Eco-safe composite edible coating of hydrocolloids with papaya leaf extract improves postharvest quality and shelf life of papaya fruit under ambient storage

Papaya postharvest management using low-temperature storage is discouraged as it is a tropical fruit. Extensive research is going on to preserve papaya quality at ambient storage using edible coatings and its composites. The present investigation examined the effects of an eco-safe composite edible coating consisting of hydrocolloid carboxymethyl cellulose (CMC) (1%), guar gum (1.5%), xanthan gum (0.3%), and Gum Arabic (10%) combined with papaya leaf extract (PLE) (1:1 ratio by volume) applied as dip treatment on "Red Lady" papaya fruit at ambient storage condition. Among all the attempted treatments, "PLE incorporated with CMC (1%)" was found to be the best, as the treated fruit exhibited the highest levels of biochemicals, whereas the lowest levels of physiological and enzymatic activity, which positively affected the shelf life. The "CMC + PLE" treatment enhanced the fruit gloss score by 70.1%, phenolics by 6.1%, ascorbic acid by 22.3%, total carotenoid content by 7.4%, and fruit predilection score by 22.0% over the control fruit. However, it lowered (controlling) the physiological loss in weight by 51.0%, decay incidence by 66.6%, and polygalacturonase and pectin methylesterase activity by 24.92% and 35.29%, respectively, over control. Moreover, this treatment exhibited the highest fruit purchase predilection score and prolonged the storage life for >3 days on the physiological loss standard basis (≤10%). This study indicates that "CMC (1%) with PLE (1:1)" composite coating application on papaya under ambient conditions might be an effective, environmentally friendly, and health-friendly way to retain the quality and extend the storage life.

Does club convergence matter in health outcomes? Evidence from Indian states

BACKGROUND

Population health is vital to a nation's overall well-being and development. To achieve sustainable human development, a reduction in health inequalities and an increase in interstate convergence in health indicators is necessary. Evaluation of the convergence patterns can aid the government in monitoring the health progress across the Indian states. This study investigates the progressive changes in the convergence and divergence patterns in health status across major states of India from 1990 to 2018.

METHODS

Sigma plots (σ), kernel density plots, and log t-test methods are used to test the convergence, divergence, and club convergence patterns in the health indicators at the state level.

RESULTS

The result of the sigma convergence suggests that life expectancy at birth has converged across all states. After 2006, however, the infant mortality rate, neonatal mortality rate, and total fertility rate experienced a divergence pattern. The study's findings indicate that life expectancy at birth converges in the same direction across all states, falling into the same club (Club One). However, considerable cross-state variations and evidence of clubs' convergence and divergence are observed in the domains of infant mortality rate, neonatal death rate, and total fertility rate. As suggested by the kernel density estimates, life expectancy at birth stratifies, polarizes, and becomes unimodal over time, although with a single stable state. A bimodal distribution was found for infant, neonatal, and total fertility rates.

CONCLUSIONS

Therefore, healthcare strategies must consider each club's transition path while focusing on divergence states to reduce health variations and improve health outcomes for each group of individuals.

Identifying the impact of social isolation and loneliness on psychological well-being among the elderly in old-age homes of India: the mediating role of gender, marital status, and education

BACKGROUND

Social isolation and loneliness can be detrimental to the overall functioning of the older adults. The study examines the impact of social isolation and loneliness on the psychological well-being of older adults residing in various old-age homes in India and investigates the mediating role of gender, marital status, and education level in the way social isolation and loneliness affect psychological well-being.

METHODS

Data has been collected from 320 individuals aged sixty years or above. Data were collected using standardized measures like Lubben Social Network Scale- 6, revised UCLA Loneliness Scale, and shortened version of psychological well-being scale by Ryff & Keyes (1995). Multivariate and mediation analysis were performed to understand the associations of social isolation and loneliness with psychological well-being.

RESULTS

A statistically significant MANOVA effect was obtained for social isolation (F = 3.836, p < .01), and loneliness (F = 3.782, p < .01). Gender and education as independent factors were significantly associated with the psychological well-being of individuals. However, both gender and education did not mediate the impact of social isolation and loneliness on the psychological well-being of older adults. Further, marital status had a partial mediating effect on the relationship between social isolation, loneliness, and psychological well-being.

CONCLUSIONS

The findings of the study can be incorporated into measures aiming at alleviation of feelings of social isolation and loneliness among the elderly. Further, the findings can be used to design various intervention strategies aimed at the reduction of social isolation and loneliness among older adults and the restoration of their psychological well-being.

Assessing reduction in multidimensional childhood poverty in India: a decomposition analysis

BACKGROUND

Empirically, the official measurement of multidimensional poverty often shows children as the poorest age group. According to Global Multidimensional Poverty Index report, Africa and South Asia bear the highest burden multidimensional child poverty (MCP). Around one-third of children aged 0-4 are multidimensionally poor in India. Policymakers in India must have appropriate information on child poverty to alleviate poverty. The purpose of this paper is to examine MCP trends and track efforts to reduce child poverty at the national level across geographic regions, castes, and religious groups.

METHODS

We used the Alkire-Foster method to calculate the MCP index (MCPI) among children aged 0-4 using the latest two rounds of National Family Health Survey data (2015-16 and 2019-21). We applied the Shapley decomposition method to analyse the marginal contribution of incidence and intensity that lead to changes in MCPI.

RESULTS

In India, the incidence of child poverty reduced by more than 40% between 2015-16 and 2019-21 (46.6-27.4%) and the MCPI reduced by half (24.2-12.6%). The relative decline in MCPI has been largest for urban areas, northern regions, Other Backward Classes (OBCs) and Hindus. Children from rural areas, Scheduled Castes (SCs), Scheduled Tribes (STs), and Muslim households are the poor performers. When focusing exclusively on the poor child, we found all the population subgroups and geographic locations reduced the censored headcount ratios in all 14 indicators. Across places of residence, castes, religions, and regions the, indicators like electricity, birth registration, drinking water, assisted delivery, sanitation and cooking fuel made significant improvements between 2015-16 to 2019-21.

CONCLUSION

The study indicates that by studying the MCPI over time, one can identify the priorities in policy development to achieve the Sustainable Development Goals.

