Bidirectional and cross-lag relationship between social media use and psychological wellbeing: evidence from an Indian adolescent cohort study

INTRODUCTION

In an online era like today, the relationship between social media and depression among adolescents and young adults is erratic and still continues to be a debatable subject. The study aims to examine the association and bi-directional relationship between social media usage and depressive symptoms among the adolescent boys and girls in India.

METHODS

The study uses data from two waves of Understanding the Lives of Adolescents and Young Adults (UDAYA) project survey conducted in two Indian states of Uttar Pradesh and Bihar. Depression was measured by a Patient Health Questionnaire. Logistic regression has been used for analyzing the data comprising the same time period, whereas the bidirectional relationship between two time periods has been evaluated by Cross-Lagged Path Model.

RESULT

Findings suggest that the percentage of moderate depressive symptoms increased from 1.7% to 3.0% from Wave 1 to Wave 2. Depression among adolescent girls increased slightly from wave 1 to wave 2 whereas a slight decrement was noticed in the moderate form of depressive symptom among adolescent girls using social media for the two waves. Socioeconomic factors like education, age, gender played an important role in affecting depression among adolescents in both the Wave of the survey. The path relationship reveals that social media users in Wave 1 [β=0.22, p<0.001] were positively associated with social media users in Wave 2. Similar patterns were observed for depressive symptoms at both the waves of the survey. However, cross lagged relations between social media use and depression could not be established between the survey periods.

CONCLUSION

A significant degree of association was found between social media use and depression among adolescent boys and girls in the study. The present study concludes that factors like age, gender and education showed significant relationships with social media use and depression.

Application of machine learning in measurement of ageing and geriatric diseases: a systematic review

BACKGROUND

As the ageing population continues to grow in many countries, the prevalence of geriatric diseases is on the rise. In response, healthcare providers are exploring novel methods to enhance the quality of life for the elderly. Over the last decade, there has been a remarkable surge in the use of machine learning in geriatric diseases and care. Machine learning has emerged as a promising tool for the diagnosis, treatment, and management of these conditions. Hence, our study aims to find out the present state of research in geriatrics and the application of machine learning methods in this area.

METHODS

This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and focused on healthy ageing in individuals aged 45 and above, with a specific emphasis on the diseases that commonly occur during this process. The study mainly focused on three areas, that are machine learning, the geriatric population, and diseases. Peer-reviewed articles were searched in the PubMed and Scopus databases with inclusion criteria of population above 45 years, must have used machine learning methods, and availability of full text. To assess the quality of the studies, Joanna Briggs Institute's (JBI) critical appraisal tool was used.

RESULTS

A total of 70 papers were selected from the 120 identified papers after going through title screening, abstract screening, and reference search. Limited research is available on predicting biological or brain age using deep learning and different supervised machine learning methods. Neurodegenerative disorders were found to be the most researched disease, in which Alzheimer's disease was focused the most. Among non-communicable diseases, diabetes mellitus, hypertension, cancer, kidney diseases, and cardiovascular diseases were included, and other rare diseases like oral health-related diseases and bone diseases were also explored in some papers. In terms of the application of machine learning, risk prediction was the most common approach. Half of the studies have used supervised machine learning algorithms, among which logistic regression, random forest, XG Boost were frequently used methods. These machine learning methods were applied to a variety of datasets including population-based surveys, hospital records, and digitally traced data.

CONCLUSION

The review identified a wide range of studies that employed machine learning algorithms to analyse various diseases and datasets. While the application of machine learning in geriatrics and care has been well-explored, there is still room for future development, particularly in validating models across diverse populations and utilizing personalized digital datasets for customized patient-centric care in older populations. Further, we suggest a scope of Machine Learning in generating comparable ageing indices such as successful ageing index.

Status and correlates of non-communicable diseases among children and adolescents in slum and non-slum areas of India's four metropolitan cities

The emergence of non-communicable diseases (NCDs) in childhood poses a serious risk to a healthy adult life. The present study aimed to estimate the prevalence of NCDs among children and adolescents in slums and non-slums areas of four metropolitan cities of India, and in rural areas of the respective states The study further, investigated the effect of the place residence as slum vs. non-slum and other risk factors of the NCDs. Nationally representative data from the Comprehensive National Nutrition Survey (CNNS) was used.. Estimates were based on children (5-9 years) and adolescents (10-19 years) for whom biomarkers predicting diabetes, high total cholesterol, high triglycerides and hypertension were determined. Weight, height and age data were used to calculate z-scores of the body mass index. Overweight and obesity was higher in urban areas than in rural areas among children and adolescents. Regional differences in the prevalence of diseases were observed; children in Delhi and Chennai had a higher likelihood of being diabetic while children in Kolkata were at a greater risk of high total cholesterol and high triglycerides. The risk of hypertension was strikingly high among non-slum children in Delhi. Children from slums were at a higher risk of diabetes compared to the children from non-slums, while children and adolecents from non-slums were at a greater risk of high triglycerides and hypertension respectively than their counterparts from slums. Male children and adolecents had a higher risk of diabetes and high cholesterol. Screening of children for early detection of NCDs should be integrated with the already existing child and adolescent development schemes in schools and the community can help in prevention and control of NCDs in childhood.

