Family and facility care variables attributing to postnatal depression among women in two tribal-dominated districts of Odisha: Log model analysis to suggest intervention.

Introduction: It is a proven fact that women are affected by poor mental health predominantly in the postnatal period. This is authenticated by the use of a validated and tested Edinburg Postnatal Depression scale (EPNS), which is a simple tool to measure depression among women after delivery by posing 10 questions and this is also validated in Odia language. Odisha has made laudable progress in delivering Maternal and Child Health care to women even in tribal-dominated districts through its robust Comprehensive Obstetrics care network restricting home delivery almost to a mere 4%-5% and reducing maternal deaths by 60%-70% as per the National Family Health Survey (NFHS-5). As a part of an Indian Council of Medical Research (ICMR) extramural project to enhance contraceptive acceptance among males in districts that had a total fertility rate (TFR) higher than 3, a qualitative objective to measure mean postnatal depression in the early postpartum period (who are also the target to advocate contraceptive acceptance) was undertaken. A secondary objective was to compare family care vs. facility care as greater attributing factors for higher EPNS scores. Materials and Methods: Due to time constraints, the study was done on a fast-track mode wherein two villages each from the sampled blocks of Koraput and Boudh (with one of the highest birth rates) were selected. All women in villages who had a baby aged between 1 and 6 months, were the sampling frame and only those were selected who consented. A questionnaire was used that elicited information on familial sociodemographic details and also facility-based antenatal care (ANC) and postdelivery services that were availed for the last-born child. General Health Questionnaire-12 (GHQ-12) scores were used as an independent variable and a proxy measure of cumulative familial stress. Descriptives and log regression were used to measure the odds of family vs. facility-based services. Results: A total of 98 women, 50 from Boudh and 48 from Koraput, participated in the study. Koraput's mean EPNS scores were 6 points higher than Boudh indicating much higher postnatal poor mental health. Log models showed that there was no difference between facility-based care in both districts as both reported 96%-97.3% institutional delivery, with out-of-pocket expenditure (OOP) being less than 520 Indian rupees on average and nearly 100% reported receipt of iron folic acid and calcium as well as streamlined Janani Suraksha Yojana (JSY) services. However, the odds of men's participation in Family planning was 2.77 times less in Koraput (SD = 2.582), fourth birth order 1.33 odds, and female gender 5.66 odds higher for the district as a result of which GHQ 12 score mean was 21.00 (CI: 19.18-22.82) hinting very high psychological stress as compared with Boudh where the mean was 17 (CI: 14.59-19.41). Conclusion: This clearly indicates that a robust healthcare delivery alone will not be able to address the holistic health of women in the childbearing age group. Familial stressors compound poor mental health and hence counseling of the family as a whole is necessary to achieve sound mental health in women in the postnatal period. The spousal role is emerging as a strong determinant, especially in terms of nonacceptance or casual approach to contraceptive use. Interestingly, a skewed gender bias is noted for the female child, which is also a contributor to postnatal depression (PND) in both districts, though a bigger sample would be needed to statistically prove it.

Developing and Evaluating the DiabetesXcel Mobile Application for Adult Patients With Type 2 Diabetes.

The authors trialed a mobile application, DiabetesXcel, which included type 2 diabetes-focused educational videos and modules, in 50 adults of Bronx, NY, a region with a high prevalence of diabetes and diabetes complications. From baseline to 4 months and from baseline to 6 months, there was significantly improved quality of life, self-management, knowledge, self-efficacy, depression, A1C, and LDL cholesterol among those who used DiabetesXcel. There was also a significant decrease in diabetes-related emergency department visits and hospital admissions from baseline to 6 months. This study demonstrates that DiabetesXcel could be beneficial for type 2 diabetes management.

Contexts for developing of national essential diagnostics lists. Lessons from a mixed-methods study of existing documents, stakeholders and decision making on tier-specific essential in-vitro diagnostics in African countries.

