomial and multivariable logistic regression models were used to examine the associations between sleep quality, sleep duration, and physical frailty (including its components), as well as to explore the moderating effect of gender., Results: 66.8% of older Indians were pre-frail, while 25.2% were frail. Relative to those with good sleep quality, older adults with poor sleep quality had significantly higher odds of frailty [AOR: 2.79; CI: 1.37-5.66]. Compared to those receiving the recommended age-appropriate 7-8 h of sleep, older adults sleeping ≥ 9 h reported a significantly lower likelihood of both pre-frailty [AOR: 0.73; CI: 0.57-0.93] and frailty [AOR: 0.68; CI: 0.51-0.91]. Analysis of specific components of frailty showed that older adults with long sleep had lower odds of exhaustion [AOR: 0.86; CI: 0.73-1.00] compared to those with age-appropriate sleep duration. Moreover, frailty was more pronounced in older men with poor sleep quality and short sleep duration (< 7 h/night) than in older women with similar sleep patterns. Poor sleep quality was not linked to any of the frailty components in older women; however, in older men, it was associated with exhaustion [AOR: 4.28; CI: 2.28-8.06], weak grip strength [AOR: 2.31; CI: 1.46-3.67], and low physical activity [AOR: 2.81; CI: 1.10-7.21]., Conclusion: The findings indicate potential associations between sleep quality, sleep quantity, and physical frailty among older Indians. Poor sleep quality was associated with frailty, yet long sleep duration was associated with a lower prevalence of frailty, independent of sleep quality. Moreover, the prevalence of frailty associated with poor sleep quality and shorter sleep duration was more pronounced among older Indian men than women, underscoring the need for targeted interventions to address sleep-related concerns in this demographic., Competing Interests: Declarations Ethics approval and consent to participate The procedures undertaken in this study and the data collection processes were conducted ethically per the World Medical Association’s Declaration of Helsinki. Ethical approvals were obtained for SAGE study from the Ethics Review Committee of the World Health Organization, the Ethics and Protocol Review Committee of the Ghana Medical School, Accra, Ghana, the Ethics Committee of the School of Preventive and Social Medicine, and the Russian Academy of Medical Sciences, Moscow, Russia. Approval was also obtained for the SAGE 1 study from the Ethics Committee of the Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China, Institutional Review Board of the International Institute of Population Sciences, Mumbai, India, and finally from the Research Ethics Committee of the Human Sciences Research Council, Pretoria, South Africa. These approvals also covered all procedures through which written informed consent was obtained from each participant. Confidential records of participants’ consent were maintained by SAGE. Further, written informed consents for participating in the SAGE study were obtained from each participant. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: The choice of de novo assembler for high-throughput sequencing (HTS) data remains a pivotal factor in the HTS-based discovery of viral pathogens. This study assessed de novo assemblers, namely Trinity, SPAdes, and MEGAHIT for HTS datasets generated on the Illumina platform from 23 apple samples, representing 15 exotic and indigenous apple varieties and a rootstock. The assemblers were compared based on assembly quality metrics, including the largest contig, total assembly length, genome coverage, and N50., Results: MEGAHIT was most efficient assembler according to the metrics evaluated in this study. By using multiple assemblers, near-complete genome sequences of citrus concave gum-associated virus (CCGaV), apple rubbery wood virus 1 (ARWV-1), ARWV-2, apple necrotic mosaic virus (ApNMV), apple mosaic virus, apple stem pitting virus, apple stem grooving virus, apple chlorotic leaf spot virus, apple hammerhead viroid and apple scar skin viroid were reconstructed. These viruses were further confirmed through Sanger sequencing in different apple cultivars. Among them, CCGaV, ARWV-1 and ARWV-2 were recorded from apples in India for the first time. The analysis of virus richness revealed that ApNMV was dominant, followed by ARWV-1 and CCGaV. Moreover, MEGAHIT identified novel single-nucleotide variants., Conclusions: Our analyses highlight the crucial role of assembly methods in reconstructing near-complete apple virus genomes from the Illumina reads. This study emphasizes the significance of employing multiple assemblers for de novo virus genome assembly in vegetatively propagated perennial fruit crops., (© 2024. The Author(s).)

