Culturally Centering the Voices of Transgender Sex Workers in Singapore: Health, Materiality and Violence.

The transgender sex worker experience of health in Singapore is multidimensional, working at the intersections of culture, social class, and gendered marginalization. Drawing on in-depth interviews with transgender sex workers in the context of Singapore's extreme neoliberalism and located within a larger culture-centered intervention that emerged through an academic-activist-community partnership, this study foregrounds the everyday meanings of health among transgender sex workers who are marginalized. We offer a discursive register for theorizing violence as disruption of health. Participants narrate health as the negotiation of stigmas coded into their everyday lives, the forms of material violence they experience, and the struggles with accessing secure housing. The theorizing of violence as threat to health by transgender sex workers shapes the health advocacy and health activism that takes the form of a 360 degrees campaign. This essay pushes the literature on the culture-centered approach (CCA) by centering voice as the basis for structurally transformative articulations amidst neoliberal authoritarianism.

Decolonizing Impact Through the Culture-Centered Approach to Health Communication: Mobilizing Communities to Transform the Structural Determinants of Health.

In this issue, we outline the central tenets of the culture-centered approach to health communication. What does the culture-centered approach address when suggesting the co-creation of voice infrastructures? What is the theory's methodological emphasis for mobilizing and transforming structures that shape health inequalities for communities at the margins? Drawing on examples of culture-centered interventions in over fifty communities spread across 17 countries and three continents, a large number of them housed under the umbrella of the Center for Culture-centered Approach to Research and Evaluation (CARE) at Massey University in Aotearoa, New Zealand, we articulate the communicative processes (referring to actionable sources and targets of communicative action) that shape the building of voice infrastructures mobilizing toward structural transformation. For instance, African American communities organizing under the framework of the culture-centered approach, documented in Dutta, Collins, and colleagues study in 2019, discuss the building of voice infrastructures where community members participate in co-creating heart health information based on comparative effectiveness research, building an African American media ecosystem disseminating the information alongside community-led initiatives growing healthy food, community-led youth activities, and activism addressing the racist structural drivers that adversely impact African American heart health. In this essay, we describe the impact of culture-centered interventions reflected in the voice infrastructures within communities that witness and articulate the oppressions that threaten human health at the margins and in the transformations of these structures that organize various facets of life and livelihood at the global margins linked to health.

Situating Health Experiences: A Culture-Centered Interrogation.

Culture-centered studies of health communication de-center the theorization of health as an individual behavior and reveal the structural conditions that shape inequalities in health outcomes. The present study examines the ways in which space and housing shape experiences of health in a low-income site in Auckland undergoing radical redevelopment. We draw from a culture-centered project undertaken in 2018-2021 predominantly among Maori and Pasifika peoples involving 60 initial in-depth interviews, seven focus groups, a series of filmed interviews, and 32 additional in-depth interviews conducted during the COVID-19 pandemic. The residents' narratives foregrounded the detrimental health impact of inadequate housing, financial constraints, transience, and displacement that severs ties to place and community. These findings reveal the relationship between housing challenges, economic marginalization, and neoliberal capitalism, highlighting the need for policy interventions to address housing as a fundamental determinant of health disparities among marginalized communities.

Prevalence of cardiac abnormalities and heart failure in unselected out-patients with type 2 diabetes mellitus and associated clinical factors: Real-world evidence from an Indian registry.