Utilisation of ANC services before and after the COVID-19 pandemic in selected resource-poor blocks of India: role of community health workers in Swabhimaan programme area

INTRODUCTION

COVID-19 has disrupted maternal and child health services. Community Health Workers (CHWs) supported the women by visiting pregnant women's homes and providing the MCH services as required. This study attempts to understand the role of CHW and its impact on the Ante-Natal Care (ANC) services pre-pandemic and post-Pandemic in the poor resource setting.

METHODS

The Swabhimaan programme interventions were carried out in the selected blocks in the Indian States of Bihar, Odisha and Chhattisgarh with the objective to improve the nutritional status of mothers, pregnant women and adolescents living in resource-poor blocks of three selected states during 2016-2022. Cross-sectional surveys, namely pre-pandemic (2018-19) and post-pandemic (2021-22) of pregnant and mothers of under two children, utilised to fulfil the objectives of this study. These surveys are part of Swabhimaan evaluation, a community-based non-randomised controlled study.

RESULTS

The ANC services received by women have increased over time from 2015 to 2022. Our findings confirm that the ground-level community and health systems were active during the pandemic, and the results show significant improvement. Additionally, the women supported by the CHW have substantially improved pregnancy registration, first ANC, Tetanus injection, consumption of Iron Folic Acid, Calcium and deworming tablets than those who did not. Propesnsity Score Matching analysis shows that the average treatment effect on the various ANC services of having the support of CHW is significant.

CONCLUSION

This study shows the vital role of CHWs in utilising various Maternal and Child Health services. Better linkage and networking of the CHWs with the community will ensure health service delivery regularly and in an emergency like a pandemic and develop resilience.

Surging trends of infertility and its behavioural determinants in India

The World Health Organisation (WHO) has recognised infertility as a public health issue. Although biological factors are considered to be the primary cause, factors like social, health, and lifestyle factors can all have an adverse effect on a couple's ability to reproduce. The study aimed to comprehend the infertility scenario in India and explore some of the potential causes. The study used standard demographic definitions and four rounds of the National Family Health Survey (NFHS) from 1992-1993 to 2015-16 to estimate the levels of primary and secondary infertility in India. Bivariate analysis, the t-test, and the Chi-square test were applied to capture significant changes in infertility over time. The multivariate logistic regression model was used to understand the extent of infertility among Indian couples from various socioeconomic groups, lifestyle levels, and reproductive behaviour in 2015-16. Primary infertility declined steadily from 1992 to 2015, whereas secondary infertility increased from 19.5% in 1992-93 to 28.6% in 2015-16. This trend is related to declining fertility rates, particularly in India's southern states. Age at marriage, biological factors, and lifestyle factors were all strongly linked to infertility. People with higher education levels and late marriages were more likely to experience primary infertility. Alcohol consumption, smoking, obesity, and noncommunicable disease are all strongly linked to secondary infertility. Our study has policy implications, and we draw attention to alarming infertility in India, which has gone unnoticed due to large population. We suggests enhancing the current health and reproductive programmes, educating people about improving their lifestyle choices and sexual behaviour, and calling attention to a significant shift in fertility dynamics.

Fasciitis ossificans: imaging features, histology, and differential diagnosis

AIM

To describe the imaging features of fasciitis ossificans and its histopathological features.

MATERIALS AND METHODS

Using a word search of existing pathology reports at the Mayo Clinic, six cases of fasciitis ossificans were identified. The clinical history, histology, and available imaging of the affected area were reviewed.

RESULTS

Imaging consisted of radiographs, mammograms, ultrasound images, bone scintigraphs, computed tomography (CT), and magnetic resonance imaging (MRI) images. All cases demonstrated a soft-tissue mass. The characteristic MRI appearance was a T2 hyperintense enhancing mass with surrounding soft-tissue oedema. Peripheral calcifications were seen on radiographs, CT, and/or ultrasound. Histological sections showed distinct zonation, with nodular fasciitis-like zones of myofibroblastic proliferation, which merged with osteoblasts that rim the ill-defined trabeculae of woven bone and became continuous with the mature lamellar bone surrounded by a thin layer of compressed fibrous tissue.