Since 2019, the WHO recommends the development and implementation of National Essential Diagnostics List (NEDL) to facilitate availability of In-Vitro Diagnostics (IVDs) across the various tiers of the healthcare pyramid, facilities with or without a laboratory on-site. To be effective, the development of NEDL should take into consideration the challenges and opportunities associated with current modalities for organization of tier specific testing services in-country. We conducted a mixed-methods analysis set out to explore available national policies, guidelines and decision-making processes that affect accessibility of diagnostics in African countries; 307 documents from 48 African countries were reviewed and 28 in-depth (group) interviews with 43 key-informants in seven countries were conducted between June and July 2022. Of the 48 countries, Nigeria was the only one with formal NEDL. Twenty-five countries had national test menus (63% outdated, from 2015 or earlier) all specifying tests by laboratory tier (5 including the "community tier"), with additional details on equipment (20), consumables (12), and personnel requirements (11). The most popular criteria to select essential IVDs in the quantitative analysis relate to specificities of the tests, whereas in the qualitative study most mentioned were health care and laboratory contextual factors. Quality assurance and waste management for tests at "community tier" were highlighted as concerns by all the respondents. Additional barriers to implementation included the low decision-making power of Laboratory Directorates within the Ministry of Health, as well as the chronic budgetary gaps for clinical laboratory services and policy and strategic plan development outside of vertical programmes. Four countries out of seven would rather revise their test menus by updating them and add ''community tier", than developing a separate NEDL, the former being considered more operational. This study provides a unique set of practical recommendations to the process of development and effective implementation on NEDL in Africa.

Targeting Technology in Underserved Adults With Type 1 Diabetes: Effect of Diabetes Practice Transformations on Improving Equity in CGM Prescribing Behaviors.

OBJECTIVE: Continuous glucose monitoring (CGM) is associated with improved outcomes in type 1 diabetes, but racial-ethnic disparities exist in use. We were interested in examining whether addressing structural health care barriers would change provider prescribing behaviors to make CGM access more equitable. RESEARCH DESIGN AND METHODS: From January 2019 to December 2021, we used multilevel stakeholder input to develop and implement several non-grant-funded practice transformations targeted toward equity, which included 1) developing a type 1 diabetes clinic, 2) conducting social needs assessments and management, 3) training support staff to place trial CGMs at the point of care, 4) optimizing prescription workflows, and 5) educating providers on CGM. Transformations were prioritized based on feasibility, acceptability, and sustainability. To examine effect on prescribing behaviors, we collected monthly aggregate data from the electronic medical record and performed multiple linear regression to examine and compare change in CGM prescriptions over the 3 years of transformation. RESULTS: In total, we included 1,357 adults with type 1 diabetes in the analysis (mean ± SD age 38 ± 18 years; 30% Black [n = 406], 45% Hispanic [n = 612], 12% White [n = 164]; and 74% publicly insured [n = 1,004]). During the period of transformation, CGM prescription rates increased overall from 15% to 69% (P < 0.001). Improvements were seen equally among Black (12% to 72%), Hispanic (15% to 74%), and White adults (20% to 48%) (between-group P = 0.053). CONCLUSIONS: Diabetes practice transformations that target equity, offload provider burdens, and focus on feasible sustainable stakeholder-driven solutions can have powerful effects on provider prescribing behaviors to reduce root causes of inequity in CGM among underserved adults with type 1 diabetes. Continued focus is needed on upstream determinants of downstream CGM use.

Comparative evaluation of pain perception during conventional greater palatine injections versus the use of a novel barovibrotactile device - In vivo study.

Background: Pain control by means of local anesthesia is an intrinsic part of clinical practice in dentistry. It is an irony that the modality used for pain free procedure itself is a source of fear & anxiety to the patient. Several modifications have been made to the injecting devices, local anesthetic solutions and techniques to render their administration comfortably. The objective of this study was thus designed to evaluate and compare anxiety and pain perception during conventional greater palatine injections versus use of a novel barovibrotactile device named Accupal to give painless anesthesia. This device has an additional attachment which works on Vibra-pulse technology thus minimizing pain during injection technique. Materials and methods: A prospective, split mouth, open label, randomized, crossover clinical study was conducted on 50 patients coming to our institute whereby on one side Accupal was used during administration of local anesthesia. And on other side, traditional local anesthetic injection technique was used with one week of time interval. Results: A statistically significant difference was found as in the pain perception between the two techniques as per Visual Analogue Scale whereas no difference was seen in the anxiety levels as per the physiological parameters recorded by noninvasive blood pressure machine at various intervals. Conclusion: The use of Accupal has thus proved to show better pain control as compared to traditional injection techniques of local anesthesia.