OBJECTIVE: Type 2 diabetes mellitus (T2DM) is known to be associated with development of left ventricular (LV) dysfunction and heart failure (HF). The study aimed to determine the prevalence of LV dysfunction and HF in unselected out-patients with T2DM with no previous cardiac history and to correlate LV dysfunction and HF with demographic and comorbid characteristics. METHODS: This cross-sectional study conducted at 27 centers in India captured demographic and clinical data through electronic case record forms. B-type natriuretic peptide of >105 pg/mL was used to diagnose HF and two-dimensional echocardiography was used to assess LV dysfunction. RESULTS: Of the 615 patients, 54.3 % (n = 334) were males; mean age was 57.4 ± 10.48 years. More than one-third of the patients had T2DM duration of >10 years (n = 238; 38.7 %), with hypertension as the most prevalent comorbidity (n = 372, 78.6 %). Approximately 61.3 % of the patients had LV hypertrophy. The mean LV mass was 135.0 ± 56.16 g (95 % CI 130.28, 139.70). The prevalence of any type of LV dysfunction, including systolic or diastolic dysfunction and HF was 55 % (95 % CI 51.0, 59.0) and 10 % (95 % CI 7.0, 12.0), respectively. A negligible but statistically significant correlation was observed between LV dysfunction and T2DM duration (p = 0.011), alongside HF and age (p < 0.0001). CONCLUSION: Real-world data from this registry from India demonstrates a substantial burden of LV dysfunction and HF in individuals with T2DM in India. It is imperative to formulate strategies for early identification of LV dysfunction in individuals with T2DM for prevention and consequent management of HF.

Bempedoic Acid for Lipid Management in the Indian Population: An Expert Opinion.

Lipid-lowering is a central theme in the management of patients with atherosclerotic cardiovascular disease (ASCVD) and heterozygous familial hypercholesterolemia (HeFH), with statins being currently used as the first-line lipid-lowering agent (LLAs). Bempedoic acid (BA) has been recently approved for lipid management in ASCVD/HeFH patients. This expert opinion paper brings out the essential concept to assess the current place of BA in the Indian population. Here we highlight that the majority of the patients with clinical ASCVD may not be receiving the optimal dose of statin, thereby failing to achieve their lipid targets. The addition of BA to statin results in a significant reduction in low-density lipoprotein cholesterol (LDL-C) along with substantial reductions in non-high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein B (ApoB), and high-sensitivity C-reactive protein (hsCRP) levels. For patients who do not achieve LDL-C targets, BA can be an effective add-on alternative to choose among non-statin LLAs. BA is a good choice for statin-intolerant cases, especially in combination with ezetimibe. Given the lack of effect of worsening hyperglycemia or any increase in the occurrence of new-onset diabetes, BA can be used without hesitation in patients with diabetes. The small risk of hyperuricemia could be mitigated with appropriate patient selection and monitoring of serum uric acid levels in patients at high risk of hyperuricemia. We believe BA is an excellent non-statin therapy that is efficacious, well-tolerated, and cost-effective for lipid management in ASCVD, HeFH, and statin-intolerant patients in India.

Expert Consensus on Ivabradine-based Therapy for Heart Rate Management in Chronic Coronary Syndrome and Heart Failure with Reduced Ejection Fraction in India.

Heart rate is an important indicator of health and disease and the modulation of heart rate can help to improve cardiovascular outcomes. Besides ß-blockers, Ivabradine is a wellestablished heart rate modulating drug that reduces heart rate without any hemodynamic effects. This consensus document was developed with the help of expert opinions from cardiologists across India on effective heart rate management in routine clinical practice and choosing an appropriate Ivabradine-based therapy considering the available scientific data and guideline recommendations. Based on the discussion during the meetings, increased heart rate was recognized as a significant predictor of adverse cardiovascular outcomes among patients with chronic coronary syndromes and heart failure with reduced ejection fraction making heart rate modulation important in these subsets. Ivabradine is indicated in the management of chronic coronary syndromes and heart failure with reduced ejection fraction for patients in whom heart rate targets cannot be achieved despite guideline-directed ß-blocker dosing or having contraindication/intolerance to ß-blockers. A prolonged release once-daily dosage of Ivabradine can be considered in patients already stabilized on Ivabradine twice-daily. Ivabradine/ß-blocker fixed-dose combination can also be considered to reduce pill burden. Two consensus algorithms have been developed for further guidance on the appropriate usage of Ivabradine-based therapies. Ivabradine and ß-blockers can provide more pronounced clinical improvement in most chronic coronary syndromes and heart failure with reduced ejection fraction patients with a fixed-dose combination providing an opportunity to improve adherence.