Background: Women in India are often responsible for unpaid household work, family caregiving, and paid work, which can contribute to poorer mental health. The provision of childcare has the potential to improve women's mental health, but evidence on the effects of providing access to daycare is limited., Methods: We designed a cluster-randomised trial and used data from a sample of 2858 mothers with age-eligible children from 160 village hamlets in rural Rajasthan, India, to evaluate the impact of providing access to a community-based daycare programme on social and emotional aspects of women's mental health. We conducted a baseline survey in early 2016, randomised hamlets to intervention or control groups approximately six months later, and delivered the final post-intervention survey approximately two years thereafter., Results: Treatment assignment increased the probability that a respondent used a daycare over the two-year follow-up by 40.9 percentage points. Providing randomised access to a daycare resulted in 0.2 (95% confidence interval (CI) = -0.1, 0.4) fewer symptoms of mental distress, representing a 9.5% decline compared to the baseline mean of 2.1 symptoms, as well as a 3.7 (95% CI = -0.8, 8.3) percentage point increase in the proportion of women who reported feeling very happy, equivalent to an 11.0% increase relative to the baseline mean of 33.6%. Among social indicators, treatment assignment was associated with a 5.6 (95% CI = -1.2, 12.4) percentage point increase in membership in an association, a relative increase of 43.4% compared to the baseline mean of 12.9%. The intervention did not have an appreciable impact on measures of life satisfaction or trust in institutions. Two-stage least squares instrumental variable analyses showed that daycare use decreased mental distress by 0.4 (95% CI = -0.1, 0.8) symptoms, increased the proportion of women who were very happy by 9.4 (95% CI = 0.0, 17.6) percentage points, and increased membership in an organisation by 15.9 (95% CI = 8.4, 23.7) percentage points., Conclusions: The provision of affordable, community-based daycare was associated with substantial uptake and showed potential for improving mothers' mental health in a rural context where most women were not employed in the formal labour force., Registration: ISRCTN clinical trial registry (ISRCTN45369145), registered on 16 May 2016; American Economic Association's registry for randomised controlled trials (AEARCTR-0000774), registered on 15 July 2015., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Background: With the increased availability of licensed vaccines for respiratory viruses such as severe acute respiratory syndrome coronavirus 2, respiratory syncytial virus (RSV), and influenza virus, a better understanding of the viral aetiology of severe acute respiratory infections (SARI) among children could help in optimising the use of these vaccines. We conducted a study among children aged <5 years hospitalised with SARI at a tertiary care children's hospital in north India and tested for common respiratory pathogens., Methods: We randomly enrolled eligible SARI cases aged <5 years from August 2013 to July 2015. SARI cases were defined as either <7-day history of fever with cough or in children aged eight days to three months, a physician diagnosis of acute lower respiratory infection requiring hospitalisation. We also enrolled an age-group matched control without any acute illness in a 2:1 ratio from the outpatient clinic within 24 hours of case enrolment. Nasopharyngeal and/or oropharyngeal swabs were collected and tested using TaqMan Array Cards, a real-time reverse transcription polymerase chain reaction-based multi-pathogen testing platform for selected respiratory viruses among the enrolled cases and controls. We compared the prevalence of each pathogen among cases and controls using the χ 2 (χ 2 ) or Fisher exact test (P < 0.05). We used logistic regression to estimate adjusted odds ratios (aORs) which were then used to calculate aetiologic fractions (EFs)., Results: We enrolled 840 cases and 419 outpatient controls. Almost half of the individuals in the whole sample were aged <6 months (n = 521, 41.4%). Females made up 33.7% of cases and 37.2% of controls. Viral detections were more common among cases (69%, 95% confidence interval (CI) = 66, 73) compared to controls (33%; 95% CI = 29, 38) (P < 0.01). RSV (n = 257, 31%; 95% CI = 28, 34%) was the most common virus detected among cases. Influenza A was detected among 24 (3%; 95% CI = 2, 4%), and influenza B among 5 (1%; 95% CI = 0, 1%) cases. The association between the virus and SARI was strongest for RSV (aOR = 23; 95% CI = 12, 47; EF = 96%). Antivirals were administered to 1% of SARI cases while 78% received antibiotics., Conclusions: Using a multi-pathogen molecular detection method, we detected respiratory viruses among more than two-thirds of children aged <5 years admitted with SARI in the Delhi tertiary care children's hospital. The guidelines for preventing and managing SARI cases among children could be optimised further with the improved availability of antivirals and vaccines., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interest., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Background: Dementia is expected to increase more rapidly in low- and middle-income countries (LMIC) than in high-income countries (HIC) in the coming decades. Nevertheless, research on dementia care remains limited for LMIC. This study aims to fill this gap by investigating care needs and care receipt in 3 LMIC: China, Mexico, and India., Methods: Using harmonized data from the Gateway to Global Aging Data in China, Mexico, and India and focusing on individuals aged 65 and older with cognitive impairment (N = 15 118), we estimated the proportions of care needs related to difficulties with activities of daily living and instrumental activities of daily living, and care receipt. We then used logistic regressions to examine the association between caregiver availability and informal care receipt., Results: We observed relatively similar patterns in care need measures across countries and over time. In contrast, the association between caregiver availability and informal care receipt showed some cross-country variations. Generally, living with family members was associated with a higher probability of receiving informal care in China and India. However, for Mexico, this association was only evident for men. Additionally, we found that the magnitude of the association between caregiver availability and informal care receipt varied with the care recipient's gender., Conclusions: Although living with family members was generally associated with a higher likelihood of receiving informal care in China, Mexico, and India, there are differences in the association between caregiver availability and informal care receipt across countries and over time., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

bla , the most prevalent carbapenemase among carbapenem-resistant Enterobacteriaceae, is thought to have emerged in India, as its initial detection in 2008 was linked to this country, and subsequent retrospective surveys had so far established the earliest NDM -positive strains to be isolated in India in 2005. Molecular dating and analyses suggest bla NDM -positive strains to be isolated in India in 2005. Molecular dating and analyses suggest bla NDM emerged within Acinetobacter species decades prior to 2005 on a Tn 125 transposon. Despite early reports of elevated rates of carbapenem-resistant Acinetobacter species in Israel starting in the 1990s, limited molecular data are available from this location. We searched for bla NDM among Acinetobacter species isolated in Israel between 2001 and 2006. One A. junii strain, Ajun-H1-3, isolated in January 2004, carried bla NDM-1 within a Tn 125 -like transposon on a 49-kb plasmid, pNDM-Ajun-H1-3, making Ajun-H1-3 the earliest NDM-positive isolate observed to date. The pNDM-Ajun-H1-3 plasmid matched numerous BJ01-like NDM-positive plasmids identified from 2005 onward in Acinetobacter species as well as Enterobacterales. These results indicate the need for further retrospective work on global strain archives to shed light on the conditions favoring the emergence as well as subsequent evolution and spread of bla NDM ., Importance: This study presents the earliest observation of bla NDM-1 , isolated in a geographical region distant from where it is believed to have originated. In doing so, this study provides novel insights into the emergence and spread of bla NDM , the most prevalent carbapenemase among carbapenem-resistant Enterobacteriaceae, and its associated mobile genetic elements. It also sheds light on the conditions that foster the evolution of antimicrobial resistance, one of the greatest public health challenges we face., Competing Interests: The authors declare no conflict of interest.