Impact of social isolation and leisure activities on cognition and depression: A study on middle-aged and older adults in India

INTRODUCTION

Recent studies highlight the negative impact of social isolation and involvement in leisure activities on enhanced well-being of individuals. However, there is dearth of evidence on relationship between social isolation and leisure activities on cognitive abilities and depression of older adults in the Indian context. The paper reports the impact of social isolation and leisure activities on cognitive functioning and depression of older adults.

METHODS

Data were collected from the Longitudinal Ageing Study of India (LASI), and 63,806 participants aged 45 years or above were considered for the study with adherence to the exclusion criteria. Multivariate analysis was carried out to analyse the group-based differences.

RESULTS

Social isolation (F = 102.09, p < 0.01; η²  = 0.09) and leisure (F = 224.54, p < 0.01; η²  = 0.07) had a statistically significant impact on the cognition and depressive symptoms of participants. Socially isolated older adults with little involvement in leisure activities had the worst cognitive functioning (M = 32.76, SD = 4.41), whereas middle-aged adults who were actively involved in leisure activities and experienced the least social isolation exhibited the best cognitive functioning (M = 32.76, SD = 4.41). However, leisure and age as independent factors did not have a significant impact on depression.

CONCLUSION

Socially isolated participants, irrespective of age, and involvement in leisure activities exhibit poor cognitive functioning and are more likely to suffer from depression as compared to their counterparts. The findings of the study can be used to design intervention strategies aimed at reducing social isolation by incorporating leisure activities to ensure the optimal functioning of middle-aged and older adults.

Living arrangement of Indian elderly: a predominant predictor of their level of life satisfaction

OBJECTIVE

This article aims to examine the level of life satisfaction (LS) among Indian older adults and to determine whether their living arrangement is one of the potential determinants of their level of LS.

METHODS

Data was drawn from the first and most recent wave of Longitudinal Ageing Study in India conducted in 2017-18. Using the Satisfaction with Life Scale, the level of LS was assessed for 30,370 elderly aged 60 + . Bivariate analysis was carried out to see the variation in the level of LS across elderlies with different socio-demographic characteristics. To investigate the association between LS and living arrangements and the selected socio-demographic factors multinomial logistic regression model was fitted.

RESULT

The findings reveal that 25.4% and 45.5% of the elderlies have reported having a low and high level of LS, respectively. Living alone was associated with low level of LS. Co-residing with a spouse was associated with a higher likelihood of reporting high level of LS. The study also found that having both spouse and children as coresident increases the likelihood of reporting high level of LS (RRR = 3.15, 95%CI = 2.3-4.28). Elderly with self-reported poor health, limitation in more than two activities of daily living and presence of depressive symptoms were significantly associated with reporting low level of LS. However, being diagnosed with more than three chronic illnesses was associated with high level of LS (RRR = 1.41, 95%CI = 1.25-1.59). Older adults with the following characteristics were more likely to report a lower level of LS: male, 60-64 years old, no or few years of schooling, unmarried, working, rural resident, living in a poor household, Scheduled Caste and Tribe.

CONCLUSION

The level of life satisfaction in Indian older adults is significantly associated with their living arrangements, thus suggesting that the LS of older adults could be facilitated through interventions that consider their living arrangements. Older adults with various personal and household characteristics were identified as vulnerable groups, who should be the prime targets of the existing welfare policies.

Does club convergence matter? Empirical evidence on inequality in the human development index among Indian states

The Human Development Index (HDI) is recognised as the most commonly used composite index to assess the socio-economic progress of a country. To preserve its pioneering role in development, there has to be a reduction in inequalities and cross-state convergence by adding a sustainable dimension. This paper investigates the convergence hypothesis for the HDI in 36 Indian states and union territories (UTs) from 1990 to 2019. For that purpose, the study used the club convergence technique of Phillips and Sul (2007) and Kernel Density estimates to assess whether states converge towards a single steady-state equilibrium or multiple groups. The paper also considers the relative performance of Indian states and UTs and the comprehension of inter-regional inequality in the HDI by employing the Gini and Theil indices. Using the Phillips and Sul technique, the results reveal that all the states converged into two final clubs (i.e., Club 1 and Club 2). The rate of convergence of HDI is approximately 0.112% for club 1 and 1.135% for club 2. The findings indicate that states with the lowest HDI converge faster than those with higher HDI. The kernel density estimates demonstrate that HDI stratifies, polarises, and becomes unimodal over time, albeit with a common steady state. Further, the Gini and Theil indices suggest a significant decline trend in HDI inequality across the Indian states and UTs from 1990 to 2019. From a policy perspective, the study recommends promoting regional development and reducing inequality, considering the unique convergence paths of the clustering states. The study's findings could provide the government with a new perspective on attaining "horizontal equity" in HDI across Indian states and UTs.

A combination of moderate and vigorous physical activities reduces the burden of multimorbidity: findings from Longitudinal Ageing Study in India

Background

Physical inactivity is a significant factor contributing to the prevalence of non-communicable diseases (NCDs). The objective of this study is to examine the association between physical activity and multimorbidity among Indian adults aged 45 years and above by residence.

Methods

Data from Longitudinal Ageing Study in India (LASI) 2017–2018, wave 1, a nationally representative study, are used to examine the above objective. A total of 59,073 adults aged 45 years and above are enlisted in the study. Physical activities and other demographic and socioeconomic variables have been used to describe the distribution of multimorbidity and investigate their relationship. Logistic regression is employed to examine the adjusted impact of physical activity on multimorbidity among Indian adults (45 + years) by residence.

Results

The level of physical activity is inversely related to the prevalence of multimorbidity in India. The rate of multimorbidity ranges from 4 to 12% among moderately active individuals in rural areas, whereas it ranges from 9 to 34% in urban areas across the age groups of 45 to 75+ years. Notably, the individuals who engage in both moderate and vigorous activities have a lower prevalence of multimorbidity than those who engage in only moderate activities.

Conclusion

Our study shows that physical inactivity has an association with the rise in multimorbidity in both rural and urban areas; however, the intensity of multimorbidity is higher in urban areas. The policymakers should consider the influence of moderate and vigorous physical activity as a key prevention measure of non-communicable disease and multimorbidity.

