ASSESSING PUBLIC SERVICE QUALITY & SERVICE SATISFACTION:WITH REFERENCE TO GOVERNANCE IN KARNATAKA, INDIA

Being a democratic country India has brought in various acts and reforms to uphold citizen centricity. Right to service act has been one of such initiatives. As on 2023, the state of Karnataka has been able to provide highest number of services under this act. This study explores and investigates citizen's perspective of service quality & service satisfaction attained by availing the public services. A questionnaire survey was formulated and study found that the ve factors 'Reliability' 'Assurance', 'Empathy', 'Valence', and 'Waiting Time' are determinants of the quality of citizen/government services. The outcome indicate that overall service quality has signicantly positive impact on service satisfaction. This research is of greater value to scholars who are interested in the area of governance, administration, and service delivery.

Unsupervised Medical Abortions: A Cause for Concern of Safety

Medical abortions have been a national as well as social concern for the society, especially in India. There have been certain laws, acts and amendments that have been designed to promote safe abortions. Despite, the rules in place, there is still need to have more awareness as the women still face difficulties in accessing abortion services. The reasons may include legal hurdles, stigma, financial concerns and many more. Through this article, we would like to emphasize the role of government, medical professionals, health care providers to come together and form more dependable guidelines that may help women to access safer abortions.

A cross-sectional evaluation of behavior and attitude of pharmacists toward dispensing non-OTC drugs without prescription in a city of Southern Rajasthan

Background: Over the counter (OTC), drugs are found to be safe and appropriate for use without supervision of a healthcare professional such as physician and they can be purchased by consumers without prescription. The study gains its importance because of the spreading of misuse of antibiotics and various drugs adverse drug reactions in the society. Aims and Objectives: The main aim of the study is to observe as to how many pharmacists/chemists/drug store sellers follow or violate the drug cosmetic act. Materials and Methods: It is an observational and cross-sectional study conducted among pharmacies of Udaipur city, urban areas of Southern Rajasthan. The study includes a sample size of 200 pharmacies selected through convenient random sampling. A detailed semi-structured questionnaire is administered to the pharmacists. The set of questions include types of drugs, reason for dispensing, knowledge, and attitude of pharmacist toward dispensing non-OTC drugs. All the private pharmacies willing to participate were included in the study. Data are entered in Microsoft Excel and statistically analyzed. Results: The results throw light on the behavior and pattern of dispensing habits of the drug store sellers of the city of Udaipur, Southern Rajasthan. It was observed that many pharmacists are in fact in the habit of dispensing non-OTC drugs in almost all the areas. Conclusions: Results give insights about the groups of drugs, logic, behavior, and knowledge level of pharmacists involved in dispensing practices in the city of Udaipur. There should be structured educational campaigns (or use of media, internet, newspaper, radio, television, advertisements, mobiles, etc.) for both pharmacists and public.

Mechanism of Fuyuan Xingnao Decoction in the treatment of cerebral infarction based on network pharmacology and molecular docking / 国际中医中药杂志

Objective:To explore the mechanism of Fuyuan Xingnao Decoction in treatment of cerebral infarction based on network pharmacology and molecular docking.Methods:The active components and action targets of Fuyuan Xingnao Decoction were screened by using Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP),Traditional Chinese Medicine Integrated Database (TCMID),Bioactivity data of small organic molecules (PubChem),Universal Protein (Uniprot) and Swiss Target Prediction database platform. The databases of GeneCards, Online Mendelian Inheritance in Man (OMIM), Therapeutic Target Database (TTD), and Drug Bank and Pharmacogenomics Knowledgebase (PharmGKB) were used to screen targets of cerebral infarction. The drug target genes in Fuyuan Xingnao Decoction were intersected with those of cerebral infarction, the intersecting targets were introduced into Cytoscape 3.8.2 software to construct the component target network, and the PPI protein interaction network was constructed by using STRING analysis platform and Cytoscape 3.8.2 software to screen the core targets. Gene Ontology (GO) function enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) function enrichment analysis were carried out on the common target genes of Fuyuan Xingnao Decoction and cerebral infarction disease to obtain the relevant signal pathways. Finally, AutoDock and Pymol software were used for molecular docking between the predicted target and its corresponding components.Results:After screening, 80 effective components of Fuyuan Xingnao Decoction for treatment of cerebral infarction and 214 common targets of Fuyuan Xingnao Decoction and cerebral infarction were obtained. The core targets such as MAPK1, RELA, TP53, JUN, AKT1 and HSP90AA1 were related to the key targets of cerebral infarction, and they participated in the biological process of regulating the response to drugs, lipopolysaccharide and oxygen level, etc. The cell composition involved membrane raft, membrane micro region and nerve cell body, etc. Molecular functions mainly focused on nuclear receptor activity, ligand activated transcription factor activity, DNA binding transcription factor binding, etc.; it also involved in signal pathway of lipid and atherosclerosis, chemical carcinogen and receptor activation, fluid shear stress and atherosclerosis, etc. Molecular docking showed that good binding activities were seen between Quercetin and HSP90AA1 (-9.4 kJ/mol), between Kaempferol and HSP90AA1 (-9.4 kJ/mol), between Isorhamnetin and HSP90AA1 (-9.1 kJ/mol), and between Quercetin and JUN (-8.6 kJ/mol).Conclusion:Fuyuan Xingnao Decoction can prevent and treat cerebral infarction by regulating vascular endothelial function, promoting blood circulation, repairing and improving neural function, protecting blood-brain barrier, reducing cell apoptosis, and regulating immune and inflammatory response.