CONCLUSION

Imaging features of fasciitis ossificans are that of an enhancing soft-tissue mass located within a fascial plane with prominent surrounding oedema and mature peripheral calcification. Imaging and histology are that of myositis ossificans but occurring within the fascia. It is important that radiologists are aware of the diagnosis of fasciitis ossificans and appreciate its similarity to myositis ossificans. This is particularly important in anatomical locations with fascias but no muscle. Given the radiographic and histological overlap between these entities, nomenclature that encompasses both could be considered in the future.

The role of self-efficacy and parental communication in the association between cyber victimization and depression among adolescents and young adults: a structural equation model

BACKGROUND

With the rapid advancement and revolutionization of information and communication technologies, adolescents and young adults use smartphones, the internet, and social networking services more frequently, as a result, the problem of cyber-bullying sharply increases, and eventually it causes psychological issues and negative thoughts in the victims. This study aimed to examine the role of self-efficacy and parental communication in the relationship between cyber victimization and depression among adolescents and young adults in India.

METHODS

Secondary data analysis was performed on a cross-sectional dataset obtained from the Understanding the Lives of Adolescents and Young Adults (UDAYA) wave 2 survey. The sample included 16,292 adolescent and young adult boys and girls aged 12-23 years. Karl Pearson Correlation coefficient analysis was done to examine the correlation between outcome variable (depressive symptoms), mediator variables (self-efficacy and parental communication) and key explanatory variable (cyber victimization). Further, structural equation modeling technique was applied to examine the hypothesized pathways.

RESULTS

Adolescents and young adults being victims of cyber-bullying [β = 0.1357, p < 0.001] and those witnessed inter-parental violence were positively [β = 0.0026, p < 0.001] correlated with depressive symptoms. Self-efficacy and parental communication were negatively related to depressive symptoms among adolescents and young adults. There was a significant positive relationship between cyber victimization [β = 0.258, p < 0.001] and depressive symptoms. Cyber victimization was positively related to self-efficacy [β = 0.043, p < 0.001] among adolescents and young adults. Self-efficacy [β= -0.150, p < 0.001] and parental communication [β=-0.261, p < 0.001] reduced depressive symptoms among the participants.

CONCLUSIONS

The findings suggest that adolescents and young adults who are victims of cyber-bully may have depressive symptoms and their mental health can be improved through the enhancement of self-efficacy and increased parental communication. Improved peer attitudes and familial support for empowering cyber victims should be taken into account while framing programs and interventions.

Modelling Determinants of Deaths Attributable to External Causes Among Adults in India

The study aimed at finding the risk factors associated with adult mortality (15-59 years) due to external causes (accidents, suicide, poisoning, homicide, and violence). Using National Family Health Survey data-4 consisting of 1,756,867 sample, we applied a Robust Poisson Regression Model to determine the potential risk factors. Findings suggest that the highest proportion of deaths due to external causes was in the age group 20-24 years. The prevalence of these deaths was higher among older adults (age 50 years and above). The risk was more among males (Incident Rate Ratio (IRR) for females is: 0.29, p < 0.001), rural residents (IRR: 1.16, p < 0.001), exposed to mass-media (IRR: 1.08, p < 0.05), residing in female-headed households, in households having a member with higher education. This risk decreased for large families (IRR: 0.89, p < .001). A need to strengthen awareness and mentorship programs for young-adults and middle-aged people to control such avoidable deaths is recommended.

Exposure to Pornographic Content Among Indian Adolescents and Young Adults and Its Associated Risks: Evidence from UDAYA Survey in Bihar and Uttar Pradesh

Adolescence is period characterized by sexual development, increasing romantic relationships, and the initiation of sexual activity. To enhance the exploration of their sexuality, adolescents may look into sexual resources such as pornography. There has been little research in India to understand how much adolescents are exposed to Internet pornography and what are the associated risk factors. This study examined the level of exposure to pornography among adolescents and the associated factors which determine the exposure to pornography in Uttar Pradesh and Bihar. Understanding the Lives of Adolescents and Young Adults (UDAYA) survey data collected in 2015-2016 was used for this study. The study was based on 3885 adolescent boys and 7766 adolescent girls aged 15-19 years. The mean age for adolescent boys was 16.66 years (SD: 1.3), and for girls it was 16.67 years (SD: 1.3). About 47% of adolescent boys but only 6% of girls were exposed to pornography. The likelihood of exposure to pornography was 1.69 times and 2.27 times more likely among adolescents and girls who had their own personal mobile phones, respectively, compared to those who did not have their own personal mobile phones. The odds of exposure to pornography were significantly higher among adolescent boys who had frequent media exposure than those who had no/rare exposure. Programs on life skills and comprehensive sexuality education need to be prioritize.

