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To develop a context-specific methodology to assess the 5 A's of food environment: availability, accessibility, affordability, acceptability, and accommodation.Cross-sectional mixed-methods study. Availability of foods was assessed by on-site observation and interviewing vendors. To assess accessibility, buffer zones around food stores were created using geographic information systems. Affordability was controlled by selecting participants from the middle-income group. Accommodation and acceptability were assessed by interviewing vendors and caregivers.Villages of Ghatkesar subdistrict (n = 4), Telangana, South India.Caregivers of children aged 6-10 years (n = 160) and food vendors (n = 68).The quality of the 5 A's was graded on the basis of concurrence between actual and perceived measures.The actual and perceived 5 A's for semiperishable foods matched, and hence the food environment was graded as good across the villages. However, for perishable foods, the food environment was graded as poor with respect to accommodation and acceptability in all villages; and with respect to availability and affordability in at least 2 villages as the actual and perceived measures did not match.This study demonstrated the use of context-specific methods to assess the 5 key dimensions of the food environment, which can be attempted in other contexts with suitable modifications.

Neonatal acute kidney injury (AKI) is common in neonatal intensive care units (NICU) and leads to worse outcomes. Stratifying neonates into an "at risk" category allows health care providers to objectively recognize opportunities for improvements in quality of care.The "Neonatal AKI Risk Prediction Scoring" was devised as the "STARZ [Sethi, Tibrewal, Agrawal, Raina, waZir]" Score. The STARZ score was derived from our prior multicentre study analysing risk factors for AKI in neonates admitted to the NICU. This tool includes 10 variables with a total score ranging from 0 to 100 and a cut-off score of 31.5. In the present study, the scoring model has been validated in our multicentre cohort of 744 neonates.In the validation cohort, this scoring model had sensitivity of 82.1%, specificity 91.7%, positive predictive value 81.2%, negative predictive value 92.2% and accuracy 88.8%. Based on the STARZ cut-off score of ≥ 31.5, an area under the receiver operating characteristic (ROC) curve was observed to be 0.932 (95% CI, 0.910-0.954; p 0.001) signifying that the discriminative power was high. In the validation cohort, the probability of AKI was less than 20% for scores up to 32, 20-40% for scores between 33 and 36, 40-60% for scores between 37 and 43, 60-80% for scores between 44 and 49, and ≥ 80% for scores ≥ 50.To promote the survival of susceptible neonates, early detection and prompt interventional measures based on highly evidenced research is vital. The risk of AKI in admitted neonates can be quantitatively determined by the rapid STARZ scoring system. A higher resolution version of the Graphical abstract is available as Supplementary information.

OBJECTIVE: A rapid AKI risk assessment score would allow for improving management and outcomes. STARZ (Sethi, Tibrewal, Agrawal, Raina, waZir) score was developed for acute kidney injury (AKI) risk stratification of critically ill neonates. This is the first independent validation for the novel score outside the original enrolled centres. STUDY DESIGN: 750 neonates were included in the study. The STARZ score was calculated after 12 hours of admission. Neonates admitted in NICU and receiving IV fluids for at least 48 hours were included. RESULTS: A total of 8.8% neonates had AKI in the first 7 days post admission. The duration of hospital stay was significantly higher among neonates with AKI [10.5 (7–19) vs. 7 (5–10) days; p

