Development of a Questionnaire on Access to Sickle Cell Disease Care in the Indigenous Tharu Population of Nepal

Purpose of Study Sickle cell disease (SCD) disproportionately affects the Tharu population of Nepal, a marginalized indigenous group concentrated in the Dang district. SCD is a structural hemoglobinopathy resulting in abnormal red blood cells with a tendency to occlude microvasculature. Since 2015, University of British Columbia medical students and a local community partner, Creating Possibilities, have improved access to SCD screening and diagnosis for the Tharu population. However, interviews conducted in 2016- 2017 found that SCD-afflicted community members encounter a number of challenges to obtain treatment once diagnosed. The purpose of this study was to develop a questionnaire on barriers to accessing SCD care in this community. Methods Used The Barriers to Accessing SCD Care Questionnaire was developed from items in existing scales, deductive and inductive item generation, and feedback from expert local partners. Reviewing literature on barriers to accessing healthcare in the Western region of Nepal informed region-specific questionnaire items, while literature on accessing SCD treatment in resource-limited settings informed SCD-specific questionnaire items. We also reviewed the literature on barriers to treatment for various stigmatized chronic health conditions in low-resource settings. Summary of Results Qualitative interviews with SCD-afflicted Tharu individuals in 2016-2017 identified inadequate local medical resources, transportation, financial strain, and limited awareness as barriers to care. Based on the literature review, we organized all survey items under the themes transportation, medical infrastructure, finances, community attitudes, and personal attitudes. The questionnaire includes closed-ended questions using a Likert scale, as well as open-ended interview prompts. It was made in collaboration with local community members to ensure it is culturally appropriate, needs-specific, and easily understandable. The questionnaire received ethics board approval, and interviews will begin once local health authorities lift COVID-19 restrictions. Conclusions Results from the Barriers to Accessing SCD Care questionnaire will guide future community-based interventions.

Access to Sickle Cell Disease Treatment in the Indigenous Tharu Population of Nepal

Purpose of Study: Sickle cell disease (SCD) is a hemoglobinopathy that disproportionately affects the indigenous Tharu population of Nepal, a marginalized ethnic group concentrated in the Dang district. There are significant global disparities in the prognosis of SCD;in low-income countries, which lack screening and management infrastructure, up to 80% of those born with SCD are undiagnosed and less than half survive beyond 5 years of age. Since 2015, University of British Columbia medical student teams have collaborated with a local community partner, Creating Possibilities (CP), to improve SCD awareness, screening, diagnosis, and management for the Tharu population in and around Dang. Community members with SCD have previously expressed numerous challenges in obtaining treatment once diagnosed. This study aims to better understand difficulties in accessing SCD care for this community. Methods Used: The Access to SCD Care Questionnaire was developed from items in existing scales, deductive and inductive item generation, and feedback from expert local partners to ensure it is culturally appropriate, needs-specific, and easily understandable. The questionnaire includes closed-ended questions using a Likert scale and open-ended interview prompts. It centers around five core themes: personal beliefs, community attitudes, finances, transportation, and medical infrastructure. Interviews were conducted in Tharu (local dialect) by CP staff members in January to March 2022. Themes and sub-themes were qualitatively analyzed. Summary of Results: Participants aged from 14 to 42 with an equal sex ratio, a total of 12 interviews were conducted before study saturation was reached. All participants reported at least one minor or major problem with access to SCD care in each of the five core themes of the questionnaire. Inadequate healthcare infrastructure was the most frequently reported barrier, with participants reporting lack of local medication accessibility and low supplies at further district hospitals. Additionally, despite government funding for treatment coverage, participants reported difficulties obtaining the necessary legal documents to prove eligibility. The second largest perceived barrier to care was transportation, which was reported to be costly, time-consuming, and not readily available. Regardless of sub-theme, participants reported that system-wide effects from COVID-19 perpetuated these issues. Conclusion(s): Results from the Access to SCD Care Questionnaire demonstrate that availability and accessibility to medications and transportation services are the primary challenges to receiving SCD care in this indigenous community. Therefore, future interventions for this community should focus on these findings. In contrast with previous literature, community stigma and personal beliefs were not often reported as hindering SCD treatment. This may be attributed to successful education campaigns within this specific community or due to participation bias.