The effects of cyberbullying victimization on depression and suicidal ideation among adolescents and young adults: a three year cohort study from India

BACKGROUND

Cyberbullying victimisation is considered a global public health issue concerning the psychological development of adolescents that oftentimes persists into adulthood. The current study explored the longitudinal relationship between cyberbullying victimisation and depression and suicidal ideation among adolescents and young adults, given the scarcity of such studies in poor-resource settings like India.

METHODS

Data were drawn from the "Understanding the Lives of Adolescents and Young Adults" (UDAYA- 2015-16 and 2018-19) surveys conducted in two most-populated Indian states of Uttar Pradesh and Bihar. Bivariate and logistic regression analysis was conducted to fulfil the objectives of the study using a sample of 4428 and 11,864 adolescent (aged 10-19 years) male and female cohorts, respectively.

RESULTS

The prevalence of cyberbullying victimization increased from 3.8% to 6.4% among female respondents and 1.9% to 5.6% among male respondents over three years. About 33% of females and 16.6% of males had depressive symptoms in their young adulthood. Nearly 7.5% females compared to 2.3% of males, reported that they have seriously considered attempting suicide in the past one year. Adolscents who experienced cyberbullying victimization were 2.07 times more likely to have depressive symptoms comapared to those who did not experience cyberbullying victimization. Similarly, adolescents who experienced cyberbullying victimization were 2.50 times more likely to have suicidal ideation than their counterparts with no experience of cyberbullying victimization.

CONCLUSION

The findings suggest that cyberbullying victims are at higher risk of depressive symptoms and suicidal thoughts and these adverse effects persist for longer period. Therefore, cyberbullying and related mental health problems need to be addressed with more efficient strategies such as increased awareness of nuances of online harassments among adolescent and young adult population.

The association of smartphone screen time with sleep problems among adolescents and young adults: cross-sectional findings from India

Background

Although sleep problem is a growing public health issue with the advancement of technology, especially among adolescents and young adults, it received little attention. The study aimed to examine the association of screen time on smartphone with sleep problems among adolescents and young-adults in India.

Methods

We used data from the “Understanding the lives of adolescents and young-adults” (UDAYA, 2018). The effective sample size for the study was 16,292 adolescents and young adults (males-4428 and females-11,864). Descriptive statistics and bivariate analysis with percentages and chi-square test were used to report the preliminary results. Multivariable logistic regression analysis was conducted to examine the association between smartphone screen time and sleep problems, separately for adolescents and young adults.

Results

Nearly 15.6% of males and 23.5% of females had sleep problems in their adolescence in the last 15 days, while these percentage were high among young-adults (18.4% males and 33.24% females). Adolescents [AOR: 1.55; CI: 1.21-1.99] and young adults [AOR: 1.48; CI: 1.24-1.75], who spent more than 2 h on smartphone had higher odds of reporting sleep problems than those who did not use smartphone in the last 24 hours. Adolescent females who used smartphone for less or equal to 2 h and three or more hours respectively, had 2.11 [AOR: 2.11; CI: 1.63-2.73] and 2.94 times [AOR: 2.94; CI: 1.97-4.38] higher odds of reporting sleep problems than adolescent males who did not use smartphones. Additionally, among the young adult females, the odds of sleep problems were 1.66 times [AOR: 1.66; CI: 1.55-2.38] and 2.36 times [AOR: 2.36; CI: 1.59-3.51] greater than the non-users young adult males.

Conclusion

The increased time spent on mobile phones’s screen among adolescents and young-adults, particularly in females is associated with a higher likelihood of reporting sleeping problems. The current findings have important implications for adolescence and young-adults’ mental health programmes. The findings can also be used to further inform how different strategies need to be developed for better sleep outcome during adolescence and young-adults.

Data quality of birthweight reporting in India: Evidence from cross-sectional surveys and service statistics

The study aims to assess the quality of birthweight data collected in two surveys, including the National Family Health Survey (NFHS) and the Comprehensive National Nutrition Survey (CNNS), and as reported in the statistics from the Health Management Information System (HMIS). The study also aims to assess the implications of the data on the estimates of low birthweight (LBW). The percentage of newborns whose birthweight is missing continues to be high in the recent surveys (NFHS-4: 22%, CNNS: 30%) despite an improvement from 66% in NFHS-3. The under-coverage of birthweight data in HMIS is around 40%. In the surveys, the percentage of missing data on birthweight is higher among newborns belonging to poor households, Scheduled Tribes, and Scheduled Castes. Irrespective of whether birthweights are reported from the health cards or from mother's recall, there's a high reporting at multiples of 500g and heaping at 2,500g. The prevalence of missing data on birthweight and of heaping is higher among children born at home in comparison to facility-based births. Birthweight data of dead children who were more likely to have had a lower birthweight is highly underreported. The paper demonstrates state-level variations in birthweight reporting and inconsistencies across surveys and HMIS. In 2015–16, the prevalence of LBW as per HMIS data was 12.5%, whereas during the same period, NFHS-4 and CNNS reported a prevalence of 18%. The findings suggest that LBW is likely to be underestimated when missing data as well as heaping at 2,500g are highly prevalent. To generate robust LBW estimates in India, there is an urgent need to devise methods to ensure coverage of all live births (including early neo-natal deaths) as well as the stillbirths, irrespective of the facility where the deliveries take place.