In heart failure, sympathetic overdrive is evidenced by norepinephrine spillover, receptor level changes, etc. Beta-blockers continue to be the cornerstone of treatment in patients with chronic heart failure due to their ability to counteract sympathetic overdrive. Extensive clinical research has demonstrated that long-term beta-blocker treatment with metoprolol succinate, carvedilol, or bisoprolol enhances left ventricular function and reverses left ventricular remodeling, decreases hospitalization risk, and increases survival. The aim of this consensus paper is to identify patient profiles, initiation or up-titration of beta-blockers and benefits of chirally pure beta-blocker in patients with heart failure. This expert consensus will ensure precise implementation of beta-blockers in heart failure as a part of guideline-directed medical therapy., (© Journal of the Association of Physicians of India 2024.)

Background: While recommending a human papillomavirus (HPV) single-dose vaccination schedule in 2022, the World Health Organization highlighted the need for long-term follow-up studies to monitor waning of protection. We report on vaccine efficacy against HPV infections in 1-, 2-, and 3-dose schedules and protection against cervical precancers at a median follow-up of 12 years postvaccination., Methods: This randomized multicenter study in India was originally designed to vaccinate unmarried girls aged 10-18 years with either 2 or 3 doses of quadrivalent HPV vaccine. A ministerial decree to halt vaccination in trials resulted in the creation of cohorts receiving different doses, including just a single dose. Cohorts were assessed for incident and persistent infections by genotyping cervical samples collected yearly for 4 consecutive years after participants were married. Cervical screening with an HPV test was initiated at age 25 years for married participants. Age- and site-matched unvaccinated married women were recruited to be compared with vaccinated cohorts. Vaccine efficacy was assessed using proportional incidence ratios., Results: The number of participants in the 1-, 2- (at 0 and 6 months), and 3-dose cohorts was 4949, 4980, and 4348, respectively. Of the recipients, 71%-82% in the different cohorts were eligible to provide samples for genotyping. Vaccine efficacy against persistent HPV 16 and 18 infection was 92.0% (95% confidence interval [CI] = 87.0% to 95.0%) in 3022 recipients of the single dose; and comparable with that observed in the 2-dose arm (94.8%, 95% CI = 90.0% to 97.3%) and the 3-dose arm (95.3%, 95% CI = 90.9% to 97.5%). No high-grade precancer associated with HPV 16 and 18 was detected among vaccinated participants compared with 8 precancers detected among the unvaccinated women., Conclusion: This observational cohort study has established that a single dose of HPV vaccine provides high protective efficacy against persistent HPV 16 and 18 infections and associated neoplasia 15 years postvaccination., (© The Author(s) 2024. Published by Oxford University Press.)

In the summer of 2024, there were higher temperatures than usual in several parts of India. Temperatures in Delhi, a huge city with millions of residents, broke several previous records. Low-income households have dwellings that do not offer much protection from the heat, and individuals struggle to access basic amenities, such as water. With accumulating evidence on consequent impacts for mortality and morbidity, governance structures are seeking to respond in a timely and efficient manner. There is a need to recognise that heat-related illnesses and deaths are not best addressed merely as an acute disaster but as public health and economic challenges that require planned responses. Responses that are sustainable and equitable combine long-term structural efforts at resilience building with emergency preparedness and prove to be most effective in averting the largely preventable deaths, morbidities, and economic shocks arising from heat-related health risks among exposed and vulnerable communities. Joint action on climate and health enhances achievement of multiple developmental goals with multistakeholder participation. Diverse sectors, including medical care, surveillance, risk communication, disaster preparedness, livelihoods and jobs, and adaptation and urban planning, are needed to raise public awareness and engagement, induce behavioural change, and focus resources for the much-needed structural changes in urban planning and health systems that can save lives and avert damages. To reduce heat-related health risks, vulnerability, inequity, and climate action in the Indian context must be urgently addressed., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Cognitive deficits are the core component in persons with schizophrenia which impacts their socio-occupational functioning. Also, cognitive deficits cause significant impairment with the person's quality of life [3]. Hence, targeting such a pivotal aspect in persons with schizophrenia through suitable interventions is very important. Developed countries have designed various cognitive remediation programs using computers involving high-end software which cannot be generalized to low-resource settings, like India, due to various factors including sociocultural factors, educational standards, and living standards of the patient population. Compensatory cognitive training (CCT) was developed to be "brief, practical, low-tech" and found to be effective in the west [9]. As there are no structured cognitive intervention modules in India, we have adapted the English CCT manual to be used for an urban population in Chennai, India. CCT was found to be feasible in face-to-face group sessions in our setting [12] and is found to be feasible and acceptable as virtual one-one intervention (unpublished data). Therefore, this study aims to evaluate the effectiveness of V-CCT in enhancing cognition and socio-occupational functioning., Methods: The proposed study will be a multicenter assessor-blinded randomized controlled trial at two clinical sites in Chennai, India. The preparatory phase of the study would include translation of the manual to the local language, recruitment and training of research assistants, and pilot testing using the translated manual. The second phase will be the main randomized controlled trial (RCT), during which a total of 160 persons diagnosed with schizophrenia will be recruited from both sites. After obtaining informed consent, baseline assessments will be conducted on cognition, functioning, self-esteem, and quality of life. Participants will be randomly assigned to either the virtual CCT group or the control group using a computer-generated randomization table. End-line assessments will be conducted 6 weeks after the baseline by research assistants who are blinded to the randomization post-intervention., Discussion: If V-CCT is found to be effective, it will be available for use in Tamil for persons with schizophrenia, and it will have an effect on their functioning, quality of life, and self-esteem., Trial Registration: The study is registered under Clinical trial registry-India (CTRI), and the registration number is CTRI/2024/04/065267. Registered on April 2024., (© 2024. The Author(s).)

