A Survey of the Training and Working Arrangements of General Practitioners Providing Asthma and Chronic Obstructive Pulmonary Disease Care in a Rural Area of Maharashtra State

Background: Chronic respiratory diseases (CRD), especially asthma and chronic obstructive pulmonary disease (COPD), are common public health problems resulting in a substantial burden of disease for individuals. There is a need to understand the perceptions and practices of primary care physicians (“general practitioners [GPs]”) who provide most of the health care in rural India. We surveyed all private and public practitioners listed as practising in a rural area of Western India with the aim of identifying GPs (GPs: graduates, registered and allowed to practice in India) to understand their training, working arrangements, and asthma/COPD workload. Methodology: We administered a short questionnaire at educational meetings or via e-mail to all private and public practitioners listed as providing community?based services in the Junnar block, Pune district, Maharashtra. The survey asked about qualifications, experience, and working arrangements, and about current asthma and COPD workload. A descriptive analysis was performed. Results: We approached 474 practitioners (434 from private sector and 40 from public sector). Eighty?eight were no longer practising in the study area. The response rate was 330/354 (93.2%) of private and 28/32 (87.5%) of public sector practitioners. We excluded 135 nonrespiratory hospital specialists and 23 private practitioners whose highest qualification was a diploma. Our final sample of 200 GPs (70% males) was 177 from private sector and 23 from public sector. The private GPs had more experience in clinical practice in comparison to public GPs (18.6 vs. 12.8 years). Eighty?four percent of GPs from the private sector only had Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) qualifications, though >90% provided “modern medicine” services. In the public sector, 43.5% GPs only had AYUSH qualifications, though all provided “modern medicine” services. A minority (9% of private GPs and 16% of public GPs) provided both services. Nearly two?thirds (62%) of private GPs had inpatient facilities compared to only 9% of public sector GPs. In both sectors, more GPs stated that they managed people with asthma than treated COPD (Private: 97% vs. 75%; Public 87% vs. 57%). Conclusion: Many GPs practising “modern medicine” only had qualifications in Ayurveda/Homeopathy and fewer GPs are involved in the management of COPD as compared to asthma. These are important factors that form the context for initiatives seeking to improve the quality of community-based care for people with CRD in Maharashtra state in India.

Understanding the association between the human gut, oral and skin microbiome and the Ayurvedic concept of prakriti

Ayurveda is one of the ancient systems of medicine which is widely practised as a personalized scientific approach towardsthe general wellness. Ayurvedic prakriti is broadly defined as the phenotypes which are determined on the basis of physical,psychological and physiological traits irrespective of their social, ethnic, dietary and geographical stature. Prakriti is theconstitution of a person, which comprises vata, pitta, and kapha and is a key determinant of how one individual is differentfrom the other. Human microbiome is considered the ‘latest discovered’ human organ and microbiome research reiteratesthe fundamental principles of Ayurveda for creating a healthy gut environment by maintaining the individual-specificmicrobiome. Hence, it is important to understand the association of human microbiome with the Ayurvedic prakriti of anindividual. Here, we provide a comprehensive analysis of human microbiome from the gut, oral and skin samples of healthyindividuals (n=18) by 16S rRNA gene-based metagenomics using standard QIIME pipeline. In the three different prakritisamples differential abundance of Bacteroides, Desulfovibrio, Parabacteroides, Slackia, and Succinivibrio was observed inthe gut microbiome. Analysis also revealed prakriti-specific presence of Mogibacterium, Propionibacterium, Pyramidobacter, Rhodococcus in the kapha prakriti individuals Planomicrobium, Hyphomicrobium, Novosphingobium in the pittaprakriti individuals and Carnobacterium, Robiginitalea, Cetobacterium, Psychrobacter in the vata prakriti individuals.Similarly, the oral and skin microbiome also revealed presence of prakriti-specific differential abundance of diversebacterial genera. Prakriti-specific presence of bacterial taxa was recorded and only 42% microbiome in the oral samples and52% microbiome in the skin samples were shared. Bacteria known for preventing gut inflammation by digesting theresistant starch were abundant in the pitta prakriti individuals, who are more prone to develop gut-inflammation-relateddisorders. In summary, human gut, oral and skin microbiome showed presence

Social and logistical barriers to the use of reversible contraception among women in a rural Indian village.

Women in a small coastal village in western India were asked to explain their preference for female sterilization over modern reversible contraceptive methods. Married women aged 19+ years were interviewed in six focus groups (n=60) and individually (n=15) regarding contraceptive methods and their use and side-effects. Women publicly denied contraceptive use but privately acknowledged limited use. They obtained contraceptive information from other village women and believed that modem reversible methods and vasectomy have high physical and social risks, and fertility goals could be achieved without their use. Women felt that reversible contraception is undesirable, socially unacceptable, and usually unnecessary, although the achievement of fertility goals is likely due to the use of female sterilization with abortion as a back-up method. Economic migration of village men may also play a role. Although women with high social capital can effectively disseminate correct knowledge, the impact on the uptake of reversible method is uncertain.