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Birthweight data in India is highly incomplete, which led to an underestimation of LBW prevalence.

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Live births from lower socio-economic groups have significant missing birthweight data.

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HMIS underreports birthweight data and gives lower LBW estimates than surveys.

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Reported data from both cards and recall show the heaping pattern that further reduces LBW.

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Programmatic efforts to improve the quality of birthweight data are needed to get robust LBW estimates.

Correlates of access to sanitation facilities and benefits received from the Swachh Bharat Mission in India: analysis of cross-sectional data from the 2018 National Sample Survey

OBJECTIVE

Equitable and affordable access to improved sanitation facilities is linked to health and is among the priority areas of development programmes in a country like India. This study assesses the level of different sanitation facilities accessed by households and attempts to understand the socioeconomic characteristics of the households that received financial benefits from the Swachh Bharat Mission (Swachh Bharat Abhiyan), a Government of India flagship programme.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

The study extracted data from the 76th round (2018) of the National Sample Survey, consisting of 106 837 households in India.

OUTCOME MEASURES

Sanitation services and benefits received from the Swachh Bharat Mission in the last 3 years preceding the survey were the two outcome variables of this study. Bivariate and multinomial logistic regression analysis were performed to identify factors associated with the outcome variables.

RESULTS

Findings show the existence of state and regional disparities, along with rural-urban gaps, in the accessibility of sanitation facilities. Half of the households (52%, n=55 555) had access to safely managed sanitation facilities, followed by basic services (14.8%, n=15 812), limited services (11.4%, n=12 179) and unimproved services/open defecation (21.8%, n=23 290). Limited and unimproved facilities decreased significantly (p<0.001) with increase in economic status, although poor and less educated households received the maximum benefit from the Swachh Bharat Mission.

CONCLUSION

The mission has been successful in increasing access overall; however, many people continue to lack access to improved sanitation and there remains a need to follow up poor and rural households to determine their usage of and the current state of their sanitation facilities.

Socioeconomic determinants of smokeless tobacco use among Indian women: An analysis of global adult tobacco survey-2, India

INTRODUCTION

The predominant form of tobacco consumption among women from many Asian countries, including India, is smokeless tobacco (SLT). The present study aimed to assess the prevalence and socioeconomic determinants of SLT use among Indian women.

METHODOLOGY

The study used data from the Global Adult Tobacco Survey-2, India, conducted during 2016-2017, with a sample size of 40,265 women aged 15 years and above. Chi-square test and binary logistic regression were applied with the current use of SLT as the dependent variable to find the sociodemographic factors associated with it.

RESULTS

Overall, 12.8% (95% confidence interval [CI]; 12.4-13.1) of all women and 7.4% (CI: 6.0-8.8) of pregnant women reported SLT use. Its use was higher among women >50 years (23.1%, CI: 22.2-23.8), and those from northeast India (34.9%, CI: 33.8-36.0). Adjusted odds of using SLT were higher among older women (adjusted odds ratio [AOR]: 5.8, CI: 4.5-7.3), women from rural areas (AOR: 1.5, CI: 1.4-1.7), and women belonging to scheduled tribe (AOR: 2.4, CI: 2.2-2.7) as compared to their counterparts. In addition, poor (AOR: 2.6; 95% CI, 2.4-2.8) and middle class (AOR: 1.8; 95% CI, 1.7-2.0) women were more likely to use SLT compared to their rich counterparts. The use of SLT within 30 min of waking up in the morning was seen in 57.2 percent of women users. SLT prevalence was highest among Mizo-speaking women (46.1%, CI: 42.6-49.6), followed by Manipuri (38.9%, CI: 35.5-42.2), Odiya (34.4%), and Khasi (34%, CI: 29.8-38.2).

CONCLUSIONS

There is an imperative need for women-centric schemes on SLT cessation, with special attention to older women, pregnant women, from rural areas, poor households, and the north-eastern region of India.

