Geospatial methodology for determining the regional prevalence of hospital-reported childhood intussusception in patients from India.

Both developed and developing countries carry a large burden of pediatric intussusception. Sentinel site surveillance-based studies have highlighted the difference in the regional incidence of intussusception. The objectives of this manuscript were to geospatially map the locations of hospital-confirmed childhood intussusception cases reported from sentinel hospitals, identify clustering and dispersion, and reveal the potential causes of the underlying pattern. Geospatial analysis revealed positive clustering patterns, i.e., a Moran's I of 0.071 at a statistically significant (p value < 0.0010) Z score of 16.14 for the intussusception cases across India (cases mapped n = 2221), with 14 hotspots in two states (Kerala = 6 and Tamil Nadu = 8) at the 95% CI. Granular analysis indicated that 67% of the reported cases resided < 50 km from the sentinel hospitals, and the average travel distance to the sentinel hospital from the patient residence was calculated as 47 km (CI 95% min 1 km-max 378 km). Easy access and facility referral preferences were identified as the main causes of the existing clustering pattern of the disease. We recommend designing community-based surveillance studies to improve the understanding of the prevalence and regional epidemiological burden of the disease.

Military to civilian cultural transition experiences of retired military personnel: A systematic meta-synthesis.

Military organizations often demonstrate contrasting features compared to civilian ones, including indoctrination of military identity and mind-set. Therefore, on returning after retirement, military personnel undergo acculturation to reconnect to the civilian world. Many military retirees face difficulty readjusting in multiple professional and personal life domains, and report decreased life satisfaction due to this transition. The present review conducted a thematic meta-synthesis of 28 studies that had qualitatively assessed military to civilian transition experiences. The aim was to understand the military-civilian culture gap and identify the challenges faced during this transition. The analysis led to six themes - "Military Institutionalization, Military-Civilian Cultural Contrast, The Three S's of Transition Challenges - Stereotypes, Skills, and Support, The Losses of Identity, Reconnecting with Family, Friends, and Civilian Counterparts, and Facilitators in Transition - Covering the Military-Civilian Gap." Based on these findings, the review further presents possible intervention suggestions for retirement adjustment and future research direction.

Community Dynamics and Engagement Strategies in Establishing Demographic Development and Environmental Surveillance Systems: A Multi-Site Report from India.

BACKGROUND: Six diverse Demographic Development and Environmental Surveillance System (DDESS) sites were established in urban slum, urban resettlement, peri-urban, rural, and tribal areas located in Northern, North-East, Eastern, and Southern regions of India from June 2020 to March 2022. Understanding the community dynamics and engaging people in the community is critically important in the process of establishing DDESS. We ascertained the barriers, challenges, and facilitators during the establishment of multiple DDESS sites across India. METHODS: This was a cross-sectional descriptive mixed-methods study. RESULTS: Multiple barriers and challenges encountered were reported in the process of community engagement (CE), such as geographical inaccessibility, language barriers, adverse weather, non-responsiveness due to perceived lack of individual benefit or financial gain, fear of contracting COVID-19, COVID-19 vaccine hesitancy, etc. Facilitators in the CE process were pre-existing links with the community, constitution of community advisory boards, community need assessment, concomitant delivery of outreach health services, and skill-building facilities. CONCLUSION: Most community barriers in the development of DDESS sites in resource-limited settings can be overcome through a multipronged approach, including effective community engagement by focusing on demonstrating trust at the local level, enlisting community mobilization and support, utilizing pre-existing community linkages, initiating community diagnosis, and meeting perceived community health needs.

Increasing Choices or Decreasing Hope? Explaining the Rising Prevalence of Depression From a Decision-Making Perspective.

In today's fast-moving society, we get a multitude of options available. However, choices once considered beneficial, are now being largely debated. In the face of rising prevalence of depression and being identified as the 'disease of modernity', this burden of increasing choices on the modern society needs to be re-evaluated. In this paper, we aim to elucidate the rising rate of depression in today's society with regard to the increasing number of choices, the decision-making process, and the consequent attribution of the decision-making situations. We also attempt to look at the role of culture, acknowledging its importance in depression and perception of choices. Lastly, a theoretical perspective is being outlined about how the increasing amount of choices being provided in today's society can give rise to a pessimistic attribution style among decision-makers. Decision-makers therein might be more likely to face post-decisional regret and self-blame, ultimately developing risk for depression. The way in which choices are perceived in a particular culture could either facilitate or act as a buffer to depression. Thus, the essential role that culture might play in moderating this relationship is also discussed.