The United Nations (UN) Card, Identity, and Negotiations of Health among Rohingya Refugees.

Being persecuted and expelled from Myanmar, Rohingya refugees are now distributed throughout the world. The Southeast Asian nation of Malaysia has been a preferred destination for Rohingyas fleeing Myanmar's state-sponsored genocide and more recently in a bid to change their fates from the refugee camps in Bangladesh. Refugees are one of the most vulnerable groups in Malaysia and often face dire circumstances, in which their health and wellbeing are compromised. Amidst a plethora of structural challenges, Rohingya refugees try to claim some of their rights with the aid of the UN card (UNHCR ID cards) in Malaysia. Guided by the culture-centered approach (CCA), this study examined the perspectives and experiences of healthcare among Rohingya refugees while living in Malaysia, now resettled in Aotearoa, New Zealand. The participants' narratives showed that the UN card not only materialized their refugee status in Malaysia but also offered them a way of living in a world where documents anchor the materiality of health.

Health Orientation as a Psychographic Framework for Understanding Physical Exercise Behavior.

The consistent association between regular physical exercise and positive health outcomes presents a compelling case for investigating the differences between individuals who exercise regularly and those who do not. Based on a randomized cross-sectional survey of 1,201 households, this study adopts a psychographic framework to investigate the role of health orientation in physical exercise behavior. This study extends the concept of health orientation, operationalized as five psychographic subscales (health information orientation, preventative orientation, exercise orientation, healthy eating orientation, and health information efficacy) as well as three behavioral constructs (sedentary behavior, BMI and cigarette smoking) to understand physical exercise behavior. The results show significant differences between regular exercisers and non-exercisers, and suggest that a psychographic framework based on health orientation could offer a more holistic approach for understanding physical exercise behavior by highlighting the treatment of the whole individual. Physical exercise, as a specific health behavior, is in fact interlinked with other health behaviors through an underlying health orientation toward health issues in general.

Clinical relevance of double-arm blood pressure measurement and prevalence of clinically important inter-arm blood pressure differences in Indian Primary Care.

Hypertension guidelines recommend measuring blood pressure (BP) in both arms at least once. However, this is seldom done due to uncertainties regarding measurement procedure and the implications of finding a clinically important inter-arm BP difference (IAD). This study aimed to provide insight into the prevalence of clinically important IADs in a large Indian primary care cohort. A number of 134678 (37% female) unselected Indian primary care participants, mean age 45.2 (SD 11.9) years, had BP measured in both arms using a standardized, triplicate, automated simultaneous measurement method (Microlife WatchBP Office Afib). On average, there were clinically minor differences in right and left arm BP values: systolic BP 134.4 vs. 134.2 mmHg (p<0.01) and diastolic BP 82.7 vs. 82.6 mmHg (p<0.01), respectively. Prevalence of significant mean systolic IAD between 10 and 15 mmHg was 7813 (5.8%). Systolic IAD ≥ 15 mmHg 2980 (2.2%) and diastolic IAD ≥ 10 mmHg 7151 (5.3%). In total, there were 7595 (5.6%) and 8548 (6.3%) participants with BP above the 140/90 mmHg threshold in only the left or right arm, respectively. Prevalence of participants with elevated BP on one arm only was highest in patients with a systolic IAD ≥ 15 mmHg; 19.1% and 13.7%, for left and right arm, respectively. This study shows that a substantial prevalence of IAD exist in Indian primary care patients. BP is above the diagnostic threshold for hypertension in one arm only for 6% of participants. These findings emphasise the importance of undertaking bilateral BP measurement in routine clinical practice. This article is protected by copyright. All rights reserved.

Seroconversion of COVID-19 in Frontline Healthcare Workers in a Tertiary Care Hospital in Oman.