Food Insecurity and Malnutrition among Indian Older Adults: Findings from Longitudinal Ageing Study in India, 2017-18

The study aims to assess the prevalence of food insecurity and malnutrition and to investigate the association between food insecurity, sociodemographic characteristics, and malnutrition among Indian older adults. Data for 28,004 older adults (60 + years) was extracted from Wave-1 of the Longitudinal Aging Study in India, 2017-18. Bivariate analysis was used for prevalence estimates. Multinomial logistic regression provided relative risk ratios (RRR) to determine the association. About 45% of older adults were food insecure and nearly half were malnourished (underweight - 26.7%, overweight - 22.2%). Overweight was widespread in southern, western, and northern India, while underweight and food insecurity were widespread in central, eastern, and north-eastern India. Food insecure older adults were significantly more likely to be underweight (mild: RRR = 1.105, 95% CI = 1.038-1.176; severe: RRR = 1.327, 95% CI = 1.186-1.485). Rather than severe food insecurity, those with moderate food insecurity have the least likelihood of being overweight. Being the oldest, male, widowed, divorced/separated/deserted, having fewer years of schooling, living in a ST or SC household, and in rural areawere associated with higher risk of being underweight; while their other counterparts were of being overweight. No association was found between working status and underweight, meanwhile the non-working older adults were less likely to be overweight (RRR = 0.804, 95% CI = 0.744-0.868). Underweight is strongly linked to food insecurity. In terms of food insecurity and malnutrition, the most vulnerable categories identified include oldest old, widowed, divorced/separated/deserted, SC, ST, economically weaker, and persons without or with only a few years of formal education.

Uneven burden of multidimensional poverty in India: A caste based analysis

Poverty is multifaceted. The global poverty profile shows 41% of multidimensionally poor people living in South Asian countries. Though castes and tribes are a more prevalent line of social stratification in India, and their socio-economic characteristics also vary remarkably, hardly any study has explored these dimensions while analysing multidimensional poverty in India. Hence, this study attempts to assess the multidimensional status of poverty among the social groups in India. National Family Health Survey, 2015–16 (NFHS-4) is a source of rich information on 579,698 households’ well-being for this analysis. Alkire- Foster technique was applied to decompose the Multidimensional Poverty Index (M₀) across its dimensions and indicators for all the social groups. Three broad dimensions of deprivation–Health, Education and Standard of Living–include 12 indicators, guided by the poverty literature, data availability and the country’s sustainable Development Goals (SDGs). There were three main findings in this study: (1) Scheduled Tribes (STs) are the most disadvantaged subgroup in India with remarkably high values of headcount (H = 0.444;), intensity (A = 0.486), and M₀ (0.216), followed by Scheduled Castes (SCs) (H = 0.292; A = 0.473; M₀ = 0.138), and Other Backward Classes (OBCs) (H = 0.245; A = 0.465; M₀ = 0.114); and Others category is the most privileged with very low values of H = 0.149, A = 0.463, and M₀ = 0.069; (2) STs contribute nearly twice their population share for both H and M₀, and the SCs contribution is also noticeably higher than their population share; (3) States located in the central and eastern regions of India have the higher H, A and M₀ for all the social groups. This suggests that there is a need for a thorough assessment of poverty at specific levels to uncover the poverty situation in society, improve the effectiveness of evidence-based planning and effective policymaking.

Hospitalization & health expenditure in Odisha: Evidence from National Sample Survey (1995-2014)

Background & objectives

Financing healthcare services through out-of-pocket payments is common in India. Household impoverishments due to health expenditure can be daunting, especially among the economically vulnerable households. This study investigated hospitalization and patient's health expenditure in Odisha State in India.

Methods

The national sample survey data were used to assess hospitalization and patient's health expenditure over two time periods (1995 and 2014). Disease classification was made following International Classification of Diseases 10th revision (ICD-10). The hospitalization rate and health expenditure were estimated for infectious, cardiovascular, non-communicable, disability and other diseases. Andersen model was used to examine the determinants of healthcare expenditure.

Results

Findings of the study revealed that hospitalization in Odisha increased nearly three folds and health expenditure by more than two times between 1995 to 2014. While the hospitalization for other diseases remained consistently higher, health expenditure for disability was the highest and it increased three times within the last two decades. The socio-economic and demographic divides in the hospitalization rate and health expenditure were evident.

Interpretation & conclusions

Our analysis indicated that predisposing factors such as age and marital status played an important role in hospitalization whereas, enabling factors likely determined the health expenditure. There is a need to recognize the unique vulnerabilities of older population, widowed and health financial mechanism for disability-related illness.

Uneven economic burden of non-communicable diseases among Indian households: A comparative analysis

BACKGROUND

Non-communicable diseases (NCDs) are the leading global cause of death and disproportionately concentrate among those living in low-income and middle-income countries. However, its economic impact on households remains less well known in the Indian context. This study aims to assess the economic impact of NCDs in terms of out-of-pocket expenditure (OOPE) and its catastrophic impact on NCDs affected households in India.

MATERIALS AND METHODS

Data were collected from the 75th round of the National Sample Survey Office, Government of India, conducted in the year 2017-18. This is the latest round of data available on health, which constitutes a sample of 113,823 households. The collection of data is based on a stratified multi-stage sampling method. Generalised Linear Regression model was employed to identify the socio-economic covariates associated with the catastrophic health expenditure (CHE) on hospitalisation.

RESULTS

The result shows a higher burden of OOPE on NCDs affected households. The mean expenditure by NCDs households in public hospitals is INR 13,170 which is more than twice as compared to the non-NCDs households INR 6,245. Particularly, the proportion of total medical expenditure incurred on medicines (0.39) and diagnostics (0.15) is troublesome for households with NCDs, treated in public hospitals. Moreover, results from the generalised linear regression model confirm the significant relationship between CHE with residence, caste, religion, household size, and economic status of households. The intensity of CHE is more for the households who are poor, drinking unsafe water, using firewood as cooking fuel, and household size of 1-5 members.

CONCLUSION

Therefore, an urgent need for a prevention strategy should be made by the government to protect households from the economic burden of NCDs. Specifically, to reduce the burden of CHE associated with NCDs, a customised disease-specific health insurance package should be introduced by the government of India in both public and private facilities.