Exploring barriers of quitting smokeless tobacco among coronary artery disease patients of India: A qualitative study.

BACKGROUND: Cessation of all forms of tobacco is necessary for controlling mortality associated with coronary artery diseases (CADs). In India, smokeless tobacco (SLT) is the most used form of tobacco. With around 60% of the world's smokeless tobacco users living in India, the task of tobacco cessation has become daunting and complicated for Indian researchers and policy makers. OBJECTIVE: We conducted the present study to understand CAD patients' perspectives towards their SLT use and to identify barriers of SLT cessation. METHODS: Using a semi-structured interview method, we obtained data from 12 CAD patients who were currently using some form of SLT. RESULTS: Thematic analysis suggests that CAD patients were unable to quit SLT addiction due to (a) certain socio-environmental factors that support SLT, (b) prevalence of misconceptions about the link between SLT use and their cardiac condition, (c) perceived lower self-efficacy to quit, (d) fatalistic attitude towards health outcomes and (e) substituting addiction with perceived lesser harmful products. DISCUSSION: The findings reveal that factors responsible for the continuation of SLT usage are multipronged. Current SLT users' perspectives can facilitate the development of effective intervention and rehabilitation programs aimed at de-addiction of cardiac patients.

A study on the motivation of Indian patients to consult complementary and alternative medicine practitioners to treat coronary artery disease.

BACKGROUND: In India, the use of traditional medicine for health problems is a part of the cultural discourse on treatment, but the introduction of Western medicines has adversely affected their popularity. However, with the rapid spread of chronic diseases like coronary artery disease (CAD), many Indians are reverting to complementary and alternative medicine (CAM) treatments. Although previous literature has identified several motivational factors underlying CAM usage, we know little from the perspective of its practitioners. AIM: The aim of the present study was to investigate the motivations behind the use of CAM treatments among Indian patients with CAD. METHOD: Using semi-structured interviews, we collected data from 15 CAM practitioners and 14 CAD patients utilising CAM treatments alongside conventional biomedical (BM) treatment. We used the Clarke and Braun (2006) method of thematic analysis. RESULT AND CONCLUSION: Our findings suggest that the use of CAM treatments depends on various factors working at multiple levels viz., personal factors, disease' characteristics, perceived treatment characteristics (positive attributes of CAM and negative attributes of BM) and external facilitators. Furthermore, our analysis also identifies the role of two underlining forces-push and pull-in motivating CAD patients to choose CAM treatments. The push force comprises factors that participants found to have a repelling nature, whereas pull forces were regarded as advantageous for CAM usage. Although some reasons behind the usage of CAM treatments according to patients and practitioners were overlapping, both groups also provided many distinct insights into the studied health behaviour.

Harmonized One Health Trans-Species and Community Surveillance for Tackling Antibacterial Resistance in India: Protocol for a Mixed Methods Study.