Objectives: This research aimed to study the seroconversion among frontline staff at the highest risk of exposure to SARS-CoV-2 infections, including emergency department, critical care, and COVID-19 isolation wards in all healthcare job categories. Methods: We conducted a prospective cohort study on the incidence of seroconversion among frontline health care workers (HCWs) at the Royal Hospital, Muscat, Oman. Two sera were collected 12 weeks apart to look for seroconversion. We used proportions with 95% confidence interval (CI) for categorical data and mean/median as appropriate for continuous data. Results: Fourteen out of 328 HCWs seroconverted in this study accounting for an incidence rate of 3.6%, excluding four HCWs that were positive at baseline. The median age was 43.5 (range = 28-57). About 75.0% of HCWs were between 31-49 years old, with a seroconversion rate of 4.9% (95% CI: 2.7-8.1). Females accounted for most seroconverted HCWs (14/257) at a rate of 5.4% (95% CI: 3.1-8.8). Omanis seroconverted with a rate of 6.4% (95% CI 2.6-12.8), whereas non-Omanis seroconverted at a rate 4.3% (95% CI: 2.2-7.5). Ninety-two percent (302/328) of the staff lived in the capital area, and a minority lived outside the capital (3/26). Thirteen Muscat citizens seroconverted at a rate of 4.3% (95% CI: 2.4-7.1). Nurses comprised the majority (accounting for about 81%) followed by doctors (19%) at rates of 5.6% (95% CI: 3.2-9.2) and 4.2% (95% CI: 1.07-10.9), respectively. Staff covering COVID-19 isolation wards and intensive care unit comprised over 60% (n = 10) of those who seroconverted with a rate of 5.4% (95% CI: 2.8-9.5) followed by infectious diseases doctors and adult emergency at 19.0% (n = 3) and 12.5% (n = 1), respectively. Approximately 81.3% (n = 13) of HCWs performed aerosol-generating procedures at a seroconversion rate of 4.3% (95% CI: 2.4-7.1). About 50.0% of those who seroconverted had a positive polymerase chain reaction (PCR) before seroconversion, 25.0% had a negative PCR before second serology testing, and 25.0% were not tested with PCR. Approximately 20.0% of seroconverted staff had no reported symptoms compared to 80.0% who reported symptoms such as sore throat (70.0%), fever (50.0%), myalgia (20.0%), and a less frequency (15.0%) runny nose, loss of smell, and headache. Conclusions: Detection of infection among HCWs is important to prevent further transmission, especially asymptomatic carriers. A combined screening strategy of symptoms, serology, and PCR might help detect potential infections and asymptomatic carriage.

Receiving Healthcare Amidst Poverty During the COVID-19 Lockdowns: A Culture-Centered Interrogation.

COVID-19 has exacerbated existing health inequalities globally. Guided by the culture-centered approach, this study examined perspectives and experiences of healthcare during two lockdowns in four marginalized contexts in Aotearoa New Zealand. The participants' narratives depicted dissatisfaction with the new modes of healthcare delivery, reporting longer waiting times, a preference for face-to-face delivery, language barriers, and issues with the limitations in support people attending appointments. This resulted in healthcare being delivered in a way that was not in keeping with the localized cultural norms of communication and collective support, further exacerbating existing health inequalities. Our findings suggest that public health interventions in response to COVID-19 within the context of healthcare delivery have the potential to further reify and reproduce exclusions and experiences of marginalization, with cultural marginalization reifying structural marginalization.

Clinical relevance of double-arm blood pressure measurement and prevalence of clinically important inter-arm blood pressure differences in Indian primary care.