Measuring catastrophe in paying for healthcare: A comparative methodological approach by using National Sample Survey, India

Healthcare expenditure significantly varies among various segments of the population. The appropriate measures of catastrophic health expenditure (CHE) will help to unravel the real burden of spending among households. Present study provides a link between the theoretical insights from Grossman's model and various methodological approaches for the estimation of CHE by using data from the three rounds of nationally representative Consumer Expenditure Surveys, India. Statistical analysis has been carried out by using multivariate logistic regression to identify the major determinants of CHE. Findings indicate that the occurrence of CHE has increased during 1993-2012. Rural residents and households with varying age composition such as with higher numbers of children and elderly were at higher risk. Economic status is significantly associated with CHE and increased demand for healthcare. The measurements differ as per the methodological approaches of CHE and definition of household's capacity to pay. Approach-based variations in the results can be of key importance in determining trends and magnitude in CHE. Despite these variations in measurements, study finds a limited incidence of CHE among the disadvantaged segment of the population though a greater share was devoted to health expenditure in recent years. Better risk pooling mechanism is required to address the healthcare needs of the disadvantaged segment such as elderly, children, poor and rural population in India.

Coronary computed tomography versus stress echocardiography-guided management of stable chest pain patients: a propensity matched analysis

Background

Recent recommendations by national and international societies advocate the use of coronary computed tomography (CCT) as the first-line test for the assessment of low-risk patients with suspected stable angina. However limited real-life data exist regarding its relative clinical value versus stress echocardiography (SE)-guided management.

Purpose

We aimed to assess in a real-life setting the clinical value of stress echocardiography (SE)-guided versus CCT-guided management in patients presenting with stable chest pain and no prior history of coronary artery disease (CAD).

Methods

We compared the relative feasibility, efficacy and the proportion of patients undergoing downstream testing including revascularisation and their impact on outcome (mortality and myocardial infarction) when CCT versus SE were used as the first line test for the assessment of stable chest pain.

Of the patients who underwent CCT (N=2192) or SE (N=2081) between October 2013 and October 2014 only those with suspected stable angina and without previous CAD were selected. The population was propensity-matched (total 1980 patients-990 patients each group) to account for differences in the baseline cardiovascular risk factors.

Results

The mean age of the population was 59±13.2 years and 949 (47.9%) patients were male. Inconclusive tests were 6% versus 3% (p&lt;0.005) in CCT versus SE. Severe (&gt;70%) luminal stenosis on CCT and inducible ischemia on SE detected obstructive CAD by invasive coronary angiography in 63% versus 57% patients (p=0.33). Over the entire follow-up period (median 717 (IQR 93–1069) days) significantly more patients underwent invasive coronary angiography (21.5% versus 7.3%, p&lt;0.005) and revascularisation (33.5% versus 3.5%, p&lt;0.005) respectively in the CCT versus the SE group. Following their initial assessment 336 (33.9%) patients in the CCT and 86 (8.7%) in the SE group underwent further functional testing (SE, stress cardiac MRI, exercise electrocardiography) (p&lt;0.005) (Figure 1A). There was no difference in all-cause mortality (p=0.26) or death and myocardial infarction (p=0.16) between the two groups (Figure 1B).

Conclusions

SE when used for the assessment of patients with stable angina and no prior CAD resulted in more conclusive tests, similar detection of obstructive CAD, less overall invasive coronary angiography and revascularization and less subsequent functional tests compared with CCT.

Figure 1

Funding Acknowledgement

Type of funding source: None

Does affordability matter? Examining the trends and patterns in health care expenditure in India

BACKGROUND

Absence of better financing mechanism results in higher out of pocket expenditure and catastrophe, which leads to impoverishment and poverty especially among low- and middle-income countries like India. This paper examines the major characteristics associated with the higher out of pocket expenditure and provides an insight from Andersen's behavioural model that how predisposing, enabling and need factors influence the level and pattern of out of pocket expenditure in India.

METHODS

Data has been extracted from three rounds of nationally representative consumer expenditure surveys, i.e. 1993-1994, 2004-2005 and 2011-2012 conducted by the Government of India. States were categorized based on regional classification, and adult equivalent scale was used to adjust the household size. Multiple Generalized-Linear-Regression-Model was employed to explore the relative effect of various socio-economic covariates on the level of out of pocket expenditure.

RESULTS

The gap has widened between advantaged and disadvantaged segment of the population along with noticeable regional disparities among Indian states. Generalized-Linear-Regression-Model indicates that the most influential predisposing and enabling factor determining the level of out of pocket expenditure were age composition, religion, social-group, household type, residence, economic status, sources of cooking and lighting arrangements among the households.

CONCLUSIONS

Present study suggests the need for strengthening the affordability mechanism of the households to cope with the excessive burden of health care payments. Furthermore, special consideration is required to accommodate the needs of the elderly, rural, backward states and impoverishment segment of population to reduce the unjust burden of out of pocket expenditure in India.

Reproductive health care status of the displaced tribal women in India: An analysis using Nussbaum Central human capabilities

Scheduled Tribes (STs) of India are characterized by distinct cultures and a close relationship with the land they inhabit. Tribal people make up to 5% of the world's population but 15% of such people are living in poverty. They face deprivations caused by social, economic, and political exclusion. In India displacement due to development projects is pushing the tribals out of their habitat dispossessing them of their traditional forest resources. Women and children in displacement suffer more than the male counterpart especially in the process of moving to a new setup. The objective of the author is to study the reproductive healthcare status of displaced tribal women in India. In this paper, the author underlines the capabilities of tribal women in post displacement settings. The study was conducted in three wildlife sanctuaries in the Indian States of Odisha and Chhattisgarh namely Simlipal, Chandaka-Dampara, and Achankamar. Sequential explanatory study design was employed for collecting the data. A total of 194 displaced tribal women within the reproductive age group of 15-49 years were surveyed and Focus Group Discussion was conducted among the displaced women. Women who had given birth in the last five years were selected using a purposive sampling method. Key findings of the study suggest that women lack awareness of child spacing capabilities (57%) and the unmet need for family planning is comparatively higher. More than half of the women face domestic violence that curtails their capabilities to avail reproductive healthcare services. It also reduces the immediate wellbeing of their children. Women in this study lack control over the decision on reproductive healthcare. Due to this, women lack social and political freedom. The Government of India has taken fewer initiatives to promote effective reproductive healthcare services. Also, there is limited awareness in the rehabilitation colonies on protection from domestic violence.