BACKGROUND: India has the largest burden of drug­resistant organisms compared with other countries around the world, including multiresistant and extremely drug­resistant tuberculosis and resistant Gram­negative and Gram­positive bacteria. Antibiotic resistant bacteria are found in all living hosts and in the environment and move between hosts and ecosystems. An intricate interplay of infections, exposure to antibiotics, and disinfectants at individual and community levels among humans, animals, birds, and fishes triggers evolution and spread of resistance. The One Health framework proposes addressing antibiotic resistance as a complex multidisciplinary problem. However, the evidence base in the Indian context is limited. OBJECTIVE: This multisectoral, trans-species surveillance project aims to document the infection and resistance patterns of 7 resistant-priority bacteria and the risk factors for resistance following the One Health framework and geospatial epidemiology. METHODS: This hospital- and community-based surveillance adopts a cross-sectional design with mixed methodology (quantitative, qualitative, and spatial) data collection. This study is being conducted at 6 microbiology laboratories and communities in Khurda district, Odisha, India. The laboratory surveillance collects data on bacteria isolates from different hosts and their resistance patterns. The hosts for infection surveillance include humans, animals (livestock, food chain, and pet animals), birds (poultry), and freshwater fishes (not crustaceans). For eligible patients, animals, birds and fishes, detailed data from their households or farms on health care seeking (for animals, birds and fishes, the illness, and care seeking of the caretakers), antibiotic use, disinfection practices, and neighborhood exposure to infection risks will be collected. Antibiotic prescription and use patterns at hospitals and clinics, and therapeutic and nontherapeutic antibiotic and disinfectant use in farms will also be collected. Interviews with key informants from animal breeding, agriculture, and food processing will explore the perceptions, attitudes, and practices related to antibiotic use. The data analysis will follow quantitative (descriptive and analytical), qualitative, and geospatial epidemiology principles. RESULTS: The study was funded in May 2019 and approved by Institute Ethics Committees in March 2019. The data collection started in September 2019 and shall continue till March 2021. As of June 2020, data for 56 humans, 30 animals and birds, and fishes from 10 ponds have been collected. Data analysis is yet to be done. CONCLUSIONS: This study will inform about the bacterial infection and resistance epidemiology among different hosts, the risk factors for infection, and resistance transmission. In addition, it will identify the potential triggers and levers for further exploration and action. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/23241.

Evaluation of physiological and molecular effect of variable virulence of Alternaria brassicae isolates in Brassica juncea, Sinapis alba and Camelina sativa.

Brassica genus comprises many prominent species valuable for human nutrition including vegetable crops and oilseed. Production of B. juncea is challenged by many abiotic and biotic stresses, Alternaria blight caused by a necrotrophic fungal pathogen Alternaria brassicae is one of the most prominent diseases of cruciferous crops including B. juncea. However, some closely related wild species like Sinapis alba and Camelina sativa exhibit a variable level of resistance towards the pathogen. Apart from the host resistance, intra-specific pathogen variability also influences disease severity to a larger extent. In this study, we identified and isolated two strains of A. brassicae viz ABS1 and ABS2 exhibiting morphological and pathological variability. These isolates were further used to artificially inoculate B. juncea and two of its wild relatives under in-vitro as well as in-vivo conditions to inspect their pathogenicity in a susceptible, a moderately resistant and a highly resistant host. virulent isolate (ABS2) was able to readily establish infection in all the three species whereas the less virulent isolate (ABS1) readily infected susceptible species B. juncea but delayed and mild infection was noticed in tolerant hosts. Variable physiological and molecular host response towards the differential level of virulence of pathogen were established with many confirmatory experiments like DAB staining study, Disease severity index and microscopic analysis. Real-time PCR results confirm that these two isolates induce a variable level of induction in genes PR1 and PDF1.2 within 48 h of the artificial inoculation in B. juncea and its wild relatives.

Investigation of anti-diabetic plants used among the ethnic communities of Kanpur division, India.

ETHNO PHARMACOLOGICAL RELEVANCE: Kanpur division is one of the large areas of India with diverse traditional medicinal heritage. In this area, a large number of people suffer from diabetes mellitus. People in this area handle diabetes with herbal and modern medicinal treatments. However, folk knowledge for the treatment of diabetes is not documented. AIM OF THE STUDY: To document and promulgate the enormous indigenous knowledge of therapeutic importance of herbal plants used by the local practitioners for diabetes mellitus. MATERIALS AND METHOD: Total 44 local practitioners (28 male and 16 female) were interviewed through a questionnaire. The medicinal plants suggested by the practitioners were identified by the taxonomist, and plant specimens were preserved. RESULTS: Thirty-five species of plants, belonging to 24 families, were suggested by 44 local healers of Kanpur division. The fidelity level (FL), use values (UV) and relative frequency of citation (RFC) for each plant have been analyzed. The UV, FL, and RFC values of the recorded plants ranged between 0.97 to 0.23, 82.7%-24.1% and 0.327 to 0.067, respectively. Leguminosae family dominated with 14.28% of the total plants. The highest used life form was recorded as tree (43%) while the most widely used plant part was leaf (30.6%). The highest UV, FL, and RFC were recorded for the Aloe vera L. (0.97), Syzygium cumini L. (82.7%) and Momordica charantia L. (0.327) respectively. CONCLUSION: The present study exhibits the knowledge and use of anti-diabetic plants adopted by the ethnic communities of Kanpur division. Future pharmacological investigations are required to test the potency and efficacy of herbal treatments. There is also a need for sustainable use and conservation of these medicinally useful plants.