Background: Karnataka, more so Bangalore, reported an increase in number of COVID-19 cases in early April 2021. Objective: To assess the burden of COVID-19 in the slums of Bengaluru city. Materials and Methods: A cross-sectional multi centre community-based study was done in the 2nd and 3rd week of April 2021 in 24 different slums in Bangalore city. WHO cluster random sampling technique was followed. Swabs for RTPCR test and 4 ml of venous blood was collected from 728 subjects more than 18 years of age. Results: A total of 51 (7%) subjects were positive for COVID-19 through RT-PCR. Majority 33 (56.9%) were in the age group of 18-44 years. 148 (20.3%) subjects were sero-positive on blood examination and 18-44 years was the (59.4%) preponderant age group. Overall seropositivity was 20.3% (95%CI; 17.4-23.2) and RT-PCR positivity is 7% (95%CI; 5.2-8.8%) among the subjects surveyed. In the inner core area of Bangalore, seropositivity was 24.2% (95%CI; 21.0 – 27.3) and RT-PCR positivity was 8% (95%CI; 6.1-9.9). Two doses of COVID-19 vaccine were taken only by 1.55% subjects during the study period. Conclusion: The study showed that one in 5 subjects were sero-positive to SARS-CoV-2 and one in 15 individuals had active COVID-19 infection.

The COVID-19 pandemic has exposed the fragmentation of the healthcare delivery systems and highlighted the role of resilient primary healthcare systems for a robust public health response during health emergencies. Primary care while being the first point of contact between the citizens and the health systems has received scant attention or targeted investments over the past several decades. Through this narrative review, we aim to outline the potential role of telehealth in augmenting health systems capacity. While teleconsultations have increased exponentially during the pandemic, evidence suggests that utilisation of primary care for non-emergency and non-COVID-19 conditions such as chronic medical conditions has significantly decreased, suggesting that most telemedicine utilisation has been to address an immediate crisis. In countries with pre-existing national digital health framework and enabling regulatory environments, telehealth interventions while strengthening the public health response to COVID-19 also supported the continuum of care at the primary care level. Even after COVID-19 is controlled, telemedicine has the potential to address persistent obstacles to primary care in the South East Asia region, including scarcity of trained healthcare workers, access challenges and costs associated with in-person care. Telemedicine holds promise in strengthening primary care and has the potential to catalyse achieving universal health coverage.

Background: Acute kidney injury (AKI) is common in neonates admitted to neonatal intensive care units (NICUs). There is a need to have prospective data on the risk factors and outcomes of acute peritoneal dialysis (PD) in neonates. The use of kidney replacement therapy in this population compared to older populations has been associated with worse outcomes (mortality rates 17–24%) along with a longer stay in the NICU and/or hospital. Methods: The following multicentre, prospective study was derived from the TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry) database, assessing all admitted neonates ≤28 days who received intravenous fluids for at least 48 h. The following neonates were excluded: death within 48 h, presence of any lethal chromosomal anomaly, requirement of congenital heart surgery within the first 7 days of life and those receiving only routine care in nursery. Demographic data (maternal and neonatal) and daily clinical and laboratory parameters were recorded. AKI was defined according to the Neonatal Kidney Disease: Improving Global Outcomes criteria. Results: Of the included 1600 neonates, a total of 491 (30.7%) had AKI. Of these 491 neonates with AKI, 44 (9%) required PD. Among neonates with AKI, the odds of needing PD was significantly higher among those with significant cardiac disease (odds ratio (95% confidence interval): 4.95 (2.39–10.27); p < 0.001), inotropes usage (4.77 (1.98–11.51); p < 0.001), severe peripartum event (4.37 (1.31–14.57); p = 0.02), requirement of respiratory support in NICU (4.17 (1.00–17.59); p = 0.04), necrotising enterocolitis (3.96 (1.21–13.02); p = 0.03), any grade of intraventricular haemorrhage (3.71 (1.63–8.45); p = 0.001), evidence of fluid overload during the first 12 h in NICU (3.69 (1.27–10.70); p = 0.02) and requirement of resuscitation in the delivery room (2.72 (1.45–5.12); p = 0.001). AKI neonates with PD as compared to those without PD had a significantly lower median (interquartile range) duration of stay in NICU (7 (4–14) vs. 11 (6–21) days; p = 0.004), but significantly higher mortality (31 (70.5%) vs. 50 (3.2%); p < 0.001). This discrepancy is likely attributable to the critical state of the neonates with AKI. Conclusions: This is the largest prospective, multicentre study specifically looking at neonatal AKI and need for dialysis in neonates. AKI was seen in 30.7% of neonates (with the need for acute PD in 9% of the AKI group). The odds of needing acute PD were significantly higher among those with significant cardiac disease, inotropes usage, severe peripartum event, requirement of respiratory support in NICU, necrotising enterocolitis, any grade of intraventricular haemorrhage, evidence of fluid overload more than 10% during the first 12 h in NICU and requirement of resuscitation in the delivery room. AKI neonates with PD as compared to AKI neonates without PD had a significantly higher mortality. There is a need to keep a vigilant watch in neonates with risk factors for the development of AKI and need for PD.