Double-negative T cells: a promising avenue of adoptive cell therapy in transplant oncology / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Tumor recurrence is one of the major life-threatening complications after liver transplantation for liver cancer. In addition to the common mechanisms underlying tumor recurrence, another unavoidable problem is that the immunosuppressive therapeutic regimen after transplantation could promote tumor recurrence and metastasis. Transplant oncology is an emerging field that addresses oncological challenges in transplantation. In this context, a comprehensive therapeutic management approach is required to balance the anti-tumor treatment and immunosuppressive status of recipients. Double-negative T cells (DNTs) are a cluster of heterogeneous cells mainly consisting of two subsets stratified by T cell receptor (TCR) type. Among them, TCRαβ+ DNTs are considered to induce immune suppression in immune-mediated diseases, while TCRγδ+ DNTs are widely recognized as tumor killers. As a composite cell therapy, healthy donor-derived DNTs can be propagated to therapeutic numbers in vitro and applied for the treatment of several malignancies without impairing normal tissues or being rejected by the host. In this work, we summarized the biological characteristics and functions of DNTs in oncology, immunology, and transplantation. Based on the multiple roles of DNTs, we propose that a new balance could be achieved in liver transplant oncology using them as an off-the-shelf adoptive cell therapy (ACT).

O crime como ato perverso: uma análise das cartas de assassinos seriais / El crimen como un acto perverso: un análisis de cartas de asesinos en serie / Crime as a perverse act: analysis of letters from serial killers

RESUMO. Este trabalho se insere no campo teórico da psicanálise e tem por objetivo discutir, a partir do conceito de perversão, a relação entre o ato perverso e os assassinatos em série, através das comunicações que certos autores desse tipo de crime realizaram com a mídia e com as forças da lei. Para a realização desse objetivo foi feita uma análise de conteúdo, segundo Bardin (2011), em 35 cartas enviadas por sete assassinos em série diferentes para a grande mídia ou para a polícia. Como resultado, encontra-se o fato de que a estrutura desses documentos é bastante similar e apresentam descrições de seus crimes, seus estados mentais, além de ameaças à população e um deboche direcionado às autoridades e forças policiais. Por fim, nota-se que a estrutura do ato perverso, conforme pensada por Freud e Lacan, está presente nas cartas estudadas, que pertencem a épocas e lugares distintos, e cujos autores não tiveram contato direto entre si.

RESUMEN. Este trabajo es parte del campo teórico del psicoanálisis y tiene como objetivo identificar los comportamientos comunes que están presentes en diferentes actos perversos, más específicamente en las comunicaciones que los asesinos en serie llevan a cabo con los medios de comunicación y las fuerzas de la ley. Para lograr este objetivo, se realizó un análisis de contenido, según Bardin (2011) sobre 35 cartas enviadas por siete asesinos en serie diferentes a los principales medios de comunicación o la policía. Como resultado, existe el hecho de que la estructura de estos documentos es bastante similar y presenta descripciones de sus crímenes, sus estados mentales, además de las amenazas a la población y un libertinaje dirigido a las autoridades y las fuerzas policiales. Finalmente, se observa que la estructura del acto perverso, como lo piensan las teorías de Freud y Lacan, tiende a repetirse en los sujetos estudiados, que pertenecen a diferentes tiempos y lugares y que no tuvieron contacto directo entre sí.

ABSTRACT This work is part of the theoretical field of psychoanalysis and aims to discuss, from the concept of perversion, the relationship between the perverse act and serial murders, through the communications that certain authors of this type of crime made with the media and with the forces of the law. To achieve this objective, a content analysis was carried out, according to Bardin (2011), on thirty-five letters sent by seven different serial killers to the mainstream media or the police. As a result, there is the fact that the structure of these documents is quite similar and presents descriptions of their crimes, their mental states, in addition to threats to the population and a debauchery directed at the authorities and police forces. Finally, it is noted that the structure of the perverse act, as thought by the theories of Freud and Lacan, is present in the studied letters, which belong to different times and places, and whose authors had no direct contact with each other.