Evaluation of suitable reference genes in Brassica juncea and its wild relative Camelina sativa for qRT-PCR analysis under various stress conditions.

Quantitative real-time PCR (qRT-PCR) is an efficient method to estimate the gene expression levels but the accuracy of its result largely depends on the stability of the reference gene. Many studies have reported considerable variation in the expression of reference genes (RGs) in different tissue and conditions. Therefore, screening for appropriate RGs with stable expression is crucial for functional analysis of the target gene. Two closely related crucifers Brassica juncea (cultivated) and Camelina sativa (wild) respond differently towards various abiotic and biotic stress where C. sativa exhibits higher tolerance to various stress. Comparative gene expression analysis of the target genes between two such species is the key approach to understand the mechanism of a plant's response to stress. However, using an unsuitable RG can lead to misinterpretation of expression levels of the target gene in such studies. In this investigation, the stability of seven candidate RGs including traditional housekeeping genes (HKGs) and novel candidate RGs were identified across diverse sample sets of B. juncea and C. sativa representing- hormone treated, wounded, Alternaria brassicae inoculated and combination treated samples (exogenous hormone treatment followed by A. brassicae inoculation). In this investigation, we identified stable RGs in both the species and the most suitable RGs to perform an unbiased comparative gene expression analysis between B. juncea and C. sativa. Results revealed that TIPS41 and PP2A were identified as the overall best performing RGs in both the species. However, the most suitable RG for each sample subset representing different condition must be individually selected. In Hormone treated and wounded samples TIPS41 expressed stably in both the species and in A. brassicae inoculated and combination treatment performance of PP2A was the best. In this study, for the first time, we have identified and validated stable reference gene in C. sativa for accurate normalization of gene expression data.

Self-silencing and women's health: A review.

The connection between gender and health has intrigued health professionals in the last few decades. Silencing-the-self theory has brought a considerable clarity in this matter. After around three decades of the theory, the literature related to the theory has immensely flourished and has covered different branches of psychology. The aim of the present work is to provide a comprehensive picture of the qualitative and quantitative research findings that have connected self-silencing to health and well-being of women. This article presents a critical review of relevant articles. These articles have used the self-silencing theory as an explanation of women's higher vulnerability to certain diseases as well as their experience with them. Self-silencing has been found to explain the gender gap in psychiatric disorders like depression, eating disorders and so on. It also influences the resilience and therapeutic effects among female patients with chronic conditions such as cancer, AIDS and so on. Moreover, self-silencing has also been found to be associated with women's health issues such as pre-menstrual dysphoric disorder. The present study discusses the existing literature in a narrative manner along with suggesting some relevant research gaps that can be worth exploring in the future.

Establishing a Demographic, Development and Environmental Geospatial Surveillance Platform in India: Planning and Implementation.

BACKGROUND: Inadequate administrative health data, suboptimal public health infrastructure, rapid and unplanned urbanization, environmental degradation, and poor penetration of information technology make the tracking of health and well-being of populations and their social determinants in the developing countries challenging. Technology-integrated comprehensive surveillance platforms have the potential to overcome these gaps. OBJECTIVE: This paper provides methodological insights into establishing a geographic information system (GIS)-integrated, comprehensive surveillance platform in rural North India, a resource-constrained setting. METHODS: The International Clinical Epidemiology Network Trust International established a comprehensive SOMAARTH Demographic, Development, and Environmental Surveillance Site (DDESS) in rural Palwal, a district in Haryana, North India. The surveillance platform evolved by adopting four major steps: (1) site preparation, (2) data construction, (3) data quality assurance, and (4) data update and maintenance system. Arc GIS 10.3 and QGIS 2.14 software were employed for geospatial data construction. Surveillance data architecture was built upon the geospatial land parcel datasets. Dedicated software (SOMAARTH-1) was developed for handling high volume of longitudinal datasets. The built infrastructure data pertaining to land use, water bodies, roads, railways, community trails, landmarks, water, sanitation and food environment, weather and air quality, and demographic characteristics were constructed in a relational manner. RESULTS: The comprehensive surveillance platform encompassed a population of 0.2 million individuals residing in 51 villages over a land mass of 251.7 sq km having 32,662 households and 19,260 nonresidential features (cattle shed, shops, health, education, banking, religious institutions, etc). All land parcels were assigned georeferenced location identification numbers to enable space and time monitoring. Subdivision of villages into sectors helped identify socially homogenous community clusters (418/676, 61.8%, sectors). Water and hygiene parameters of the whole area were mapped on the GIS platform and quantified. Risk of physical exposure to harmful environment (poor water and sanitation indicators) was significantly associated with the caste of individual household (P=.001), and the path was mediated through the socioeconomic status and density of waste spots (liquid and solid) of the sector in which these households were located. Ground-truthing for ascertaining the land parcel level accuracies, community involvement in mapping exercise, and identification of small habitations not recorded in the administrative data were key learnings. CONCLUSIONS: The SOMAARTH DDESS experience allowed us to document and explore dynamic relationships, associations, and pathways across multiple levels of the system (ie, individual, household, neighborhood, and village) through a geospatial interface. This could be used for characterization and monitoring of a wide range of proximal and distal determinants of health.