Mental Health Perspectives of Youth & Young Adults at a Medical Sciences University in Bhutan

Purpose of Study: Since 1972, Bhutan has followed the philosophy of Gross National Happiness (GNH) - an alternative to GDP which quantifies the holistic wellness of its citizens' as opposed to the production of materials as a metric of the nation's development & prosperity. Nonetheless, the government identified youth and young adult (YYA) mental health to be a major/increasing point of concern from a 2015 national survey, indicating need for a closer look at Bhutan's mental health burden. By exploring YYA perspectives of mental health via an online survey, we hope to inform resource creation, support existing infrastructure, & guide future research. Methods Used: Survey questions were developed via collaboration of Canadian and Bhutanese shareholders to ensure cultural appropriateness and relevance. In all, 11 demographics questions, 17 10-point Likert scale questions, and 7 written answer questions were included in the survey. Students enrolled at university in Thimphu, Bhutan, between the ages of 18-25 inclusive and who are Bhutanese citizens or who have lived the majority of their life in the country were recruited via email. 289 participants consented to & completed the online survey via Qualtrics. Survey responses were quantitatively analyzed in R-Studio, save for written responses still under qualitative analysis in NVivo and not included in this discussion. Summary of Results: On average, YYA indicated feeling sad, anxious, and/or depressed more frequently than they perceived peers/family to feel the same. Strong agreement was seen regarding treatability of mental health conditions (median of 9 on 10-point Likert scale). Environmental factors, adverse childhood experiences, & personal weakness were noted to have detrimental impacts on wellbeing. The majority of respondents indicated positive familial relationships & confidence in parents to understand/support mental health issues, with medians for all family-related 10-point Likert scale questions being above 7.5. Most respondents agreed they were able to get through difficult times and be self-reliant, with all associated 10-point Likert questions having a median over 5 for moderate agreement. A general positive response to using apps or websites as mental health resources was noted. Relating to COVID-19, minimal negative outcomes in terms of diet, anxiety/depression, home life, & substance use were reported. Strong agreement (median of over 7.5 on 10-point Likert scale) was noted with regard to increases in domestic violence as a result of the pandemic. Conclusion(s): Differences between self-ratings and perceptions of others' mental health by Bhutanese YYA indicate a lack of open communication about the topic. Directing resources towards discussions about mental health may be beneficial - especially if technologically accessible. Impacts of the pandemic may continue to develop as Bhutan emerges from lockdown protocols;increasing domestic violence is a primary concern of Bhutanese YYA meriting research.

Wastewater-based surveillance of COVID-19 and removal of SARS-CoV-2 RNA across a major wastewater treatment plant in San Antonio, Texas

Wastewater-based epidemiology (WBE) targeting SARS-CoV-2 RNA detection in municipal wastewater is considered a valuable tool for COVID-19 surveillance in a community. However, the persistence and removal of SARS-CoV-2 RNA in wastewater treatment plants (WWTPs) have not been well investigated. This study is aimed at detecting SARS-CoV-2 RNA in wastewater to correlate viral concentrations with clinical COVID-19 cases in the sewershed and determine whether the SARS-CoV-2 genetic material is detectable after treatment. Raw influent, primary effluent (after primary clarification), secondary effluent (after activated sludge treatment), and final effluent (after chlorination) samples were collected two times a week from the largest WWTP in San Antonio (Texas) during April to November 2021 and analyzed for SARS-CoV-2 RNA (N1 and N2 genes) concentrations using the reverse transcription droplet digital polymerase chain reaction (RT-ddPCR). SARS-CoV-2 RNA was detected in 98.5% (n = 34 weeks) of the raw influent samples and anticipated the trends of the COVID-19 outbreak. Furthermore, a higher correlation between viral concentrations and COVID-19 cases was observed for two days a week sampling frequency (ρ = 0.75, p <0.001) than one day per week (ρ = 0.60, p <0.001). Despite the high SARS-CoV-2 RNA concentrations in raw sewage, a significant amount of viral RNA was removed at primary and secondary clarifiers (removal efficiencies were 54% and 94%, respectively) and was undetectable in final effluents. These results demonstrate the performance of the WWTP in reducing the SARS-CoV-2 RNA concentration and further highlight the role of tertiary treatment and chlorination in eliminating SARS-CoV-2 RNA in receiving waters. © 2023 RSC.