The Psychoanalytical Act and the Causation of the Sensitive in Analysis / O Ato Analítico e a Causação do Sensível em Análise

Abstract In this article, we will work on the articulation between the psychoanalytical act and the experience with the sensitive in an analysis. For this, we will initially approach the logical operations of causation of the subject in order to understand what being we are talking about when we maintain that the psychoanalytic act gives rise to the certainty of existing. Then we will unfold the experience of the sensitive from the notion of a living body, voice and resonance of the real. In the end, we understand that the analysis calls us to sustain a sensitivity beyond reason, one that consents to the resonance of the real and opens us to the power of life, of the act.

Resumo Trabalharemos no presente artigo a articulação entre o ato analítico e a experiência com o sensível em uma análise. Para isso abordaremos inicialmente as operações lógicas de causação do sujeito para compreendermos de que ser falamos ao sustentarmos que o ato analítico faz advir a certeza de existir. Em seguida desdobraremos a experiência do sensível a partir da noção de corpo vivente, voz e ressonância do real. Ao fim, compreendemos que a análise nos convoca a sustentar uma sensibilidade aquém e além da razão, aquela que consente com a ressonância do real e nos abre para a potência da vida, do ato.

Midwives are crucial human resources for health to achieve universal health care

@#Midwives are primarily considered as professionals with expertise in assisting women before, during, and after childbirth. Thus, the competencies for midwifery as defined by the International Confederation of Midwives revolve principally around assessment and provision of care to women and the fetus/newborn/infant during the pre-pregnancy and antenatal periods, labor and birth, postnatal/postpartum periods.1 The availability of skilled midwives in communities has allowed women, especially those who belong to lower income groups, to access professional services around childbirth, as reflected in responses from the National Demographic and Household Survey.2 For instance, while 50% of all women surveyed received antenatal care from a midwife, it is notable that 70% of those who belonged to the lowest wealth quintile were seen by a midwife during the antenatal period. Furthermore, midwives assisted 30% of deliveries reported by respondents, while roughly a little over a third of deliveries for each of the three lowest quintiles were attended by a midwife. Furthermore, in the Philippine setting, midwives are recognized as the first professional point of contact for most members of a community, especially in rural and remote places, as midwives are the ones deployed to manage Barangay Health Stations. Elaborating the scope of the practice of midwifery in relation to the provision of “primary health care services in the community” as stipulated in Republic Act No. 73923, the Board of Midwifery of the Professional Regulation Commission, in a primer for the profession, stated that midwives are expected to, among others, (a) implement government health programs in accordance with policies and guidelines of the Department of Health; (b) supervise barangay health workers; and (c) manage a Barangay Health Station.4 Stated differently, midwives, given the scope of work that they do and the areas where they are deployed, serve as the face and touchpoint of the health sector in our communities. They are the embodiment of the different health policies and programs enacted at the national and local levels through which Filipinos experience, individually and collectively, the drive for better health (or lack thereof ) advanced by different agencies, personalities, and stakeholders. However, as pointed out by Felipe-Dimog et al.5 in this issue of Acta Medica Philippina, midwives, especially those working in the public health sector, may take on roles beyond that contemplated by law. For instance, in the course of my professional practice during which I was deployed briefly in a rural health unit, and worked with an urban health department, I have encountered midwives who were tasked to work as program coordinators (or assistant coordinators), sanitation inspectors, field epidemiologists, and supply managers, among others, because of scarcity in the overall staff complement of health departments. Given their close ties with their areas of assignments, midwives are also expected to be community coordinators, if not organizers. The extent to which midwives are assigned these additional tasks depend on their professional relationship with their immediate supervisor; the level of trust and confidence reposed on them by their superiors; in some instances, their attendance to specific training workshops; as well as the availability of more qualified personnel (or lack thereof ) in the locality. Yet despite all these – placement in remote, if not hardship posts; additional assignments beyond their job description – midwives receive salaries that may not be commensurate after consideration of the job context. Staff midwife positions (i.e., Midwife I to III) in government institutions are remunerated at Salary Grades 9 to 13 (i.e., approximate gross pay of PHP 21,000 to PHP 31,000, based on the fourth tranche of the Salary Standardization Law, but may be lower depending on the income classification of the local government unit6). Additional compensation and benefits under special laws may not always be provided as this will depend on the paying capacity of the employing agency. Furthermore, midwives – especially those who completed the two-year program under the previous policy – also must contend with issues concerning their professional status. I have personally encountered community members who do not consider midwives as professionals in the same league as nurses or physicians, or who view midwives as “assistants” or “subordinates” of nurses and physicians, forgetting that a certain degree of independent practice is allowed each professional licensed by the Republic of the Philippines. Midwives play a crucial role in caring for Filipinos not only around childbirth – this is their primary professional duty – but throughout the lifespan – especially for midwives working in local health departments. Stakeholders must not forget to give due recognition to the value and worth contributed by midwives in shaping the health and well-being of each generation of Filipinos.