Silent Corticotroph and Somatotroph Double Pituitary Adenoma: A Case Report and Review of Literature.

Clinically silent double pituitary adenomas consisting of corticotroph and somatotroph cells are an exceedingly rare clinical finding. In this report, we present the case of a 28-year-old man with a 1-year history of recurrent headaches. Imaging revealed a 2.1 (anterior-posterior) × 2.2 (transverse) × 1.3 (craniocaudal) cm pituitary adenoma invading into the left cavernous sinus and encasing the left internal carotid artery. Endoscopic transnasal resection was performed without complications. Immunohistochemical staining revealed a double adenoma consisting of distinct sparsely granulated somatotroph and densely granulated corticotroph cells that were positive for growth hormone and adrenocorticotropic hormone, respectively. K i -67 index labeling revealed a level of 6% within the corticotroph adenoma. No increase in serum growth hormone or adrenocorticotropic hormone was found, indicating a clinically silent double adenoma. While transsphenoidal surgery remains a first-line approach for silent adenomas presenting with mass effects, increased rates of proliferative markers, such as the K i -67 index, provide useful insight into the clinical course of such tumors. Determining the K i -67 index of silent pituitary adenomas could be valuable in predicting recurrence after initial surgical resection and identifying tumors that are at an increased risk of needing additional therapeutic interventions or more frequent surveillance imaging.

The Association of Lactose Intolerance With Colon and Gastric Cancers: Friend or Foe?

BACKGROUND: Lactose intolerance (LI) appears usually in later ages when the lactase enzyme becomes deficient or absent in the small intestine. Conflicting results have been reported in the literature about the association of lactose intolerance with various gastrointestinal malignancies. Hence, our aim was to study the association between LI, colon cancer (CCa), and gastric cancer (GC) using a large database. METHODS: A cross-sectional study was performed using the National Inpatient Sample (NIS) database between 2004 and 2014. We identified adult patients (18-90 years) who were diagnosed with LI (study group) using appropriate International Classification of Diseases, Ninth Revision (ICD-9) codes. The control group comprised patients who did not have a diagnosis of LI. We identified the diagnosis of CCa and GC in both study and control groups using the ICD-9 codes. Univariable and multivariable logistic regression analyses were performed to assess the association between LI, CCa, and GC. RESULTS: The total population comprised 71,360,501 patients, of which 57,909 (0.08%) were diagnosed with LI. LI patients were older (62 vs 51 years) with more females (61.5% vs 60.1%) and less African American patients (11.8% vs 14.3%) (p <0.0001 for all). In addition, LI patients had more smoking (12.4% vs 12%) and obesity (15% vs 8.9%). On the other hand, patients in the LI group had less alcohol use (3.8% vs 4.2%) (p <0.0001). After adjusting for the age, gender, race, smoking, alcohol, obesity, and inflammatory bowel disease, the LI group had a slightly lower rate of CCa (OR 0 .974, 95%CI 0.906-1.048, p = 0.486) and a lower rate of GC (OR: 0.993, 95%CI 0.924-1.068, p =0.853); however, the results were not statistically significant. CONCLUSION: Patients with lactose intolerance may have a lower risk of colon and gastric cancer. However, these findings were not statistically significant. Further studies are needed to understand this association.

Candidate gene identification for systemic lupus erythematosus using network centrality measures and gene ontology.

Systemic lupus erythematosus (SLE) commonly accredited as "the great imitator" is a highly complex disease involving multiple gene susceptibility with non-specific symptoms. Many experimental and computational approaches have been used to investigate the disease related candidate genes. But the limited knowledge of gene function and disease correlation and also lack of complete functional details about the majority of genes in susceptible locus, encumbrances the identification of SLE related candidate genes. In this paper, we have studied the human immunome network (undirected) using various graph theoretical centrality measures integrated with the gene ontology terms to predict the new candidate genes. As a result, we have identified 8 candidate genes, which may act as potential targets for SLE disease. We have also carried out the same analysis by replacing the human immunome network with human immunome signaling network (directed) and as an outcome we have obtained 5 candidate genes as potential targets for SLE disease. From the comparison study, we have found these two approaches are complementary in nature.