Evaluation of data accuracies within a comprehensive geospatial-health data surveillance platform: SOMAARTH Demographic Development and Environmental Surveillance Site, Palwal, Haryana, India.

Evidence exists of an increasing prevalence of chronic conditions within developed and developing nations, notably for priority population groups. The need for the collection of geospatial data to monitor the health impact of rapid social-environmental and economic changes occurring in these countries is being increasingly recognized. Rigorous accuracy assessment of such geospatial data is required to enable error estimation, and ultimately, data utility for exploring population health. This research outlines findings from a field-based evaluation exercise of the SOMAARTH DDESS geospatial-health platform. Participatory-based mixed methods have been employed within Palwal-India to capture villager perspectives on built infrastructure across 51 villages. This study, conducted in 2013, included an assessment of data element position and attribute accuracy undertaken in six villages, documenting mapping errors and land parcel changes. Descriptive analyses of 5.1% (n = 455) of land parcels highlighted some discrepancies in position (6.4%) and attribute (4.2%) accuracy, and land parcel changes (17.4%). Furthermore, the evaluation led to a refinement of the existing geospatial health platform incorporating ground-truthed reflections from the participatory field exercise. The evaluation of geospatial data accuracies contributes to understandings on global public health surveillance systems, outlining the need to systematically consider assessment of environmental features in relation to lifestyle-related diseases.

Study of human allergic milk whey protein from different mammalian species using computational method.

Nowadays, safety and quality assessment of food used for human consumption have to consider by its possible contribution to the maintenance or improvement of the consumer's health. Milk is an important food with many nutrients. Cow milk is an important source of energy, protein, vitamins and minerals for the growing child as well as adults. But, numerous cow milk proteins have been implicated in allergic responses and most of these have been shown to contain multiple allergic epitopes. The present study disclosed best alternatives to cow milk, which are not allergic and as good as cow milk in nutritional value. The in silico analysis of casein (alpha s1, alpha s2, beta and kappa) and beta-lactoglobulin, unveils that sheep milk is a more suitable alternate to cow milk for allergic infants and buffalo milk for allergic adult humans.

Cognitive load and task condition in event- and time-based prospective memory: an experimental investigation.

Prospective memory is memory for the realization of delayed intention. Researchers distinguish 2 kinds of prospective memory: event- and time-based (G. O. Einstein & M. A. McDaniel, 1990). Taking that distinction into account, the present authors explored participants' comparative performance under event- and time-based tasks. In an experimental study of 80 participants, the authors investigated the roles of cognitive load and task condition in prospective memory. Cognitive load (low vs. high) and task condition (event- vs. time-based task) were the independent variables. Accuracy in prospective memory was the dependent variable. Results showed significant differential effects under event- and time-based tasks. However, the effect of cognitive load was more detrimental in time-based prospective memory. Results also revealed that time monitoring is critical in successful performance of time estimation and so in time-based prospective memory. Similarly, participants' better performance on the event-based prospective memory task showed that they acted on the basis of environment cues. Event-based prospective memory was environmentally cued; time-based prospective memory required self-initiation.