Introduction: Air pollution presents a major public health threat to India, affecting more than three quarters of the country's population. In the current project, GEOHealth Health Effects of Selected Environmental Exposomes Across the Life CourSe-India, we aim to study the effect of environmental exposomes-fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ), ozone (O 3 ) and extremes of temperature-on multiple health outcomes using a modified life course approach. The associated training grant aims to build capacity in India to address the unique environmental health problems., Methods and Analysis: The project aims to (A) Develop exposure assessments in seven cities, namely Delhi, Chennai, Sonipat, Vizag, Pune, Hyderabad and Bikaner, for: (1) A fine-scale spatiotemporal model for multiple pollutants (PM 2.5 , NO 2 , O 3, temperature); (2) Combined ground monitoring and modelling for major chemical species of ambient PM 2.5 at seven cities; and (3) Personal exposure assessment in a subsample from the six cities, except Pune, and (B) Conduct health association studies covering a range of chronic non-communicable diseases and their risk factors leveraging a unique approach using interdigitating cohorts. We have assembled existing pregnancy, child, adolescent, adult and older adult cohorts across India to explore health effects of exposomes using causal analyses. We propose to use Bayesian kernel machine regression to assess the effects of mixtures of all pollutants including species of PM 2.5 on health while accounting for potential non-linearities and interactions between exposures. This builds on earlier work that constructed a fine spatiotemporal model for PM 2.5 exposure to study health outcomes in two Indian cities., Ethics and Dissemination: Ethical clearance for conduct of the study was obtained from the Institutional Ethics Committee (IEC) of the Centre for Chronic Disease Control, and all the participating institutes and organisations. National-level permission was provided by the Indian Council of Medical Research. The research findings will be disseminated through peer-reviewed publications, policy briefs, print and social media, and communicating with the participating communities and stakeholders. Training of Indian scientists will build the capacity to undertake research on selected adverse environmental exposures on population health in India., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In consideration of patient out-of-pocket costs in low- and middle-income countries, this observational cohort study sought to quantify the travel expenses associated with receiving free cardiac services in India and create a point-of-care ultrasound (POCUS) referral model., Methods: In a tertiary hospital that offers free services in Bangalore, India, we interviewed outpatients awaiting cardiac evaluation regarding their out-of-pocket expenses. A subgroup underwent POCUS for signs of left atrial enlargement, inferior vena cava plethora, and extravascular lung water, and subsequent chart review for significant findings on echocardiography or need for immediate care. A model was tested in which a normal POCUS would negate the requirement for referral., Results: Patients (N = 219), of age (mean ± SD) 49.0 ± 12.9 y, traveled [median (IQR)] 1178 miles (248-1240), spent $104 ($26-$195), and lost 4.5 (0-10) days of work at a daily wage of $3.90 ($1.95-$6.50). The one-way travel cost equated to 27 days of daily pay. In the POCUS subgroup, symptoms were commonly chest pain (57%) and dyspnea (48%) and were less than moderate in severity (71%). Abnormal echo findings were present in 54% of patients, of whom 29% needed immediate care, and 71% were dismissed without follow-up. POCUS signs were related to an abnormal echo (p < 0.001), but not immediate care (p = 0.50). POCUS-based referral would have prevented 51% (35/68) of unnecessary referrals and missed 13% (9/68) of cases that required immediate care., Conclusions: Out-of-pocket costs, relative to income, can be significant for those seeking free cardiac care. POCUS performed locally could potentially reduce the costs of travel but would risk missing cases, depending on symptom type., (© 2024. The Author(s).)