P1467Long-term prognostic value of simultaneous assessment of atherosclerosis and ischemia in patients with suspected angina: implications for routine use of carotid ultrasound during stress echocardiograp

Background

The long-term clinical impact of carotid plaque burden (CPB) in patients with new onset suspected stable angina beyond stress echocardiography (SE) with no history of coronary artery disease (CAD) is not known.

Methods

Consecutive patients referred for SE, underwent simultaneous carotid ultrasonography to assess CPB. Patients were prospectively followed up for major adverse events (MAE).

Results

Of the 592 patients, 573 (age 59±11, 45% male) had follow-up data. During a mean of 7±1.2 years, 85 patients had first MAE (all-cause mortality and acute myocardial infarction: 67 (hard events) and 18 unplanned revascularisation). On multivariate Cox regression analysis, pre-test probability of CAD, peak wall thickness scoring index and CPB predicted MAE (p<0.0001 for all); however, only CPB retained significance for both hard events and hard cardiac events (p=0.008 and 0.001, respectively). MAE and hard events were least in patients with normal SE and absent carotid plaque (annualised event rate: 1.1% and 1.01%respectively) with significant increase in normal SE with plaque disease (2.4% and 2.05%, p=0.004 and 0.01 respectively). Presence of plaque did not impact on these outcomes in abnormal SE.

Conclusions

In patients with suspected stable angina, carotid atherosclerosis and myocardial ischemia in combination provided synergistic MAE information long term but atherosclerosis predicted hard events particularly in patients with normal SE but not in ischemic patients. This implies routine use of simultaneous carotid ultrasound following a normal SE for optimum prognostication

Does spending matters? Re-looking into various covariates associated with Out of Pocket Expenditure (OOPE) and catastrophic spending on accidental injury from NSSO 71st round data

BACKGROUND

Accidental Injury is a traumatic event which not only influences physical, psychological, and social wellbeing of the households but also exerts extensive financial burden on them. Despite the devastating economic burden of injuries, in India, there is limited data available on injury epidemiology. This paper aims to, first, examine the socio-economic differentials in Out of Pocket Expenditure (OOPE) on accidental injury; second, to look into the level of Catastrophic Health Expenditure (CHE) at different threshold levels; and last, to explore the adjusted effect of various socio-economic covariates on the level of CHE.

METHODS

Data was extracted from the key indicators of social consumption in India: Health, National Sample Survey Organisation (NSSO), conducted by the Government of India during January-June-2014. Logistic regression analysis was employed to analyse the various covariates of OOPE and CHE associated to accidental injury.

FINDINGS

Binary Logistic analysis has demonstrated a significant association between socioeconomic status of the households and the level of OOPE and CHE on accidental injury care. People who used private health services incurred 16 times higher odds of CHE than those who availed public facilities. The result shows that if the person is covered via any type of insurance, the odd of CHE was lower by about 28% than the uninsured. Longer duration of stay and death due to accidental injury was positively associated with higher level of OOPE. Economic status, nature of healthcare facility availed and regional affiliation significantly influence the level of OOPE and CHE.

CONCLUSION

Despite numerous efforts by the Central and State governments to reduce the financial burden of healthcare, large number of households are still paying a significant amount from their own pockets. There are huge differentials in cost for the treatment among public and private healthcare providers for accidental injury. It is expected that the findings would provide insights into the prevailing magnitude of accidental injuries in India, the profile of the population affected, and the level of OOPE among households.

Perceived Barriers in Accessing the Reproductive Health Care Services in Odisha

Background: The utilization of Reproductive, Maternal, and Newborn and Child health (RMNCH) services is often influenced by the socio-cultural, financial, access, political barriers acting at the community, family and individual level. Yet, very little attention has been given, either by policy makers or researchers for minimizing their effect. Aim and objective: To examine the demand and supply side barriers in accessing the maternity services and to understand the perception on maternal healthcare services. Material & Methods: The study was carried out in four districts of Odisha state, with a well representative sample of 1194 women, who delivered a child in last 2 years. Quantitative and qualitative study design was followed to collect the data. Results: The supply side barriers such as physical access and facilities were faced by the service providers. The demand side barriers such as socio-cultural, financial and access barriers were faced by the service receivers in order to avail the services. Conclusions: In order to overcome the barriers faced by the women of Odisha it is important to improve the access to services so that they get them easily. Some of the imperative actions such as strengthening community mobilization through inter-personal communication, dialogue with the key influencers in the community as well as continuous engagement with and sensitization of the service providers

Concern and Maintenance During Twilight Years

The present article focuses on the perception of elderly regarding younger generation in rural Odisha. Data for this study were collected from the rural areas of Bargarh district using semi-structured interview schedule. For this study, 310 males and females were interviewed by using systematic sampling technique. Various issues like condition of the aged in context of respect and care have been taken into consideration. Other factors like their level of satisfaction from the care provided by their children and how they perceive today’s youth has been analysed. ANOVA was conducted to see which socio-demographic variables have the most significant effect on the perception of elderly later, factor analysis is used and the results show that the elderly have a negative perception regarding the younger generation. Results show that the elderly feels that today’s youth is selfish and least bothered about their needs and demands.

Does equity in healthcare spending exist among Indian states? Explaining regional variations from national sample survey data

BACKGROUND

Equity and justice in healthcare payment form an integral part of health policy and planning. In the majority of low and middle-income countries (LMICs), healthcare inequalities are further aggravated by Out of Pocket Expenditure (OOPE). This paper examines the pattern of health equity and regional disparities in healthcare spending among Indian states by applying Andersen's behavioural model of healthcare utilization.

METHODS

The present study uses data from the 66th quinquennial round of Consumer Expenditure Survey, of the National Sample Survey Organization (NSSO), conducted in 2009-10 by Ministry of Statistics and Programme Implementation (MoSPI), Government of India (GoI). To measure equity and regional disparities in healthcare expenditure, states have been categorized under three heads on the basis of monthly OOPE i.e., Category A (OOPE > =INR 100); Category B (OOPE between INR 50 to 99) and Category C (OOPE < INR 50). Multiple Generalised Linear Regression Model (GLRM) has been employed to explore the effect of various socio-economic covariates on the level of OOPE.