Supplemental Material, sj-docx-1-ptd-10.1177_08968608221091023 for Risk factors and outcomes of neonates with acute kidney injury needing peritoneal dialysis: Results from the prospective TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry) study by Sidharth Kumar Sethi, Sanjay Wazir, Jagdish Sahoo, Gopal Agrawal, Naveen Bajaj, Naveen Parkash Gupta, Shishir Mirgunde, Binesh Balachandran, Kamran Afzal, Anubha Shrivastava, Jyoti Bagla, Sushma Krishnegowda, Ananth Konapur, Azmeri Sultana, Kritika Soni, Nikhil Nair, Divya Sharma, Prajit Khooblall, Avisha Pandey, Khalid Alhasan, Mignon McCulloch, Timothy Bunchman, Abhishek Tibrewal and Rupesh Raina in Peritoneal Dialysis International

Supplemental Material, sj-docx-2-ptd-10.1177_08968608221091023 for Risk factors and outcomes of neonates with acute kidney injury needing peritoneal dialysis: Results from the prospective TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry) study by Sidharth Kumar Sethi, Sanjay Wazir, Jagdish Sahoo, Gopal Agrawal, Naveen Bajaj, Naveen Parkash Gupta, Shishir Mirgunde, Binesh Balachandran, Kamran Afzal, Anubha Shrivastava, Jyoti Bagla, Sushma Krishnegowda, Ananth Konapur, Azmeri Sultana, Kritika Soni, Nikhil Nair, Divya Sharma, Prajit Khooblall, Avisha Pandey, Khalid Alhasan, Mignon McCulloch, Timothy Bunchman, Abhishek Tibrewal and Rupesh Raina in Peritoneal Dialysis International

The uprise of digital media has bypassed the language and cultural barriers of communicating about food with peers. Sharing exaggeratively glamourized food visuals with fancy hashtags and folksonomy, generally termed as Foodporn, is "trendy". Exposure to Foodporn affects food choices, directly or indirectly, through psychological, physiological and psychosocial means. Though unhealthy connotation is often attributed to foodporn, this perspective article implores that the plausible potential to alluring food pictures to prompt healthy food choices, be explored. Can foodporn be effectively used for e-priming (electronically priming) healthy food choices by glamourizing and idealizing healthy foods?

As indicated by the WHO, the variety of mental issues incorporates dementia, discouragement, schizophrenia and other psychoses, intellectual disabilities and developmental disorders. Sadness alone influences in excess of 300 million individuals. Indeed, even with admittance to proficient medical care and social administrations, those tormented with emotional well-being conditions wonder whether or not to profit from the therapy because of the stigma encompassing the disease. Accordingly, to this we would like to build an artificial intelligent agent that responds and helps the patient using an interactive chat bot. With the recent changes in Deep learning technology and specifically in NLP with models such as BERT and Open-AI GPT getting efficient contextual responses is not a task too hard. The chatbot will be able to identify, address and help relieve the mental stress of the user through soothing message responses similar to a therapist’s conversation. Also, other relaxation techniques are provided on the same platform for further support to the distressed user.