Dual Modulators of Selected Plant Secondary Metabolites Targeting COVID-19 Main Protease and Interleukin-2: An In-Silico Approach based Novel Hypothesis

Background: Owing to the recent scenario on this ongoing Coronavirus pandemic outbreak around the world, the present study has been undertaken. Aim(s): In this study, we adopted two strategies, i.e., via computational method, a search for the novel plant secondary metabolites from the Indian Traditional Medicine to target and combat the enduring novel 2019 CoVs main protease that causes pneumonia, followed by the effect of these selected secondary metabolites on the host's immune system for their immunomodulatory potential on Interleukin-2. Method(s): A detailed literature review has been done to identify the assorted plant secondary metabolites from the natural sources, which have been extensively used traditionally for their immunomodulatory potential. Next, the resulting compounds have processed for the molecular docking study to predict whether the compounds have the potency to fight against 2019-CoVs protein or it could have the ten-dency to battle the cytokines, which are responsible for the immune response of the host, thereby pre-venting the CoVs caused infection in humans. Furthermore, to explore molecular mechanics, the in-silico docking study with COVID-19 Mpro and Interleukin-2 has been performed. Results & Discussion: Among the six secondary metabolites selected, five compounds showed its possible promising potency with COVID-19 and IL-2 proteins, which are compared with the standard drug Remdesivir, one of the anti-viral drugs for treating and managing the present coronavirus condition and an IL-2 inhibitor, which is the native IL-2 ligand protein (i.e., from PDB Id-1PW6) itself. Besides, based on the docking scores, the Curcumin (from Curcuma longa) showed the highest score towards these two targets taken for this study. The identified compounds have a promising binding affinity with the Mpro receptors, in the narrow range of binding energy for the protein PDB Id: 6LU7 and the score range between-10.9102 to-19.8790 kcal/mol: when compared to the standard-21.8600 kcal/mol. Whereas, the binding affinity with the Interleukin-2 receptor, for the protein PDB Id: 1PW6 the range between-11.3899 to-17.1366 kcal/mol: when compared to that of standard-16.9554 kcal/mol. Conclusion(s): Our result findings demonstrate that the integrated Indian traditional herbal treatment might be hopefully used for the viral respiratory infection due to either it may have acted directly on the viral protein or through regulating the immune response, which could lead to the rapid drug discovery of the drug leads with clinical potency towards the novel infectious disease, where there is no drug or vaccines are available.Copyright © 2021 Bentham Science Publishers.

Assessment of Concentration, Recovery, and Normalization of SARS-CoV-2 RNA from Two Wastewater Treatment Plants in Texas and Correlation with COVID-19 Cases in the Community

The purpose of this study was to conduct a correlative assessment of SARS-CoV-2 RNA concentrations in wastewater with COVID-19 cases and a systematic evaluation of the effect of using different virus concentration methods and recovery and normalization approaches. We measured SARS-CoV-2 RNA concentrations at two different wastewater treatment plants (WWTPs) in the Bexar County of Texas from October 2020 to May 2021 (32 weeks) using reverse transcription droplet digital PCR (RT-ddPCR). We evaluated three different adsorption-extraction (AE) based virus concentration methods (acidification, addition of MgCl2, or without any pretreatment) using bovine coronavirus (BCoV) as surrogate virus and observed that the direct AE method showed the highest mean recovery. COVID-19 cases were correlated significantly with SARS-CoV-2 N1 concentrations in Salitrillo (rho = 0.75, p < 0.001) and Martinez II (rho = 0.68, p < 0.001) WWTPs, but normalizing to a spiked recovery control (BCoV) or a fecal marker (HF183) reduced correlations for both treatment plants. The results generated in this 32-week monitoring study will enable researchers to prioritize the virus recovery method and subsequent correlation studies for wastewater surveillance.

Information sharing through twitter by public health care institution during covid-19 pandemic: A case study of aiims, Raipur

Background: During the time of COVID 19, public health care institutions have used social media to inform and aware society. Aim & Objective: To analyze how Public Health Care Institutes conveyed the health information and messages through social media platform-Twitter during COVID 19, and analyzing its impact through sentiment analysis of comments. Material & Methods: The Thematic and sentiment analysis method has been used to analyze the data of the Twitter handle of AIIMS, Raipur in two phases;January-March 2020, and April-June 2020. Results: The analysis shows that the sharing of COVID-19 updates on AIIMS, Raipur Twitter handle increased the followers 15 times from 2,000+ in March 2020 to 30,000+ in June 2020, and the sentiment analysis reflects that COVID related updates received 96.7 % positive comments. Conclusion: The case study finds that transparent and informative message sharing through social media by public health care institutions can create an effective channel of communication. This results in a positive institutional image. © 2021, Indian Association of Preventive and Social Medicine. All rights reserved.