RESULTS

The gap in the ratio of average healthcare spending between the poorest and richest households was maximum in Category A states (richest/poorest = 14.60), followed by Category B (richest/poorest 11.70) and Category C (richest/poorest 11.40). Results also indicate geographical concentration of lower level healthcare spending among Indian states (e.g., Odisha, Chhattisgarh and all the north-eastern states). Results from the multivariate analysis suggest that people residing in urban areas, having higher economic status, belonging to non-Muslim communities, non-Scheduled Tribes (STs), and non-poor households spend more on healthcare than their counterparts.

CONCLUSIONS

In spite of various efforts by the government to reduce the burden of healthcare spending, widespread inequalities in healthcare expenditure are prevalent. Households with high healthcare needs (SCs/STs, and the poor) are in a more disadvantaged position in terms of spending on health care. It has also been observed that spending on healthcare was comparatively lower among backward or isolated states. No doubt, the overall social security measures should be enhanced, but at the same time, looking at the regional differences, more priority should be assigned to the disadvantaged states to reduce the burden of OOPE. It is proposed that there is need to increase government spending, especially for the disadvantaged states and population, to minimise the burden of OOPE.

Do we provide affordable, accessible and administrable health care? An assessment of SES differential in out of pocket expenditure on delivery care in India

BACKGROUND

Reproductive and Child Health (RCH) financing is a key area of focus which can lead towards an overall empowerment of women through financial inclusion. The major objectives of this paper are: first; to examine the socio-economic differentials in Out of Pocket Expenditure (OOPE) on delivery care, second; to look into the role of insurance coverage, third; to analyse various sources of financing, and fourth; to measure the adjusted effect of various covariates on the level of OOPE.

METHODS

Data were extracted from the National Sample Survey Organisations (NSSO), 71st round "Key indicators of social consumption in India, Health" conducted by the GoI during January to June 2014. Multivariate Generalised Linear Regression Model (GLRM) has been used to analyse the various covariates of OOPE on maternity care.

FINDINGS

Multivariate analysis has demonstrated a significant association between socioeconomic status of women and the level of OOPE on delivery care. Level of education, urban residence, higher caste and social group affiliation, strong economic conditions, and use of private facilities for the child birth among the mothers were a significant predictor of the expenditure on maternity care.

CONCLUSION

Despite various efforts by the central and state governments to reduce financial burden, still a large number of households are paying a significant amount from their own pockets. There is an immediate need to re-look in the aspects of insurance coverage and high level of OOPE in delivery care.

Estimating financial resources for universal access to sexual reproductive health care: Evidence from two states in India

India has made insignificant progress towards achieving universal access to sexual and reproductive health (SRH). One of the key inputs for achieving universal access to SRH is financial resources. Given this, many international agencies including the UN are emphasising on monitoring the financial progress towards achieving SRH.

OBJECTIVE

To generate evidence on spending on SRH from various sources - (government, household, international donors and NGOs) to improve the accountability of the government towards SRH goal.

METHODOLOGY

Adapting a sub account framework of the NHA, this paper investigated the SRH expenditure of the two divergent states of India. The data were collected from government, households (NSSO), and foreign donors and were classified as per the International Classification of Health Accounts (ICHA).

RESULTS AND DISCUSSIONS

Total SRH expenditure is less than one percent of SGDP from all sources in each state. Among the sources, government's spending on SRH is more than household. A large part of household spending is on curative care which has implications for accessing services by the poor. In spite of data constraints, this paper presents a comprehensive analysis on SRH spending, which is critical for monitoring the commitment towards universal access to SRH. This evidence can be used for further improving data quality for RCH account in LMICs.

Factors associated with the life satisfaction amongst the rural elderly in Odisha, India

Background

Life Satisfaction (LS) is an indicator of subjective well-being (SWB) among the elderly, and is directly associated with health and mortality. Present study deals with the factors associated with the LS among the rural elderly in Odisha, India.

Methods

A cross-sectional survey using multi-stage random sampling procedure was conducted among elderly (60+ years) in Bargarh district of Odisha. The survey was conducted among 310 respondents. Hierarchical regression analysis was used to assess the adjusted effect of various socio-economic, demographic, health conditions (physical and mental), social support and effects of multi-morbidity on LS.

Results

Cognitive health was the most influential factor in determining LS among both men (β = 0.327) and women (β = 0.329). Individual’s social support also plays an influential role in LS among rural elderly. Elderly who are living alone and have any sort of disability and had low score of activities of daily living (ADL) have also reported significantly lower perceived LS for both the genders.

Conclusion

It is necessary to analyze and identify the major factors which can improve upon the level of LS among the elderly population. Better understanding of these factors can help in removing the superfluous anxiety of old age in the mindset of people which is pervading in the society.

Reproductive health financing in Kenya: an analysis of national commitments, donor assistance, and the resources tracking process

Understanding the flow of resources at the country level to reproductive health is essential for effective financing of this key component of health. This paper gives a comprehensive picture of the allocation of resources for reproductive health in Kenya and the challenges faced in the resource-tracking process. Data are drawn from Kenyan budget estimates, reproductive health accounts, and the Resource Flows Project database and compare budgets and spending in 2005-06 with 2009-10. Despite policies and programmes in place since 1994, services for family planning, maternity care and infant and child health face serious challenges. As regards health financing, the government spends less than the average in sub-Saharan Africa, while donor assistance and out-of-pocket expenditure for health are high. Donor assistance to Kenya has increased over the years, but the percentage of funds devoted to reproductive health is lower than it was in 2005. We recommend an increase in the budget and spending for reproductive health in order to achieve MDG targets on maternal mortality and universal access to reproductive health in Kenya. Safety nets for the poor are also needed to reduce the burden of spending by households. Lastly, we recommend the generation of more comprehensive reproductive health accounts on a regular basis.

Socio-economic inequalities in the prevalence of multi-morbidity among the rural elderly in Bargarh District of Odisha (India)

BACKGROUND

Multi-morbidity among elderly is increasingly recognized as a major public health challenge in most of the developing countries. However, information on the size of population suffering from multi-morbidity and socio-economic differentials of multi-morbidity is scarce. The objectives of this paper are twofold; first, to assess the prevalence of various chronic conditions and morbidity among rural elderly and second, to examine the socio-economic and demographic factors that have a significant effect on the morbidity.