BACKGROUND Neonates admitted in the neonatal intensive care unit are vulnerable to acute kidney injury leading to worse outcomes. It is important to identify "at-risk" neonates for early preventive measures. METHODS The study was a multicenter, national, prospective cohort study done in 11 centers in India. A multivariable logistic regression technique with step-wise backward elimination method was used, and a "Risk Prediction Scoring" was devised [the STARZ score]. RESULTS The neonates with admission in the NICU within

Iron deficiency is the leading cause of anemia in India. In spite of implementation of a National iron supplementation programme of anemia control, the rate of decline in anemia prevalence has not been satisfactory. To address this issue, a National consultation meeting is being organized by the Ministry of Health and Family Welfare, Government of India, 23-24th April 2018, AIIMS, New Delhi. The purpose of the background document is to facilitate the deliberations of the above meeting. In this document, we discuss the latest progress in studies of iron metabolism, bioavailability, requirement and RDA for Indians. Hepcidin is a circulating peptide hormone secreted by the liver that plays a central role in coordinating the use and storage of iron with iron acquisition. Therefore, we considered it important to review and include trials on modulation of hepcidin during iron supplementation. Further, we made an attempt to review iron supplementation trials in Indian pregnant women and children to sequentially assess the basis for fixing iron dosage. Finally, we made an attempt to apply theoretical basis of computation of iron dose for the age/gender and physiological group for treatment of anemia due to iron deficiency. In the light of the role of hepcidin in iron nutrition, we consider it important to characterize the contextual determinants and establish the iron dosage. We believe that the systemic regulation may not allow the body to store adequate amounts of iron from oral doses in short duration of 100 days. Based on the biology of iron it appears that iron homeostasis leading to assimilation of storage of iron is a very slow process and may require practice of contextual food synergy systems to improve iron content (fortified foods) and bioavailability (vitamin C rich fruits) throughout life cycle.

Micronutrient deficiencies, majorly iron, iodine, vitamin-A, pose a serious threat to public health in many developing countries, including India. A surfeit of nutrition and health programs was developed to address micronutrient malnutrition in India, covering many aspects of lifecycle. The importance of nutrition education and communication is emphasized in public health nutrition policies. Concomitantly, there is a surge in various interventional studies with the integration of nutrition education and communication. However, there is a lack of clarity on the overall impact of community level nutrition education/communication interventions on micronutrient (mal)nutrition in India, which may be due to the lack of critical evaluation of the nutrition education/communication components in these studies. Given this background, this article reviews the studies conducted in the last two decades in India. This systematic review identified and analyzed the studies that aimed to use nutrition education an...

ObjectiveTo develop and validate a context-specific comprehensive knowledge, attitude and practice (KAP) questionnaire for literate mothers on factors affecting micronutrient status of 6–10-year-old children.DesignSequential exploratory mixed-methods study using focus group discussions (FGD) and psychometric validation.SettingSeven randomly selected villages with >500 households with three to five family members each, in Ghatkesar sub-district, Medchal district, Telangana state, India.ParticipantsLiterate mothers from middle-income households with at least one child (6–10 years) for FGD (n44), for testing the internal consistency (n80) and for test–retest reliability (n30).ResultsThe themes for FGD were diet diversity, micronutrients, cooking and eating practices, national programmes and sunlight exposure. Knowledge among caregivers about sources of micronutrients, deficiency symptoms, cooking/eating practices was low, while attitude towards diet diversity and sunlight was good. Non-availability of fruits and vegetables was a barrier to diet diversity. About 72 % of the questions from the item pool were based on FGD. After content validity, 125 items were selected for the questionnaire which, upon psychometric validation, was reduced to an eighty-eight-item questionnaire with difficulty index of 0·10–0·91, discrimination index of 0·09–0·68, Cronbach’sαof 0·78 (reliability of knowledge and attitude) and 0·50 (practice). A Bland–Altman plot showed good agreement between test and retest scores.ConclusionsThe questionnaire developed and validated using a sequential exploratory mixed-methods approach can be used for assessing KAP on micronutrients and factors affecting consumption of diverse diets in rural Indian households.