Background: Excess dietary sodium intake has been associated with death and disability. WHO has released global sodium benchmarks for packaged foods to support countries to reduce population sodium intake. This study aimed to assess the potential health effect, costs, and cost effectiveness of implementing these WHO sodium benchmarks in India., Methods: We used a multiple cohort, proportional multistate, life table (Markov) model to estimate the health gains and cost effectiveness for adults if sodium content in packaged foods complied with the WHO benchmarks compared to the status quo. We used India-specific dietary surveys, food composition tables, foods sales data, and sodium content data from packaged food labels to estimate sodium intake before and after the intervention. Data on blood pressure, cardiovascular disease, and chronic kidney disease burden were obtained from the Global Burden of Diseases, Injuries, and Risk Factors study, and the effect of sodium reduction on blood pressure and disease risk was modelled on the basis of meta-analyses of randomised trials and cohort studies. Intervention and health-care costs were used to estimate net costs, and calculate the incremental cost per health-adjusted life-year (HALY) gained. Costs and HALYs were discounted at 3%., Findings: In the first 10 years, compliance with the WHO sodium benchmarks was estimated to avert a mean of 0·3 (95% uncertainty interval [UI] 0·2-0·5) million deaths from cardiovascular diseases and chronic kidney disease, a mean of 1·7 (95% UI 1·0-2·4) million incident cardiovascular disease events, and 0·7 (0·4-1·0) million new chronic kidney disease cases, compared with current practice. Over 10 years, the intervention was projected to be cost saving (100·0% probability), generating 1·0 (0·6 to 1·4) billion HALYs and US$0·8 (95% UI 0·3 to 1·4) million in cost savings. Over the population lifetime, the intervention could prevent 4·2 (2·4-6·0) million deaths from cardiovascular diseases and chronic kidney disease, 14·0 (8·2-20·1) million incident cardiovascular disease events, and 4·8 (2·8-6·8) new chronic kidney disease cases, with an 84·2% probability of being cost-saving and 100·0% probability of being cost-effective., Interpretation: Our modelling data suggest a high potential for compliance with WHO sodium benchmarks for packaged food being associated with substantial health gains and cost savings, making a strong case for India to mandate the implementation of the WHO sodium benchmarks, particularly as packaged food consumption continues to rise., Funding: WHO Country Office India., Competing Interests: Declaration of interests KT is co-Director of the WHO Collaborating Centre on Salt Reduction. LH reports grant support from the Australian National Health and Medical Research Council, outside of the present study. LNA is supported by an Australian National Health and Medical Research Council Investigator Grant and an Honorary Heart Foundation Fellowship. MM reports grant support from Resolve To Save Lives and Northwestern University, and travel support from the Nordic Dairy Congress 2022, all outside of the present work. RG is a staff member of WHO, and the authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the views, decisions, or policies of WHO. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Research, mainly conducted in Europe and North America, has shown an inequitable burden of internalising mental health problems among adolescents from poorer households. We investigated whether these mental health inequalities differ across a diverse range of countries and multiple measures of economic circumstances., Methods: In this longitudinal observational cohort study, we analysed data from studies conducted in eight countries (Australia, Ethiopia, India, Mexico, Peru, South Africa, the UK, and Viet Nam) across five global regions. All studies had self-reported measures of internalising symptoms using a validated scale at two timepoints in adolescence; a measure of household income, household consumption expenditure, or subjective wealth; and data collected between 2000 and 2019. Household income (measured in four countries), consumption expenditure (six countries), and adolescents' subjective assessment of household wealth (five countries) were measured in mid-adolescence (14-17 years). The primary outcome (internalising symptoms, characterised by negative mood, affect, and anxiety) was measured later in adolescence between age 17 and 19 years. Analyses were linear regression models with adjustment. Effect estimates were added to random-effects meta-analyses to aid understanding of cross-country differences., Findings: The overall pooled sample of eight studies featured 18 910 adolescents (9568 [50·6%] female and 9342 [49·4%] male). Household income had a small or null association with adolescents' internalising symptoms. Heterogeneity (I 2 statistic) was 71·04%, falling to 39·71% after adjusting for baseline symptoms. Household consumption expenditure had a stronger association with internalising symptoms (decreases of 0·075 SD in Peru [95% CI -0·136 to -0·013], 0·034 SD in South Africa [-0·061 to -0·006], and 0·141 SD in Viet Nam [-0·202 to -0·081] as household consumption expenditure doubled). The I 2 statistic was 74·24%, remaining similar at 74·83% after adjusting for baseline symptoms. Adolescents' subjective wealth was associated with internalising symptoms in four of the five countries where it was measured. The I 2 statistic was 57·09% and remained similar after adjusting for baseline symptoms (53·25%). We found evidence for cross-country differences in economic inequalities in adolescents' internalising symptoms, most prominently for inequalities according to household consumption expenditure. Subjective wealth explained greater variance in symptoms compared with the objective measures., Interpretation: Our study suggests that economic inequalities in adolescents' mental health are prevalent in many but not all countries and vary by the economic measure considered. Variation in the magnitude of inequalities suggests that the wider context within countries plays an important role in the development of these inequalities., Funding: Wellcome Trust., Competing Interests: Declaration of interests SE-L reports grants from the UK Medical Research Council, the National Institute for Health and Care Research, and the Economic and Social Research Council. KR-C reports support through a UK Research and Innovation Future Leaders Fellowship; grants from UK Research and Innovation and WHO; and previous membership on the Global Alliance for Chronic Disease expert advisory panel. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: India currently accounts for a majority of global suicide deaths. Research in European ancestry has established that suicide mortality has a significant genetic component, and suggests that inflammation may play a crucial role in the pathophysiology of suicide. Inflammation is also highly relevant in regions of increased pollution exposure, such as the megacities of India. To address the existing gaps in genetic research on suicide and possible association with inflammatory biomarkers, we examined genetic polymorphism and clinical risk phenotypes in a population-based suicide-death cohort, India., Material and Methods: Genotyping of IL-1β(rs16944) & (rs1143627), IL-4(rs2070874), IL-6(rs1800795) and IL-10(rs1800896) was done in 234 post-mortem suicide-death cases and 256 post-mortem controls ( N  = 490) using PCR RFLP method., Results: Our analyses identified three significant ( p  < 0.001) associations of cytokine variants with suicide death, including IL-1β(rs16944), OR = 0.627; IL-4(rs2070874), OR = 0.524; and IL-6(rs1800795), OR = 2.509. Cases were more likely female and were more likely to have a history of psychiatric illness, though rate of psychiatric illness was low in suicide cases(9%)., Conclusion: Our genetic results are generally consistent with previous research on risk for depression and suicidal behaviour, and both genetic and phenotypic results provide new insights into risk factors that may contribute to suicide in India.