Does substance use by family members and community affect the substance use among adolescent boys? Evidence from UDAYA study, India

Background

Substance use among adolescents is risky behavior that had emerged as a concern in both developed and developing countries. Evidence revealed that substance use is more frequent among those adolescents whose immediate family members (parents, siblings and grandparents) also indulge in such consumption; however, scarce literature is present in the Indian context. Therefore, the present study examined whether substance use among family members and in the community is associated with the substance use behavior of adolescent boys in Uttar Pradesh and Bihar.

Method

We used the data for 5969 adolescent boys aged 10–19 years from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey conducted in 2016. A three-level random intercept logit model was utilized to understand the association of adolescent substance use behavior with familial and community context.

Results

We found that 16% of adolescent boys were using any substance (tobacco or alcohol or drug). The substance use was significantly higher among adolescent boys who were school dropouts (40%) than those who were currently in school. The prevalence of substance use is also high among those who were working (35%). Moreover, 19, 24 and 28% of the adolescents come from families where at least one of the family members consumed tobacco, alcohol and drugs, respectively. The odds of substance use were 2.13 times [CI:1.44–3.17] higher among those adolescent boys whose family members also indulged in substance use. Moreover, the likelihood of substance use was 1.24 times [CI:1.01–1.68] higher among the adolescent boys who come from a community with high substance use. Additionally, the risk of substance use is more likely among adolescent boys belonging to the same household of the same community.

Conclusion

It is evident that exposure to substance use in the family and community increases the likelihood of substance use among adolescent boys. There is a need for household- and community-level programmatic interventions to alleviate the risk of substance use among adolescents.

Banned by the law, practiced by the society: The study of factors associated with dowry payments among adolescent girls in Uttar Pradesh and Bihar, India

Background

Despite the prohibition by the law in 1961, dowry is widely prevalent in India. Dowry stems from the early concept of ’Stridhana,’ in which gifts were given to the bride by her family to secure some personal wealth for her when she married. However, with the transition of time, the practice of dowry is becoming more common, and the demand for a higher dowry becomes a burden to the bride’s family. Therefore, this study aimed to determine the factors associated with the practice of dowry in Bihar and Uttar Pradesh.

Methods

We utilized information from 5206 married adolescent girls from the Understanding the lives of adolescents and young adults (UDAYA) project survey conducted in two Indian states, namely, Uttar Pradesh and Bihar. Dowry was the outcome variable of this study. Univariate, bivariate, and multivariate logistic regression analyses were performed to explore the factors associated with dowry payment during the marriage.

Results

The study reveals that dowry is still prevalent in the state of Uttar Pradesh and Bihar. Also, the proportion of dowry varies by adolescent’s age at marriage, spousal education, and household socioeconomic status. The likelihood of paid dowry was 48 percent significantly less likely (OR: 0.52; CI: 0.44–0.61) among adolescents who knew their husbands before marriage compared to those who do not know their husbands before marriage. Adolescents with age at marriage more than equal to legal age had higher odds to pay dowry (OR: 1.60; CI: 1.14–2.14) than their counterparts. Adolescents with mother’s who had ten and above years of education, the likelihood of dowry was 33 percent less likely (OR: 0.67; CI: 0.45–0.98) than their counterparts. Adolescents belonging to the richest households (OR: 1.48; CI: 1.13–1.93) were more likely to make dowry payments than adolescents belonging to poor households.

Conclusion

Limitation of the dowry prohibition act is one of the causes of continued practices of dowry, but major causes are deeply rooted in the social and cultural customs, which cannot be changed only using laws. Our study suggests that only the socio-economic development of women will not protect her from the dowry system, however higher dowry payment is more likely among women from better socio-economic class.

An assessment of the role of socio-economic, maternal and service utilization factors in increasing self-reported maternal complications in India

Background

Self-reported maternal complications are associated with maternal morbidity, deliveries by C-section, postpartum depression, and maternal death. Thus, it is necessary to examine the contribution of socio-demographic and maternal characteristics, as well as service utilization in the rising self-reporting of maternal complications (difficulty with daylight vision, convulsions, swelling of the legs, body or face, heavy vaginal bleeding or high fever) in India. The study aimed at examining the factors that have influenced the increasing prevalence of maternal complications between 2005–06 and 2015–16 in India.

Methods

Data from the two most recent rounds of the National Family Health Survey, which covered a sample of 36,850 and 190,898 women respectively who delivered in the last five years preceding the survey has been used. Logistic regression analysis was performed to carve out the factors which significantly contributed to maternal complications among women aged 15 – 49 years in India. With the help of the Fairlie decomposition technique, the study quantified the contribution of factors which influenced the changes in maternal complications in the period from 2005–06 to 2015–16.