Voluntary blood donation among the youth: Time to consider service-improving strategies?

@#Voluntary blood donation is a key strategy in improving availability of, and access to, a life-saving product for populations requiring blood transfusion for a variety of medical conditions.1 In the Philippines, the value of voluntary blood donation is recognized by the state through Republic Act No. 7719, enacted nearly three decades ago.2 Among others, this piece of legislation aims to encourage citizens to donate blood through educational and advocacy activities that will “instill public consciousness of the principle that blood donation is a humanitarian act.” But is this appeal to altruism sufficient? The repeated calls for action by the Department of Health (DOH), through its National Voluntary Blood Services Program, may indicate otherwise. For instance, it was noted that in 2009, about one in four blood units collected were from replacement donation (i.e., blood donation from family and friends in exchange for stored blood used by a patient).3 The low voluntary blood donation rates were further exacerbated by the pandemic situation amidst a constant demand for blood transfusion, hence the DOH taps its regular donors such as uniformed personnel.4 Stakeholders particularly appealed to the youth to donate blood to boost supply.5,6 But how do the youth fare? In the paper by Mappala et al.7 in this issue of the Acta Medica Philippina, the authors reported that among a sample of relatively young, educated, internet-savvy, and urban-dwelling respondents, only about one in three ever donated blood, and of this number, about two-thirds either donated blood only when needed, or just did the practice once. Most of the respondents have a relatively high knowledge and awareness of blood donation, and were motivated to donate blood for altruistic and pro-social purposes. From this data alone, appealing to humanitarian and civic duty, the very heart of the current national policy and program, appears to be not enough to encourage the practice of blood donation, at least in so far as this population segment is concerned. Other results from the same survey, however, point to one other area that stakeholders in the voluntary blood donation program can focus on to increase uptake by the population, and this is with respect to the availability and accessibility of the service to the target population. Participants rated highly the statements pertaining to the geographic proximity of the facility, attitude of staff towards blood donors, and availability of communication lines for addressing queries, as motivators for blood donation. From a management perspective, these align with the value chain strategic service delivery model, which can be considered by stakeholders in designing the voluntary blood donation service and facility.8 More specifically, blood donation services can look into incorporating value-adding service delivery strategies in their design of their offering, considering the experience of the service user before, during, and after the service has been rendered. These strategies are described in detail elsewhere, and I will just attempt to list down some considerations specific to the blood donation service. Pre-service strategies include market analysis (including market segmentation and differentiation, in this case possibly developing different approaches and messages for target donors such as the youth, older adults, etc.), pricing (while voluntary blood donation is free, some facilities are authorized to charge a fee for the processing of the donated blood), location (of the blood donation facilities, and deciding whether these should be fixed post or mobile units), and promotion (among others, how to inform the target donors about the service). Point-of-service considerations, meanwhile, pertain to the totality of the donor experience from the time they arrive, and eventually leave, the blood donation facility, and encompasses all aspects of clinical operations, quality assurance, process innovation, and patient satisfaction. Lastly, after-service strategies will have to include aspects on how to encourage a person who donated blood once to become a regular donor, as well as an advocate and ambassador for blood donation who can encourage and influence family and friends to likewise donate blood in a voluntary manner (i.e., as part of follow-up and follow-on activities). I write this Editorial on the eve of the 29th year since Republic Act No. 7719 was promulgated. Given the evolving characteristics of the target blood donor pool, this may be the opportune time to shift from focusing purely on promotion of the pro-social value of blood donation, and incorporate service-improving strategies in the blood donation system, to bring us closer to the policy vision of mobilizing “all sectors of the community to participate in mechanisms for voluntary and nonprofit collection of blood.”