Background: Accurate assessment of body composition during infancy is an important marker of early growth. This study aimed to develop anthropometric models to predict body composition in 3-24-month-old infants from diverse socioeconomic settings and ethnic groups., Methods: An observational, longitudinal, prospective, multi-country study of infants from 3 to 24 months with body composition assessed at three monthly intervals using deuterium dilution (DD) and anthropometry. Linear mixed modelling was utilized to generate sex-specific fat mass (FM) and fat-free mass (FFM) prediction equations, using length(m), weight-for-length (kg/m), triceps and subscapular skinfolds and South Asian ethnicity as variables. The study sample consisted of 1896 (942 measurements from 310 girls) training data sets, 941 (441 measurements from 154 girls) validation data sets of 3-24 months from Brazil, Pakistan, South Africa and Sri Lanka. The external validation group (test) comprised 349 measurements from 250 (185 from 124 girls) infants 3-6 months of age from South Africa, Australia and India., Results: Sex-specific equations for three age categories (3-9 months; 10-18 months; 19-24 months) were developed, validated on same population and externally validated. Root mean squared error (RMSE) was similar between training, validation and test data for assessment of FM and FFM in boys and in girls. RMSPE and mean absolute percentage error (MAPE) were higher in validation compared to test data for predicting FM, however, in the assessment of FFM, both measures were lower in validation data. RMSE for test data from South Africa (M/F-0.46/0.45 kg) showed good agreement with validation data for assessment of FFM compared to Australia (M/F-0.51/0.33 kg) and India(M/F-0.77/0.80 kg)., Conclusions: Anthropometry-based FFM prediction equations provide acceptable results. Assessments based on equations developed on similar populations are more applicable than those developed from a different population., (© 2024. The Author(s).)

In 2021, the U.S. Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and state partners investigated a multistate sample-initiated retrospective outbreak investigation (SIROI) consisting of a cluster of nine Salmonella Weltevreden illnesses associated with frozen, precooked shrimp imported from India. Import surveillance testing identified Salmonella Weltevreden recovered from a cooked shrimp sample from Supplier B. In total, nine patients with clinical isolates highly related via whole genome sequencing were reported in four states with illness onset dates between February 26 and July 17, 2021. Epidemiologic data were gathered by state partners for seven patients, who all reported exposure to shrimp. Five patients reported consuming shrimp cocktail from the same retailer. A traceback investigation for five of the six patients converged on Supplier B. This evidence demonstrated that the outbreak of Salmonella Weltevreden illnesses was caused by the consumption of cooked, ready-to-eat shrimp manufactured by Supplier B. At the time of the investigation, outbreak and recall information was shared with Indian competent authorities. In March 2022, a follow-up inspection of Supplier B's facility in India was conducted, and insanitary conditions and practices were observed. This outbreak investigation highlighted the importance of multidisciplinary national and international public health partnerships. The lessons learned from this investigation should continue to inform investigational activities and food safety guidance for the industry., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Inc.)

Introduction: We retrospectively studied the societal value of lost health due to alcohol use and compared it with excise taxes on alcohol sales for India in 2019., Methods: We estimated the overall alcohol-attributable disease burden using disability-adjusted life-years (DALY) for India and its 30 states for all causes with alcohol use as a risk factor from the GBD 2019 Study. The societal value of lost health was calculated using value of life-year (VLY) approach by multiplying region-specific factors from 'Global Health 2035', 2019-2020 GDP per capita and DALYs. We acquired the national and state-level (top 10 states) alcohol sales excise taxes from the Reserve Bank of India. Net losses were assessed by subtracting the revenue collected from excise taxes from VLY. All values are in Indian rupees (INR)., Results: The societal value of health lost due to alcohol use in India was 6.2 (95% uncertainty interval 4.8, 7.8) trillion INR in 2019. The absolute state-level values varied from 7.3 (4.7, 10.4) billion INR in Mizoram to 1.1 (0.8, 1.4) trillion INR in Maharashtra. The per capita values ranged from 950.2 (642.9, 1285.3) INR for Bihar to 61,332 (39,273.7, 87,288.5) INR for Mizoram. Nationally, excise tax collection from alcohol sales was 1.8 trillion INR depicting a net loss of 4.4 (3.1, 6.0) trillion. Maharashtra had the largest absolute and per capita net loss., Discussion and Conclusions: These are novel estimates depicting the net losses due to alcohol use in India with direct policy implications to disincentivise sales and adequately raise taxes., (© 2024 Australasian Professional Society on Alcohol and other Drugs.)

Objective: There is an increasing focus on understanding health disparities among various cultural groups in the United States. The need for heterogeneity in norms and test stimuli across ethnically diverse individuals are being increasingly recognized. However, to date it remains unknown whether and to what extent differences in cognitive norms and tests exist in Asian Indians, a fast-growing population in the U.S. It is essential to understand these differences to improve diagnostic accuracy and provide timely and appropriate clinical care. Method: In this study, we conducted a scoping review of available cognitive tests that were normed, developed, or adapted for Asian Indians living in the U.S. Results: The results suggested a paucity of norms and tests specifically examining cognition in this community. Conclusions: Based on the findings, we provide suggestions for research directions focusing on the development of culturally sensitive neuropsychological tools, normative data representative of this demographic, and interventions addressing healthcare access barriers. Overall, this review provides readers with relevant clinical information to immediately enhance patient care as well as provide actionable items in research to improve the future utility of neuropsychology for Asian Indians in the United States.