METHODS

A cross-sectional survey has been done using multi-stage random sampling procedure that was conducted among elderly (60+ years) in Bargarh District of Odisha during October 2011-February 2012. The survey was conducted among 310 respondents including 153 males and 157 females. Descriptive analyses were performed to assess the pattern of multi-morbidity. Logistic regression analyses were used to see the adjusted effect of various socio-economic and demographic covariates of multi-morbidity.

RESULTS

The overall prevalence of multi-morbidity is 57% among rural elderly in Bargarh District of Odisha. The most common diseases in rural areas are: Arthritis, Chronic Obstructive Pulmonary Disease (COPD), High Blood Pressure and Cataract. Results from the logistic regression analyses show that age, state of economic independence and life style indicators are the most important measured predictors of multi-morbidity. Unlike earlier studies, wealth index and education have a marginal impact on multi-morbidity rate. Moreover, the occurrence of multi-morbidity is higher for elderly males compared to their female counterparts, though the difference is not significant.

CONCLUSION

The high prevalence of morbidity observed in the present study suggests that there is an urgent need to develop geriatric health care services in a developing country like India. Any effort to reorganize primary care for elderly people should also consider the high prevalence of multi-morbidity among rural elderly in India.

Mapping of reproductive health financing: methodological challenges

Low level of funding for reproductive health (RH) is a cause for concern, given that RH service utilization in the vast majority of the developing world is well below the desired level. Though there is an urgent need to track the domestic and international financial resource flows for RH, the instruments through which financial resources are tracked in developing countries are limited. In this paper we examined the methodological and conceptual challenges of monitoring financial resources for RH services at international and national level. At the international level, there are a number of estimates that highlights the need for financial resources for RH programmes but the estimates vary significantly. At the national level, Reproductive Health Accounts (RHA) in the framework of National Health Accounts (NHA) is considered to be the ideal source to track domestic financial flows for RH activities. However, the weak link between data production by the RHA and its application by the stakeholders as well as lack of political will impedes the institutionalization of RHA at the country level.

Outbreak of scrub typhus in the North East Himalayan region-Sikkim: an emerging threat

Scrub typhus is an acute febrile illness that is known to be endemic in the South East Asian countries and the Western Pacific region. We here report an outbreak in the tiny Himalayan state of Sikkim. Patients with pyrexia of unknown origin were evaluated. They were screened by Weil-Felix test and the rapid immunochromatographic method. Samples that were positive by either Weil-Felix agglutination test or by rapid immunochromatography were confirmed by IgM enzyme-linked immunosorbent assay (ELISA). A total 204 samples were screened. Sixty-three patients were confirmed positive among which 42 were male and 21 were female. Effective management and early administration of antibiotics will help prevent the complications and mortality associated with scrub typhus.

Financing Reproductive Health in Bangladesh

Bangladesh is the signatory of both, International Conference on Population and Development (ICPD) programme of action and Millennium Development goals (MDGs). The Government of Bangladesh has set ambitious agendas for improving Reproductive Health (RH) services, to achieve the targets till 2015. In Bangladesh, poor access to services, both primary and tertiary care, low quality services, high rate of maternal mortality and child malnutrition are the key challenges in achieving MGDs. An equitable and efficient use of financial resources is essential for the adequate implementation of these agendas to achieve MGDs for reproductive health. This paper discusses the financing for reproductive health in Bangladesh based on various secondary sources including National Health Accounts.

The budget allocation for Reproductive Health (RH) and Family Planning (FP) is around 11 per cent of the total health budget. Among RH providers, nearly 48 per cent of the expenditure is incurred through Family Planning Centres, which are key providers for reproductive health services in Bangladesh. General hospitals and outpatient care centres are providers for 23 per cent and 21 per cent expenditure respectively. A large proportion the total expenditure on service provision for RH is spent through the government system, which includes donor support channelled through the government system under pooled funding. The donor expenditure on population assistance in Bangladesh showed fluctuations in the past, but is showing increasing trend for last three to four years. Of the total donor expenditure, almost half is distributed through multilateral channels, one-third through NGOs in 2008, and remaining through bilateral channels. The role of multilateral channels has increased since 2006. Out of pocket spending constitutes a significant proportion (around 65 per cent) of the total spending on reproductive health. The study suggests that Bangladesh needs to increase spending on RH in order to achieve MDG 5. Due to resource constraints, the GOB is currently in a position to contribute only one-fourth of the total estimated budget needed for implementing the RH related operational plans, while the rest is considered to be the funding gap, and needs to be ensured from external sources.

Socio-economic inequality of immunization coverage in India

To our knowledge, the present study provides a first time assessment of the contributions of socioeconomic determinants of immunization coverage in India using the recent National Family Health Survey data. Measurement of socioeconomic inequalities in health and health care, and understanding the determinants of such inequalities in terms of their contributions, are critical for health intervention strategies and for achieving equity in health care. A decomposition approach is applied to quantify the contributions from socio-demographic factors to inequality in immunization coverage. The results reveal that poor household economic status, mother's illiteracy, per capita state domestic product and proportion of illiterate at the state level is systematically related to 97% of predictable socioeconomic inequalities in full immunization coverage at the national level. These patterns of evidence suggest the need for immunization strategies targeted at different states and towards certain socioeconomic determinants as pointed out above in order to reduce socioeconomic inequalities in immunization coverage.JEL Classification: I10, I12.

Measuring wealth-based health inequality among Indian children: the importance of equity vs efficiency

The concentration index is the most commonly used measure of socio-economic-related health inequality. However, a critical constraint has been that it is just a measure of inequality. Equity is an important goal of health policy but the average level of health also matters. In this paper, we explore evidence of both these crucial dimensions-equity (inequality) and efficiency (average health)-in child health indicators by adopting the recently developed measure of the extended concentration index on the National Family Health Survey (NFHS-3) data from India. An increasing degree of inequality aversion is used to measure health inequalities as well as achievement in the following child health indicators: under-2 child mortality, full immunization coverage, and prevalence of underweight, wasting and stunting among children. State-wise adjusted under-2 child mortality scores reveal an increasing trend with increasing values of inequality aversion, implying that under-2 child deaths have been significantly concentrated among the poor households. The level of adjusted under-2 child mortality scores increases significantly with the increasing value of aversion even in states advanced in the health transition, such as Kerala and Goa. The higher values of adjusted scores for lower values of aversion for child immunization coverage are evidence that richer households benefited most from the rise in full immunization coverage. However, the lack of radical changes in the adjusted scores for underweight among children with increasing degrees of aversion implies that household economic status was not the only determinant of poor nutritional status in India.