Stigma kills

@#Stigma due to an HIV diagnosis is a well-known phenomenon and is a major barrier to accessing care.1 Over the last forty years, HIV has been transformed from a fatal disease to a manageable one, thanks to the remarkable success of antiretroviral (ARV) medication.2 When people living with HIV (PLHIV) start ARV treatment early, their life expectancy is almost completely restored. Moreover, a suppressed viral load means that PLHIV are no longer able to infect other people.3 They can have children naturally without risk to their seronegative partner or their child. PLHIV nowadays are more likely to die with HIV, not of HIV. While a cure remains elusive, the successful global rollout of ARVs means that there is no good reason for a PLHIV to die of AIDS and its complications due to lack of access to proper treatment. The Philippine AIDS Law Republic Act 8504 and its successor, Republic Act 11116 explicitly states that the State should “ensure access to HIV and AIDS-related services by eliminating the climate of stigma and discrimination that surrounds the country’s HIV and AIDS situation, and the people directly and indirectly affected by it.” Unfortunately, despite this admonition, stigma remains a significant cause of delayed HIV testing and of not seeking treatment in our country. In this issue of the journal, Dr. De Los Santos and her colleagues examine the effect of healthcare facility stigma on PLHIV accessing care in the Philippines.4 They report that 81% of their Filipino PLHIV respondents experienced stigma, which is an unacceptably high number. They identify which facilities are more likely to be correlated with stigma and make suggestions on how to address this problem. This study is very timely and comes at a time when the Department of Health is shifting first line antiretrovirals to dolutegravir-based regimens.5 Dolutegravir-based treatment is associated with fewer side effects than efavirenz-based regimens and is much more durable against resistance.6 With an HIV transmitted-drug resistance rate of 11.7%, it is imperative that PLHIV are started on more durable regimens which they are less likely to discontinue.7 Properly addressing stigma means that more people will access care. Better regimens will ensure that people stay in care. This will go a long way towards minimizing the impact of HIV and AIDS on Filipino PLHIV. Stigma among PLHIV is a complicated subject matter. Aside from the stigma associated with diagnosis, there is also stigma associated with the mode of acquisition of the disease. The most-at-risk populations are highly stigmatized. Men who have sex with men, people who inject drugs, and female sex workers experience additional stigma on top of the stigma from an HIV diagnosis.8 Aside from societal stigma, PLHIV are also prone to self-stigma.9 This phenomenon occurs when PLHIV believe they no longer deserve to live since they contracted the disease from deviant or sinful behavior. High rates of depression are found among these self-stigma sufferers. This significantly impacts the entire HIV healthcare cascade, starting from early diagnosis, to accessing treatment, and staying in care. The finding that Public Rural Health Units are the most stigmatizing healthcare facilities is very concerning since these are usually the only facilities available to PLHIV in far-flung areas. This needs to be addressed with better sensitivity training as well as concrete guidelines on avoiding stigma. It is very troubling that facilities that are supposed to cater to vulnerable populations inadvertently make it difficult for them to access care.10 Unfortunately, even facilities in urban areas are not immune to discrimination and stigmatizing behavior. I recall the experience of one of my early PLHIV patients who developed and eventually succumbed to a disseminated fungal infection.11 He told me that he had tried getting tested several years earlier but he had a traumatic experience in the government health facility that he accessed. He made a wrong turn and entered a different clinic in that hospital and when he asked for an HIV test, people recoiled from him in horror. Because of that terrible experience, he put off getting his HIV test for years until he started developing the fungal infection that eventually killed him. Had he been started on proper treatment earlier, he could have been saved. For me, it wasn’t just the fungus that killed him but it was the delay in diagnosis and care as a direct result of stigma. Addressing HIV-related stigma in our country entails a whole-of-society and a whole-of-nation approach. Mental health services to address self-stigma and depression should be standard of care not just among confirmed PLHIV but among the most-at-risk populations. Proactive education of all members of society, especially healthcare workers in facilities that diagnose and care for PLHIV is essential for ensuring sustained linkage to care. Ensuring that the majority of the PLHIV population are properly diagnosed, enrolled in treatment hubs, and have suppressed viral loads will ultimately lead to fewer transmissions and less AIDS-related deaths.

Vision related quality-of-life among patients with traumatic or non-traumatic ocular disease and its association with the Rights of Persons with Disabilities Act: Unveiling-the-hidden

Purpose: To assess vision?related quality of life (VrQoL) in cases with visual loss after ocular trauma (OT) or non?traumatic ocular disease (NTOD) using the National Eye Institute’s 25?Item Visual Function Questionnaire 25 (VFQ?25) and its association with visual disability % (VD%) based on the Rights of Persons with Disabilities (RPwD) Act, 2016. Methods: This was a prospective observational study conducted among cases with ocular morbidity in either or both eyes with a visual acuity of ?6/24. VFQ?25 questionnaire was administered to measure QoL scores. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 23. P < 0.05 was taken as significant. Results: Eighty-eight respondents completed the questionnaire. Mean age of participants was 40.272 ± 9.35 years (range: 23–55 years). Forty?three (48.9%) and 45 (51.1%) participants had OT and NTOD, respectively. The most common cause was traumatic optic neuropathy (21.6%) followed by corneal causes (19.4%). Low visual QoL scores were reported in all the cases (57.52 ± 16.08). Between OT and NTOD, a significant difference in terms of age (P = 0.001) and general vision (P = 0.03) was seen. Lowest scores were for driving. Based on VD%, 77 cases had ?40 and the rest had >40% VD with a significant difference in overall mean scores (P = 0.03), specifically in domains of general vision (P = 0.00), near activities (P = 0.00), and driving (P = 0.007). QoL was decreased in each subscale of ?40%VD group, who faced the same predicament everywhere as by the cases with more disability. Conclusion: Ocular morbidity is associated with low QoL, predominantly in domains like general vision, near activities and driving. The RPwD Act leaves out a huge population with VD without any government benefits. One might need to consider other vision?related factors also to provide them with social, psychological, and employment benefits.