Tracking new variants of SARS-CoV-2 is vital for managing COVID-19 spread and allocating resources. Domestic antigen testing has created surveillance gaps that make it hard to identify new viral variants. We conducted whole genome sequencing of wastewater viral genes from major and minor treatment facilities in Dehradun from March 2022 onwards. Based on our analysis, the samples that achieved higher sequencing depth and covered >90 % of the viral genome uncovered a major variant pattern resembling the XAP recombinant lineage that is reported for the first time in the City of Dehradun, Uttrakhand and is the first ever records in India as on date. This novel XAP recombinant lineage had 9, 2, 30, 1, 2, 5, 1, 1, 1 aminoacid changes (total 54 mutations) in Orf1a, Orf1b, S, E, M, N, Orf3a, Orf6 and Orf8 regions of the gene respectively that shares 49 mutations common to the ancestral lineages BA.1* and BA.2*, with 6 unique mutations. Subsequent comparison and analysis of the clinical sequence data from the region post-detection of this rare and unusual variant showed no causalities infected with the newly detected XAP lineage. These findings are indicative of future alarming situation with plausible threats of fresh spur of Omicron variant led infections in the urban community., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Childhood cancers are a significant global health concern, particularly in low- and middle-income countries (LMICs), where over 80% of childhood cancer patients reside. In India, acute myeloid leukemia (AML) constitutes a significant portion of childhood cancers; however, the data on the cost-effectiveness of childhood AML treatment in India and other LMICs remain limited., Methods: The study focused on children (<15 years of age) diagnosed with AML at a tertiary care cancer center in North India. Data, including treatment outcome, treatment-related morbidity, mortality, and costs were retrospectively collected from the electronic medical record and hospital database. Cost-effectiveness was assessed using disability-adjusted life years (DALY) averted in relation to the country-specific cost-effectiveness threshold., Results: Among 59 AML patients, treatment-related high mortality rates, abandonment, and limited access to bone marrow transplantation were notable challenges. Intensive chemotherapy resulted in substantial sepsis-related complications, with treatment-related mortality reaching 30%. The 3-year event-free survival and overall survival of the 43 patients who received intensive therapy were 24.5% ± 7.6% and 27.9% ± 8.3%, respectively. Despite these challenges, treating childhood AML was still found to be cost-effective. The total cost per newly diagnosed patient treated with curative intent was $4454. Cost per DALY averted accounted for 24% of the gross domestic product (GDP) per capita, rendering the treatment to be cost-effective with a stringent cost-effectiveness threshold utilized., Conclusion: The study underscores the challenges faced while treating childhood AML in LMICs, including treatment-induced high sepsis-related mortality and abandonment. Despite these challenges, it remains cost-effective to treat childhood AML in India. Future efforts should focus on reducing treatment-related morbidity and mortality to further improve outcomes and cost-effectiveness., (© 2024 The Author(s). Pediatric Blood & Cancer published by Wiley Periodicals LLC.)

Food adulteration with toxic chemicals is a global public health threat. Lead chromate adulterated spices have been linked with lead poisoning in many countries, from Bangladesh to the United States. This study systematically assessed lead chromate adulteration in turmeric, a spice that is consumed daily across South Asia. Our study focused on four understudied countries that produce >80 % of the world's turmeric and collectively include 1.7 billion people, 22 % of the world's population. Turmeric samples were collected from wholesale and retail bazaars from 23 major cities across India, Pakistan, Sri Lanka, and Nepal between December 2020 and March 2021. Turmeric samples were analyzed for lead and chromium concentrations and maximum child blood lead levels were modeled in regions where samples had detectable lead. A total of 356 turmeric samples were collected, including 180 samples of dried turmeric roots and 176 samples of turmeric powder. In total, 14 % of the samples (n = 51) had detectable lead above 2 μg/g. Turmeric samples with lead levels greater than or equal to 18 μg/g had molar ratios of lead to chromium near 1:1, suggestive of lead chromate adulteration. Turmeric lead levels exceeded 1000 μg/g in Patna (Bihar, India) as well as Karachi and Peshawar (Pakistan), resulting in projected child blood lead levels up to 10 times higher than the CDC's threshold of concern. Given the overwhelmingly elevated lead levels in turmeric from these locations, urgent action is needed to halt the practice of lead chromate addition in the turmeric supply chain., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Older adults are at risk of committing cognitive and decision-making errors due to the decline in cognitive functions. However, the understanding of the determining factors of cognitive errors among ageing adults is limited. In this study, we explored the role of various psychiatric factors, life satisfaction, and other socioeconomic, health and behavioural risk factors of committing cognitive errors among middle-aged and older adults in India. The study utilized the data from the experimental module of the Longitudinal Ageing Study in India (LASI) Wave-1 (2017-2018) with a sample of 12,754 adults aged 45 years and above. The cognitive error was measured using logical fallacies committed in the activity-based experiments. The study employed descriptive, bivariate statistics and multivariable logistic regression models to identify the factors associated with cognitive errors among the study participants. Depression (aOR = 1.28, 99%, CI: 1.16-1.41), life satisfaction (aOR = 0.99, 99%, CI: 0.98-1.00), and cognitive impairment (aOR = 1.13, 90% CI: 1.00-1.30) self-reported psychiatric) were significantly associated with higher odds of committing cognitive errors among the middle-aged and older adults. Also, ageing adults with low educational levels, functional limitations, sleep disturbances, smoking history, living in rural areas and belonging to scheduled tribes had a higher probability of committing cognitive errors. However, involvement in physical activity, reading habits and social interactions reduced the odds of cognitive errors among this sample. Mental health and well-being indicators, including depression, life satisfaction, cognitive impairment, and other health and behavioural health factors, determine cognitive errors among ageing adults. Programs and policies should be initiated to address these factors, reduce cognitive errors, and ensure active ageing., (© 2024. The Author(s).)