Synthesis and magnetic characterizations of La(1-x)Sr(x)MnO3 nanoparticles for biomedical applications

The La(1-x)Sr(x)MnO3 (LSMO) nanoparticles have been synthesized by citric gel process followed by ball milling method. These nanoparticles demonstrated high crystalline quality. Nanoparticle size was further decreased by ball milling technique as observed by the field-emission scanning electron microscopic studies. The ball milled and silica coated LSMO nanoparticles show magnetic transition at about 370 K with a superparamagnetic properties. The ferromagnetic resonance (FMR) spectra analysis of LSMO nanoparticles shows large FMR linewidth due to the surface strain of the nanoparticles. Both magnetization and FMR studies demonstrate that the LSMO nanoparticles are highly anisotropic. The toxicity of the nanoparticles was studied for safe biomedical applications. Measurement of intracellular reactive oxygen species (ROS) and MTT assay results show that LSMO nanoparticles are relatively nontoxic and the toxicity is further reduced by SiO2 coating. These results are very important for applications in the field of biotechnology.

Socio-economic inequalities in child survival in India: a decomposition analysis

This paper provides a first time assessment of the decomposed contributions of socio-economic determinants of under2 child mortality in India and its states using the recent National Family Health Survey (NFHS-3, 2005-06) data. In the first stage analysis, concentration indices of under2 mortality were generated as measures of socio-economic inequalities. The concentration indices were then decomposed into their determining factors. Decomposition results reveal that poor household economic status (46%), mother's illiteracy (35%) and rural residence (15%) contribute to 96% of total socio-economic inequalities in child survival at the national level. The contribution of economic status is relatively smaller in 5 states that are advanced in health transition. The varying pattern of evidence across the states from decomposition analysis suggests the need for unique health intervention strategies for different states in accordance with the evidence of major contributions to total child health inequalities arising from poverty, illiteracy and rural residence.

Why immunization coverage fails to catch up in India? A community-based analysis

BACKGROUND

An effort has been made in this paper to examine the impact of community and household vis-à-vis individual-level variables on immunization coverage among Indian children.

METHODS

National Family Health Survey-2 data set has been used for the analysis. Multilevel regression analyses have been used to explore the relative effects of community-, household- and individual-level factors on immunization coverage. Three community-level variables, i.e. availability of health facilities, availability of all-weather roads and information, education and communication (IEC) activities conducted during last year, are included in this analysis.

RESULTS

Availability of health facility and information, education and communication activities plays a significant role in determining the level of immunization coverage among children. Even with community-level variables in the model, individual-level variables, i.e. parent's education, birth order of child and number of antenatal care visits, retain their predictive role for the potential immunization coverage.

CONCLUSIONS

Universal immunization can be achieved by providing services at community level and information about the available services and their benefits to the community. There is a considerable, unexplained variation in the immunization coverage between different communities, even in the most complex model used in this study, which could explain the entire heterogeneity of immunization coverage among Indian states.

Removal of Cr(VI) from Aqueous Solution Using Activated Cow Dung Carbon

Removal of hexavalent chromium from aqueous medium by using activated cow dung carbon was studied. Cow dung was carbonized and activated by treating with concentrated H(2)SO(4) followed by heating for 24 h at 120 degrees C. The extent of adsorption was studied as a function of pH, contact time, amount of adsorbent, concentration of adsorbate, and temperature. At lower pH (<3.5), the prepared sorbent was capable of removing approximately 90% Cr(VI) at 5 ppm concentration from aqueous synthetic solution. The dynamics of migration of the sorbate ions from the bulk onto the sorbent surface was studied and the results obtained under various experimental conditions were found to follow standard adsorption isotherms. The reaction kinetics was found to be of first order. Copyright 2000 Academic Press.

Adsorption of Hexavalent Chromium from Aqueous Solution by Using Activated Red Mud

Adsorption by activated red mud (ARM) is investigated as a possible alternative to the conventional methods of Cr(VI) removal from aqueous synthetic solutions and industrial effluents. Adsorption characteristics suggest the heterogenous nature of the adsorbent surface sites with respect to the energy of adsorption. Various factors such as pH, contact time, Cr(VI) concentration, amount of adsorbent, and temperature are taken into account, and promising results are obtained. The applicability of the Langmuir as well as Freundlich adsorption isotherms for the present system is tested. The loading factor (i.e., milligrams of Cr(VI) adsorbed per gram of ARM) increased with initial Cr(VI) concentration, whereas a negative trend was observed with increasing temperature. The influence of the addition of anions on the adsorption of Cr(VI) depends on the relative affinity of the anions for the surface and the relative concentrations of the anions. Copyright 1999 Academic Press.

Adsorption of Phosphate from Aqueous Solution Using Activated Red Mud

Adsorption of phosphate (PO3-4) from aqueous solution on activated red mud (ARM) was studied as a function of time, pH, temperature, concentration of adsorbent and adsorbate in acetic acid-sodium acetate buffer medium. The adsorption of phosphate follows Langmuir as well as Freundlich adsorption isotherms. The process efficiency was found to be 80-90% at room temperature. This can be extended to the treatment of industrial effluents containing phosphates like that from phosphatic fertilizer plants. Copyright 1998 Academic Press.

Characterization of mycobacterial species in clinically diagnosed cases of pulmonary tuberculosis and their HIV status

A total of 75 clinically diagnosed and radiologically evident cases suggestive of pulmonary tuberculosis were selected for study. Sputum sample of each patient was screened for AFB by Ziehl Neelsen staining and culture. On examination 20 smears were found positive for AFB and 55 smears were negative by concentration method. A total of 23 samples were found to be culture positive and 52 were culture negative. Of these, 22 stains were identified as Mycobacterium tuberculosis, one was identified as M. Scrofulaceum. Of the 75 patients 3 were seropositive for HIV-I antibodies. Out of these 3, one was found to be smear and culture positive and was identified as M. scrofulaceum. Other two seropositive patients were smear and culture negative for AFB.