Hypertension guidelines recommend measuring blood pressure (BP) in both arms at least once. However, this is seldom done due to uncertainties regarding measurement procedure and the implications of finding a clinically important inter-arm BP difference (IAD). This study aimed to provide insight into the prevalence of clinically important IADs in a large Indian primary care cohort. A number of 134 678 (37% female) unselected Indian primary care participants, mean age 45.2 (SD 11.9) years, had BP measured in both arms using a standardized, triplicate, automated simultaneous measurement method (Microlife WatchBP Office Afib). On average, there were clinically minor differences in right and left arm BP values: systolic BP 134.4 vs 134.2 mmHg (p < .01) and diastolic BP 82.7 vs 82.6 mmHg (p < .01), respectively. Prevalence of significant mean systolic IAD between 10 and 15 mmHg was 7,813 (5.8%). Systolic IAD ≥ 15 mmHg 2,980 (2.2%) and diastolic IAD ≥ 10 mmHg 7,151 (5.3%). In total, there were 7,595 (5.6%) and 8,548 (6.3%) participants with BP above the 140/90 mmHg threshold in only the left or right arm, respectively. Prevalence of participants with elevated BP on one arm only was highest in patients with a systolic IAD ≥ 15 mmHg; 19.1% and 13.7%, for left and right arm, respectively. This study shows that a substantial prevalence of IAD exists in Indian primary care patients. BP is above the diagnostic threshold for hypertension in one arm only for 6% of participants. These findings emphasize the importance of undertaking bilateral BP measurement in routine clinical practice.

Evaluation of Effectiveness and Tolerability of Fondaparinux in the Management of Symptomatic Acute Coronary Syndrome: A Real-World Evidence-Based Study on an Indian Population.

INTRODUCTION: Fondaparinux is a low molecular weight heparin anticoagulant used to manage the full spectrum of acute coronary syndrome (ACS) patients and has proved its efficacy and safety in multiple clinical trials. However, there are limited data available showing whether the same results could be reproduced in real-world practice on an Indian population. Our objective was to determine the effectiveness and tolerability of fondaparinux in the management of symptomatic ACS in real-world clinical practice. METHODS: The EMR data of hospitalized ACS patients (n = 611), from January 2015 to January 2020, representing UA or NSTEMI or STEMI and were prescribed fondaparinux (2.5 mg once daily) to manage ACS were analyzed. The effectiveness was analyzed as recurrence of ACS and tolerability as total incidence of major bleeding during hospitalization, at 30 days and 180 days. Appropriate statistical analysis was used with a statistically significance of p value < 0.05. RESULTS: The incidence of recurrent ACS was not seen during hospitalization and in the first 30 days, while in only 0.65% (n = 4) patients, ACS reoccurred within 180 days. In a mean duration of 172.75 ± 3.20 days, UA was reported in 0.49% (n = 3) patients, NSTEMI in 0.16% (n = 1) of patients, and STEMI was not documented. None of the major bleeding events occurred during the entire study period, whereas minor bleeding events were reported during hospitalization 0.98% (n = 6) and at 30 days 0.16% (n = 1). The bleeding events were statistically insignificant (p value > 0.05). No incidences of stent thrombosis were reported during the entire study period. CONCLUSIONS: In the real world, fondaparinux was found to be effective and tolerable when used to manage symptomatic ACS patients regardless of revascularization procedure with no incidence of stent thrombosis, and minimal recurrent ACS and insignificant increase in bleeding events.

Droplet-based lab-on-chip platform integrated with laser ablated graphene heaters to synthesize gold nanoparticles for electrochemical sensing and fuel cell applications.

Controlled, stable and uniform temperature environment with quick response are crucial needs for many lab-on-chip (LOC) applications requiring thermal management. Laser Induced Graphene (LIG) heater is one such mechanism capable of maintaining a wide range of steady state temperature. LIG heaters are thin, flexible, and inexpensive and can be fabricated easily in different geometric configurations. In this perspective, herein, the electro-thermal performance of the LIG heater has been examined for different laser power values and scanning speeds. The experimented laser ablated patterns exhibited varying electrical conductivity corresponding to different combinations of power and speed of the laser. The conductivity of the pattern can be tailored by tuning the parameters which exhibit, a wide range of temperatures making them suitable for diverse lab-on-chip applications. A maximum temperature of 589 °C was observed for a combination of 15% laser power and 5.5% scanning speed. A LOC platform was realized by integrating the developed LIG heaters with a droplet-based microfluidic device. The performance of this LOC platform was analyzed for effective use of LIG heaters to synthesize Gold nanoparticles (GNP). Finally, the functionality of the synthesized GNPs was validated by utilizing them as catalyst in enzymatic glucose biofuel cell and in electrochemical applications.