Background: Medical undergraduate students are often unaware of the managerial aspects of operating a healthcare facility. This leads to confusion and a sense of being lost when they assume administrative roles, highlighting the need for hospital management and leadership training. This prompted us to evaluate the needs of medical undergraduates concerning these crucial aspects., Methods: An exploratory study was conducted on 240 medical undergraduate students to assess the medical undergraduates' need to learn about hospital management and leadership training, their views about the importance and their self-perceived knowledge of the various elements of hospital management and leadership training. A meticulously validated questionnaire, comprising three essential parts, based on the Likert scale was effectively employed in the study. Part A asked students to evaluate the importance of 15 selected elements of hospital management and leadership training, ranging from not important to very important, in their role as a doctor. Part B required the students to assess their self-perceived knowledge levels on a scale from no knowledge to very adequate for the same 15 elements. Part C inquired about the students' opinions on including these topics in their curriculum and, if so, the appropriate timing., Results: Nearly 75% of the students felt that time management, stress management, and patient safety issues were very important for their role as doctor. Closely following these were communication/ public relation skills, hospital information system & record keeping, quality improvement/assurance, law, ethics & code of conduct. Only 25% of the students reported their self-perceived knowledge as very adequate for almost all the elements. For inclusion in the curriculum, the majority wanted to learn about these elements and throughout the course was the preferred timing., Conclusion: The students felt that hospital management and leadership training were pivotal for their roles as doctors. They expressed a lack of sufficient knowledge in these areas and the need for these important aspects to be included in their curriculum as a longitudinal course., (© 2024. The Author(s).)

Background: Anaemia continues to be a pressing public health concern in India. Despite the high burden of anaemia among lactating adolescents in the country, research addressing this concern among this population remains scarce. Hence, this study attempted to examine the prevalence and determinants of anaemia among lactating adolescents in India., Methods: We used data from three latest rounds of the National Family Health Survey (NFHS) carried out in 2005-06, 2015-16, and 2019-21 and analysed a pooled sample of 10,689 lactating adolescents aged 15-19 years from these three rounds. Bivariate statistics was used to analyse the prevalence of anaemia according to the background characteristics of lactating adolescents. Further, binary multivariate logistic regression was carried out to examine the factors associated with anaemia in the study population., Results: Three in every five lactating adolescents from the pooled sample were found to have anaemia (66.98% in NFHS-3, 61.08% in NFHS-4 and 66.27% in NFHS-5). Lactating adolescents with a higher education had a 30% lower likelihood [adjusted odds ratio (AOR): 0.70, 95% CI: 0.49-1.01, p = 0.050] of being anaemic compared to those with no education. The likelihood of being anaemic among the poorest quintile was 41% (AOR: 1.41, 1.12-1.77; p = 0.003) higher than those from the richest quintile. Lactating adolescents from the Scheduled Tribe category had higher odds (AOR: 1.29, 95% CI: 1.01-1.46, p = 0.001) of anaemia than those categorised as 'Others'. Those living in rural areas were 22% more likely to suffer from anaemia (AOR: 1.22, 95% CI: 1.00-1.26, p = 0.050) compared to their urban counterparts. Additionally, underweight lactating adolescents were 15% more likely (AOR: 1.15, 95% CI: 1.05-1.26, p = 0.002) to be anaemic than those with normal BMI. Odds of being anaemic were higher among the ones receiving supplementary nutrition during pregnancy (AOR: 1.18, 95% CI: 1.08-1.29, p < 0.001) in contrast to those not receiving., Conclusion: The consistently high prevalence of anemia among lactating adolescents, especially among those with lower education level, rural residence, underweight status, and belonging to ST category and poorest quintile, underscore the urgent need for targeted public health interventions to address and reduce anemia in this population., (© 2024. The Author(s).)

This study examined the relation between pandemic-related stressors and mental health among young people (YP) in India during two time points in the waning phase of the pandemic. We use data from two cross-sectional waves of over 20,000 YP aged 5-19 in February 2022, during the peak of the Omicron wave, and October 2022, during a reduction in infections and easing of restrictions. COVID illness/death in the family's social network, current lockdown stringency, and significant change in household income were examined in relation to adult respondents' reports of YP internalizing symptoms. Internalizing symptoms declined slightly from February to October 2022. COVID-19 illness/death in the family's network was generally associated with more internalizing symptoms. Higher lockdown stringency was associated with lower levels of internalizing symptoms. YP in households with increases in income tended to have more internalizing symptoms. Many associations were driven by older adolescents and were stronger during the earlier (Feb-2022) than later (Oct-2022) data collection time-points. The findings illustrate the importance of anchoring results within a study's specific geographic context, including concurrent events during the study period. Importantly, findings that may initially seem counterintuitive ultimately illuminate the dynamic and complex processes underlying child and adolescent mental health., (© 2024. The Author(s).)