Adaptação de um programa de prevenção à violência contra criança para versão remota / Adaptation of a program to prevent violence against children into a remote model / Adaptación de un programa de prevención de la violencia contre el niño para una versión remota

Trata-se de um estudo transversal sobre o processo de adaptação do Programa ACT paraEducar Crianças em Ambientes Seguros para a versão remota. O processo de adaptação foi constituído por quatro etapas: (1) elaboração do roteiro com as adaptações para a aplicação na versão remota, (2) avaliação da proposta por seis juízas especialistas; (3) realização de modificações e alterações necessárias, e; (4) integração dos resultados para desenvolvimento da versão final. Os dados foram analisados de maneira quantitativa e qualitativa. As modificações do Programa ACT na versão remota foram consideradas adequadas pelas juízas, sendo realizadas adaptações de atividades por meio de plataformas digitais, como Google Meet, Google Forms, entre outras. Foi sugerido que contatos com entidades governamentais e não-governamentais fossem realizados a fim de incluir pais e cuidadores que não possuíssem acesso a equipamento e suporte tecnológico. A versão remota possibilitará disseminar o programa, incluindo cuidadores de diferentes locais do Brasil (AU).

This is a transversal study about the process of adapting the ACT Raising Safe Kids Program to a remote version. The adaptation process consisted of four stages: (1) elaboration of the script with adaptations for application in the remote version; (2) evaluation of the proposal by six expert judges; (3) necessary modifications and alterations; and (4) integration of the results as part of the development of the final version. The results were analyzed quantitatively and qualitatively. The modifications of the ACT Program in the remote version were considered adequate by the judges, with adaptations of activities being carried out through digital platforms, such as Google Meet, Google Forms, among other digital platforms. A suggestion was made regarding contacting governmental and non-governmental entities in order to include parents and caregivers who do not have access to equipment and technological support. This remote version willmake possible the wide dissemination of the program, including caregivers from different parts of Brazil (AU).

Se trata de un estudio transversal sobre el proceso de adaptación del Programa de ACT para Educar Niños en Ambientes Seguros para la versión remota. El proceso de adaptación fue constituido por cuatro etapas: (1) elaboración del guion con las adaptaciones para la aplicación en la versión remota; (2) evaluación de la propuesta por seis jueces especialistas; (3) realización de modificaciones y alteraciones necesarias; y (4) integración de los resultados para desarrollo de la versión final. Los datos fueron analizados de manera cuantitativa y cualitativa. Las modificaciones del Programa de ACT en la versión remota fueron consideradas adecuadas por las juezas, siendo realizadas adaptaciones de actividades por medio de plataformas digitales, como Google Meet, Google Forms, entre otras. Fue sugerido que contactos con entidades gubernamentales y no gubernamentales fueran realizados a fin de incluir padres y cuidadores que no tuvieran acceso a equipo y soporte tecnológico. La versión remota posibilitará diseminar ampliamente el programa, incluyendo cuidadores de diferentes lugares de Brasil (AU).

Programa ACT com casais: repercussões na dinâmica familiar / ACT program with couples: repercussions on family dynamics / Programa ACT con parejas: repercusiones en la dinámica familiar

Este estudo qualitativo buscou compreender as repercussões de um treinamento parental (Programa ACT) na parentalidade, coparentalidade, conjugalidade e no comportamento infantil. O Programa tem como foco a melhoria das práticas educativas dos pais e a sigla ACT significa ação, devido ao caráter dinâmico da intervenção, que abrange orientações, atividades e discussões em grupo. Os dados foram coletados por meio de entrevistas semiestruturadas com três casais heteroafetivos que participaram da intervenção e foram submetidos à análise categorial temática. Os resultados indicaram melhoria na parentalidade e redução de problemas de comportamento dos filhos. A participação de ambos os pais promoveu repercussões favoráveis não apenas na coparentalidade e na conjugalidade, mas na dinâmica familiar como um todo. Este estudo sugere que a participação de duplas coparentais em programas de treinamento tende a potencializar a aplicação do conhecimento, beneficiando o desenvolvimento da criança.