Perceived stress and psychological well-being of working mothers during COVID-19: a mediated moderated roles of teleworking and resilience

Purpose: The present study examines the mediating role of teleworking and the moderating role of resilience in explaining the relationship between perceived stress and psychological well-being of working mothers in India. Conservation of resource theory (COR) is taken to support the present study. Design/methodology/approach: The data of 326 respondents has been collected from working mothers in various sectors of Delhi NCR region of India. Confirmatory factor analysis was used for construct validity, and SPSS Macro Process (Hayes) was used for testing the hypotheses. Findings: The results of the study found an inverse association between perceived stress and psychological well-being. Teleworking acted as a partial mediator and resilience proved to be a significant moderator for teleworking-well-being relationship. Research limitations/implications: The study is based at Delhi NCR of India, and future studies may be based on a diverse population within the country to generalize the findings in different cultural and industrial contexts. The present work is based only on the psychological well-being of the working mothers, it can be extended to study the organizational stress for both the genders and other demographic variables. Practical implications: The study extends the research on perceived stress and teleworking by empirically testing the association between perceived stress and psychological well-being in the presence of teleworking as a mediating variable. The findings suggest some practical implications for HR managers and OD Practitioners. The organizations must develop a plan to support working mothers by providing flexible working hours and arranging online stress management programs for them. Originality/value: Although teleworking is studied previously, there is a scarcity of research examining the impact of teleworking on psychological well-being of working mothers in Asian context. It would help in understanding the process that how teleworking has been stressful for working mothers and also deliberate the role of resilience in the relationship between teleworking and psychological well-being due to perceived stress, as it seems a ray of hope in new normal work situations. © 2021, Emerald Publishing Limited.

ASSESSING JOB PREFERENCES OF MEDIA AND COMMUNICATION STUDENTS IN THE COVID ERA: A CONJOINT ANALYSIS

The purpose of this paper is to explore job attribute preferences of students in the media and communication stream. The study is conducted to get an understanding of job expectations of students in the COVID era that can help provide conceptual guidelines to hiring managers in media houses for future planning of manpower/job offers. Based on the conjoint analysis technique, a questionnaire was designed and responses of 152 students of media and communication were recorded from a university in Delhi/NCR. Estimation of preference function was created using orthogonal arrays. Results of this study suggest that job security is the most preferred attribute which influences job choice decisions of students, second preferred attribute being appropriate work hours. The paper presents an important tool that can be of great use for recruitment managers, to understand the psyche of students and their preferences, which may further help in designing appropriate recruitment policies and create job offers that can attract the suitable talent pool. Results also reveal that high compensation package is not the most preferred attribute anymore, perhaps due to the uncertainty of the times. Limitation of this study is that individual behaviour cannot be ascertained through the survey and data from students of different universities can be studied for more robust results. The paper is novel in approach as it empirically identifies the preferred job attributes of media students amid the pandemic situation, by applying conjoint analysis. Therefore, it gives new insights to understand how the pandemic has affected students’ job expectation and decisions. © 2020. All Rights Reserved.

Highly sensitive and full-genomeinterrogation of SARS-CoV-2 using multiplexed PCRenrichment followed by next-generation sequencing

Many detection methods have been used or reported for the diagnosis and/or surveillance of COVID-19. Amongthem, reverse transcription polymerase chain reaction (RT-PCR) is the most commonly used because of its highsensitivity, typically claiming detection of about 5 copies of viruses. However, it has been reported that only 47-59%of the positive cases were identified by some RT-PCR methods, probably due to low viral load, timing of sampling, degradation of virus RNA in the sampling process, or possible mutations spanning the primer binding sites.Therefore, alternative and highly sensitive methods are imperative. With the goal of improving sensitivity andaccommodating various application settings, we developed a multiplex-PCR-based method comprising 343 pairs ofspecific primers and demonstrated its efficiency at detecting SARS-CoV-2 at low copy numbers. The assayproduced clean characteristic target peaks of defined sizes, which allowed for direct identification of positives byelectrophoresis. We further amplified the entire SARS-CoV-2 genome from 8 to half a million viral copies purifiedfrom 13 COVID-19 positive specimens and detected mutations through next-generation sequencing. Finally, wedeveloped a multiplex-PCR-based metagenomic method in parallel that required modest sequencing depth foruncovering SARS-CoV-2 mutational diversity and potentially novel or emerging isolates..