Results

A significant increase was seen in the prevalence of maternal complications — from 43.6% to 53.7% between the years 2005–06 and 2015–16. About 21% of the increase could be explained by certain maternal, households level factors, service utilization and birth outcomes. For example, service utilization, in which 13% was attributed to the place of delivery and 6% to postnatal care, was the major contributor to the increase in maternal complications from 2005–06 to 2015–16). This was followed by individual-level factors like education (2%), body mass index (4%) and tobacco use,. It was also found that household-level factors like standard of living (-3.7%) and region (-1.4%), and birth weight contributed to the reduction of complications during the period.

Conclusion

The increase in the prevalence of maternal complications in India could be attributed mainly attributed to increase in reporting behavior, an outcome of increased utilization of maternal healthcare services, and increase in BMI. However, reduced prevalence of maternal complications can be attributed to the decrease in the prevalence of low-birth-weight babies and tobacco use among women in India.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03997-x.

Factors associated with gynaecological morbidities and treatment-seeking behaviour among adolescent girls residing in Bihar and Uttar Pradesh, India

BACKGROUND

Gynaecological morbidities are more common than reproductive and contraceptive morbidities and constitute a substantial proportion of disease burden in women. This study aimed to examine the prevalence and factors associated with gynaecological morbidities and the treatment-seeking behaviour among adolescent girls residing in Bihar and Uttar Pradesh, India.

METHODOLOGY

The study utilized data from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey with a sample size of 14,625 adolescents girls aged 10-19 years. We defined gynaecological morbidity in dichotomous form, created from five questions on different morbidities. Further, the treatment-seeking behaviour was assessed for reported gynaecological morbidities three months prior to the survey. Univariate and bivariate analysis was used to perform analysis to carve out the preliminary results. Additionally, the study employed the heckprobit selection model, a two-equation model, to identify the determinants of outcome variables.

RESULTS

Overall, about one-fourth (23.6%) of the adolescent girls reported suffering from gynaecological morbidities, and only one-third of them went for treatment. Non-Scheduled Caste/Scheduled Tribe (Non-SC/ST) adolescents were significantly less likely to have gynaecological morbidities (β: -0.12; CI: -0.18, -0.06) compared to SC/ST counterparts; however, they were more likely to go for the treatment (β: 0.09; CI: 0.00, 0.19). The adolescents who had 8-9 (β: 0.17; CI: 0.05, 0.29) or ten and above years of education (β: 0.21; CI: 0.09, 0.34) had a higher likelihood of going for the treatment than adolescents with no education. Moreover, adolescents who belonged to rural areas were less likely to go for the treatment of gynaecological morbidities (β: -0.09; CI: -0.17, -0.01) than urban counterparts.

CONCLUSION

Multi-pronged interventions are the need of the hour to raise awareness about the healthcare-seeking behaviour for gynaecological morbidities, especially in rural areas. Adolescent girls shall be prioritized as they may lack the knowledge for gynaecological morbidities, and such morbidities may go unnoticed for years. Mobile clinics may be used to disseminate appropriate knowledge among adolescents and screen asymptomatic adolescents for any possible gynaecological morbidity.

Examining the predictors of use of sanitary napkins among adolescent girls: A multi-level approach

Background

This paper aimed to explore various factors associated with the use of sanitary napkins among adolescent girls in Uttar Pradesh and Bihar.

Methods

The study uses information from the Understanding the Lives of Adolescents and Young Adults (UDAYA) project survey conducted in Uttar Pradesh and Bihar in 2016. The study sample consisted of 14,625 adolescent girls aged 10–19 years. The study sample was selected using a multi-stage systematic sampling design. Multilevel logistic regression (MLR) was used to identify the individual and community level factors associated with the use of sanitary napkins.

Results

The results revealed a wide variation in sanitary napkins’ use across the socio-economic and demographic factors. The use of sanitary napkins was significantly higher among girls with 8–9 (53.2%) and 10 and more (75.4%) years of schooling compared to those who had no formal education (26.4%). The use of sanitary napkins was higher among adolescent girls who were not engaged in paid work (54.7%) than those who did any paid job (40.8%). Adolescent girls reporting frequent exposure to mass media (OR = 2.10), belonging to the richest wealth quintile (OR = 3.76), and whose mothers had 10 or more years of education (OR = 2.29) had a higher propensity to use sanitary napkins than their counterparts. We did not find a significant role of community-level education of mothers on the menstrual hygiene practices of adolescents.

Conclusion

Ensuring that adolescent girls have access to hygienic means to manage their menses is critical from a public health perspective and in enabling them to realize their full potential. Programs to enhance menstrual hygiene are warranted. These programs should involve mothers, who are an important source of knowledge about menstrual hygiene. Facilitating girls’ access to education may also produce tangible menstrual hygiene benefits.