Negotiating Health Amidst COVID-19 Lockdown in Low-income Communities in Aotearoa New Zealand.

Aotearoa New Zealand's public health crisis communication approach amidst the COVID-19 pandemic effectively mobilized the nation into swift lockdown, significantly reducing community transmission. This communication approach has been applauded around the world. How did communities situated amongst the "margins of the margins" in Aotearoa New Zealand navigate through the existing structural barriers to health during the pandemic? In this study, we use a culture-centered analysis to foreground the structural context of disenfranchisement amidst the COVID-19 lockdown. Drawing on in-depth interviews with participants in a larger ethnographic project on poverty and health across three communities in Aotearoa New Zealand, we attend to the ways in which health is negotiated amidst the COVID-19 outbreak and lockdown response at the "margins of the margins." The narratives point out that health communication interventions to prevent COVID-19 in the context of Aotearoa New Zealand furthered the marginalization of communities at the margins, and community voices were largely erased from the enactment of interventions. With the extant structures failing to recognize these aspects of everyday struggles of health at the margins, the health and access challenges were further magnified during COVID-19. Our attention to communication situated in relationship to structures builds a register for health communication scholarship in the context of COVID-19 that is committed to disrupting the behaviorally based hegemonic health communication literature and transforming the unequal terrains of health experiences.

Fine-needle aspiration of pancreatic cystic lesions: a randomized study with long-term follow-up comparing standard and flexible needles.

BACKGROUND: Pancreatic cystic lesions (PCLs) are increasingly found on cross-sectional imaging, with the majority having a low risk for malignancy. The added value of fine-needle aspiration (FNA) in risk stratification remains unclear. We evaluated the impact of three FNA needles on diagnostic accuracy, clinical management, and the ability to accrue fluid for tumor markers. METHODS: A multicenter prospective trial randomized 250 patients with PCLs ≥ 13 mm 2:1:1 to 19G Flex, 19G, and 22G needles with crossover for repeated FNA procedures. Diagnostic accuracy was established at 2-year follow-up, with the final diagnosis from surgical histopathology or consensus diagnosis by experts based sequentially on clinical presentation, imaging, and aspirate analysis in blinded review. RESULTS: Enrolled patients (36 % symptomatic) had PCLs in the head (44 %), body (28 %), and tail (26 %). Percentage of cyst volume aspirated was 78 % (72 % - 84 %) for 19G Flex, 74 % (64 % - 84 %) for 22G, and 73 % (63 % - 83 %) for 19G (P = 0.84). Successful FNA was significantly higher for 19G Flex (89 % [82 % - 94 %]) and 22G (82 % [70 % - 90 %]) compared with 19G (75 % [63 % - 85 %]) (P = 0.02). Repeated FNA was required more frequently in head/uncinate lesions than in body and tail (P < 0.01). Diagnostic accuracy of the cyst aspirate was 84 % (73 % - 91 %) against histopathology at 2-year follow-up (n = 79), and 77 % (70 % - 83 %) against consensus diagnosis among nonsurgical cases (n = 171). Related serious adverse events occurred in 1.2 % (0.2 % - 3.5 %) of patients. CONCLUSIONS: Our study results demonstrate a statistically significant difference among the three needles in the overall success rate for aspiration, but not in the percentage of cyst volume aspirated. Flexible needles may be particularly valuable in sampling cystic PCLs in the pancreatic head/uncinate process.