This qualitative research sought to understand the repercussions of the ACT Program on parenting, coparenting, conjugality, and child behavior. ACT is a parenting training program focused on improving parenting practices. Data were collected through semi-structured interviews with three heteroaffective couples who participated in the intervention and submitted to thematic categorical analysis. The results indicated an improvement in parenting and a reduction in children's behavior problems. The participation of both parents promoted favorable repercussions not only on coparenting and conjugality but on family dynamics as a whole. This study suggests that the participation of coparental pairs in training programs tends to enhance the application of knowledge, benefiting the child's development.

Esta investigación cualitativa buscó comprender las repercusiones del Programa ACT en la crianza, la crianza compartida, la conyugalidad y el comportamiento del niño. ACT es un programa de capacitación para padres enfocado en mejorar las prácticas de crianza. Los datos fueron recolectados a través de entrevistas semiestructuradas con tres parejas heteroafectivas que participaron de la intervención, y sometidas a análisis temático categórico. Los resultados indicaron una mejora en la crianza de los hijos y una reducción en los problemas de conducta de los niños. La participación de ambos progenitores promovió repercusiones favorables no solo en la coparentalidad y la conyugalidad, sino en la dinámica familiar en su conjunto. Este estudio sugiere que la participación de parejas coparentales en los programas de capacitación tiende a mejorar la aplicación del conocimiento, beneficiando el desarrollo del niño.

Medida socioeducativa de liberdade assistida: cartografia de redes (sociotécnicas) / Socio-educational measure of assisted freedom: cartography of (sociotechnical) networks / Medida socioeducativa de libertad asistida: cartografía de las redes (sociotécnicas)

Este artigo propõe uma análise sobre a rede de políticas públicas envolvidas no atendimento de adolescentes em Medida Socioeducativa de Liberdade Assistida (LA), utilizando-se de uma análise a partir da Teoria-Ator-Rede (TAR) proposta por Latour (2006). Analisou-se que cada adolescente pesquisado produz e é produzido pela rede em que se conecta, em um jogo de força que estabiliza e desestabiliza configurações e situações e provoca movimentos. Essa rede é composta por atores humanos e não-humanos que os produzem enquanto sujeitos, destacando-se a LA, a qual tem um caráter socializador e de responsabilização e busca assegurar alguns direitos, o que demanda a implicação de outras políticas públicas. É no desabrochar de um trabalho interdisciplinar que se analisa o potencial para ampliação das experiências e a inserção de novos agentes para a emergência de novas tramas na rede de produção destes adolescentes.(AU)

The idea of this article is to discuss the network of public policies involved in the care of adolescents in Socio-educational Measures of Assisted Freedom (LA), using an analysis based on the Actor-Network Theory (ANT) proposed by Latour (2006). We analyzed that each researched adolescent produces and is produced by the network in which he is connected, in a game of force that stabilizes and destabilizes configurations and situations and causes movements. This network is composed of human and non-human actors that produce them as subjects, highlighting LA, which has a socializing character and also of responsibility, and seeks to ensure some rights, which demands the implication of other public policies. It is in the development of an interdisciplinary work that we analyze the potential for expansion of experiences and the insertion of new agents for the emergence of new plots in the production network of these adolescents.(AU)

La idea del artículo es discurrir sobre la red de políticas públicas involucradas en la atención de adolescentes en Medida Socioeducativa de Libertad Asistida (LA), utilizando un análisis a partir de la Teoría Actor-Red (TAR) propuesta por Latour (2006). Se analizó que cada adolescente investigado produce y es producido por la red en que se conecta, en un juego de fuerza que estabiliza y desestabiliza configuraciones y situaciones y provoca movimientos. Esta red se compone por actores humanos y no humanos que los producen como sujetos, destacándose la LA, la cual tiene un carácter socializador y de responsabilización y busca asegurar algunos derechos, lo que demanda la implicación de otras políticas públicas. Es en el desarrollo de un trabajo interdisciplinario que se analiza el potencial para ampliar las experiencias y la inserción de nuevos agentes para la emergencia de nuevas tramas en la red de producción de estos adolescentes.(AU)

Defensive Medicine in the Context of the Indian Health System

Defensive medicine; although a recent concept, is slowly beginning to cement its place in the Indian health system. An interaction of multiple factors has paved way for this form of practice. Need for certainty of the diagnosis, lack of hierarchy in medical care, exponential growth of micro/super specializations and private/corporate health institutions, incentive-based practice, increasing incidences of violence against health personnel, rising trend of defamation suites against doctors, bad publicity by media, and interference by elected representatives have jeopardized the situation. This has led to decline in practice of clinical medicine, increased burden of investigations, especially in already compromised public facilities, and high out-of-pocket health expenditure. As much as ethical medical practice, standard patient management protocols, strict protection of interest of medical practitioners by law, responsible role of media and elected representatives are the need of the hour; we need to find ways to accept and incorporate defensive medicine into the modern medicine. Different stakeholders are required to come together and take substantial steps to understand the phenomenon and preserve the art and science of practicing medicine in its true form.

An Exploration of Pulmonary Fitness of Construction Workers in Delhi NCR in Light of the Building and Other Construction Workers Act, 1996

Workers in the construction sector are exposed to high concentrations of particulate matter at their workplace. This increases their susceptibility to various respiratory diseases, particularly chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS). The study reports comparative pulmonary fitness and hematological parameters of the migrant workers in the construction sector versus other sectors in Delhi. Parameters such as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 ), the ratio of FEV1 to FVC, and peak expiratory flow were measured in both groups using a spirometer. We observed significant differences (P < 0.05) in FEV1 and FVC between both groups. The study thus confirms that workers exposed to poor air quality at the construction site are susceptible to respiratory diseases, particularly ARDS. All of this reflects the poor enforcement of the adequate safety measures well enlisted in social legislations such as the Building and Other Construction Workers Act.

Covid-19: Catalyst for a comprehensive law to combat potential pandemics in India

Despite the relative decline in communicable diseases, India witnesses hundreds of outbreaks every year. Including the current Covid-19 pandemic, India has suffered through several major pandemics and large-scale epidemics since 1900s. However, the response to most of the epidemics has been inadequate. The Epidemic Diseases Act, enacted in 1897 (EDA 1897), has been in action since and is based on the science and the socio-political environment of the country in the nineteenth century. India has several legal mechanisms to help contain and control the spread of epidemics, but on different platforms. There has been a paradigm shift in the socio-political milieu as well as scientific advancements in the prevention and control of epidemics. The century-old EDA 1897 has not been effective in containing and controlling such epidemics/pandemics, as has been witnessed during the ongoing Covid-19 pandemic. Hence, it needs to be revised to define an appropriate structural scalar chain, provide clear-cut and unambiguous terms/definitions and guidelines, delineate ethics and human rights, determine the duties and responsibilities of the affected population/community, determine the role of the private health sector, and provide for appropriate punitive measures to deter repeated violations.

Knowledge and Perception of Child Maltreatment among Parents of Under 18children in a Metropolitan City: A Cross-Sectional Study

Introduction : Child maltreatment is the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation. To assess the Knowledge and perception of Child maltreatmentObjective : among parents of Under 18 children. This was a Cross-Sectional Study done among parents ofMethod : paediatric patients (aged under 18 years) who attended a private tertiary level hospital. A total of 324 selected parents were interviewed during the study period. The study was conducted in the form of a questionnaire which consisted of 3 parts. In the study 96.2% of the parents who participated wereResults : aware of the term “child abuse” but among them, 6.1% were unaware of the fact that there are different types of abuse. More than 2/3 (76.85%) of the parents felt that alcohol influences the behavior of predators ofrd child abuse. Overall, age, education level, and marital status were the statistically significant factors in the current study. The parents in our society today are aware of what child abuse is and its influenceConclusion: on children, society, and the community in general but the knowledge related to legislations have to improve.

An Unanticipated Prolonged Baseline ACT During Cardiac Surgery Due to Factor XII Deficiency

Factor XII (FXII) deficiency is a congenital disorder inherited as an autosomal recessive condition. In his heterozygous form, it is relatively common in the general population. However, a total absence of FXII as seen in homozygous patients, is rare, with an incidence of approximately 1/1,000,000 individuals. Surprisingly, FXII deficiency is rather associated with thromboembolic complications. Patients do not experience a higher risk of surgical bleeding despite a markedly prolonged activated partial thromboplastin time. Given its low incidence in the general population, the finding of an unknown FXII deficiency is rare during cardiac surgery. This unique case describes a patient with an unanticipated prolonged baseline activated clotting time (ACT) during cardiac surgery in which his bleeding history and rotational thromboelastometry tracings lead us to the diagnosis of a FXII deficiency. The finding of a hypocoagulable INTEM tracing and a concurrent normal EXTEM tracing in a sample of a patient with prolonged ACT and adverse anamnestic bleeding history should prompt clinicians to consider a FXII deficiency. It may help clinicians in further perioperative management where there is not enough time to wait for the results of individual coagulation factor testing.

Analyzing the Role and Liability of Paramedics in the Indian Healthcare System

The Nursing and staff serves as backbone of a healthcare system. Despite being central to any healthcare system, not much has been written about them, especially on the issue of their regulations and legal liabilities emanating from their professional activities. Though they are governed by National and State councils, the implications of their acts are different in Civil Law, Criminal Law and under their respective regulations. These differences are primarily the subject matter of this paper.