Experience of gender-based violence and its effect on depressive symptoms among Indian adolescent girls: Evidence from UDAYA survey

BACKGROUND

Violence against women has been one of the most prominent issue and a major public health concern. It is a principle violation of basic human rights and has both physical and mental effect on the victim. This study focuses on married and unmarried girls aged 15 to 19 years, belonging to Uttar Pradesh and Bihar, India. This study attempts to examine depression level among married and unmarried girls who have faced violence against them. With the unprecedented growth in social networking, online digital platform and its accessibility, the study also brings out the pertinent aspect of internet based violence and its psychological outcome on adolescent girls. Hence, the study can be seen as an important and needed value addition to the existing pool of knowledge on the subject.

METHODS

The study uses Understanding the lives of adolescents and young adults (UDAYA) project data for Uttar Pradesh and Bihar. Depressive symptoms among adolescent girl is the outcome variable of the study. Descriptive statistic and bivariate analysis has been used to get to preliminary results. Chi-squared test is used to test the significant of variables. Further, multi-variate analysis (logistic regression) was used.

RESULTS

Almost 29, 23 and 26 percent of married adolescent girls had faced emotional, physical and sexual violence respectively. It was found that about five per cent of unmarried and eight per cent of married girls had high depressive symptoms. It was found that unmarried adolescent girls who had witnessed their father beating mother were 71 percent more likely to suffer from higher depressive symptoms [OR: 1.71, 1.09-2.69]. Adolescents who faced perpetrated bullying had 90 per cent [OR: 1.90, 1.32-2.72] and 86 per cent [OR: 1.86, 0.98-3.52] higher likelihood to suffer from higher depressive symptoms.

CONCLUSION

The study goes beyond intimate partner violence and includes various covariates to explain the association between violence and depressive symptoms among married and unmarried adolescents. Hence, more inclusive policies are needed to address the issue of violence against women as the spectrum of the violence is expanding with time.

Associated factors and socio-economic inequality in the prevalence of thinness and stunting among adolescent boys and girls in Uttar Pradesh and Bihar, India

Background

Despite economic growth observed in developing countries, under-nutrition still continues to be a major health problem. Undernutrition in adolescence can disrupt normal growth and puberty development and may have long-term impact. Therefore, it is important to study the undernutrition among adolescents. This study aimed to assess the prevalence and the associated factors of stunting, thinness and the coexistence of both (stunting and thinness) among the adolescent belonging to Uttar Pradesh and Bihar, India.

Methods

The study utilized data from Understanding the Lives of Adolescents and Young Adults (UDAYA) project survey, which was conducted in two Indian states Uttar Pradesh and Bihar, in 2016 by Population Council under the guidance of Ministry of Health and Family Welfare, Government of India. Utilizing information on 20,594 adolescents aged 10–19 years (adolescent boys-5,969 and adolescent girls-14,625), the study examined three outcome variables, i.e., thinness, stunting, and co-existence of both. The study used descriptive and bivariate analysis. Furthermore, the study examined income-related inequality in stunting and thinness through concentration index. At last, the study used Wagstaff decomposition analysis to decompose the concentration index.

Results

The prevalence of thinness was higher among adolescent boys as compared to girls (25.8 per cent vs. 13.1 per cent). However, stunting was more prevalent among girls (25.6 per cent) than in boys (39.3 per cent). The odds of stunting were higher among late adolescents [Boys- OR:1.79; CI: 1.39, 2.30] and [Girls- OR: 2.25; CI: 1.90,2.67], uneducated adolescents [Boys- OR:2.90; CI: 1.67, 5.05] and [Girls- OR: 1.82; CI: 1.44,2.30], and poorest adolescents [Boys- OR:2.54; CI: 1.80, 3.58] and [Girls- OR: 1.79; CI: 1.38,2.32]. Similarly age, educational status, working status and wealth index were significantly associated with thinness among adolescent boys and girls. Media exposure [Boys- OR: 11.8% and Girls- 58.1%] and Wealth index [Boys: 80.1% and Girls: 66.2%] contributed significantly to the inequality in the prevalence of thinness among adolescents. Similarly, wealth index [Boys: 85.2% and Girls: 84.1%] was the only significant contributor to the inequality in the prevalence of stunting among adolescents.

Conclusion

The study provides an understanding that stunting and thinness is a significant public health concern among adolescents, and there is a need to tackle the issue comprehensively. By tackling the issue comprehensively, we mean that the state government of Uttar Pradesh and Bihar shall screen, assess, and monitor the nutritional status of adolescent boys and girls. The interventions shall focus towards both boys as well as girl adolescents, and particular emphasis should be given to adolescents who belonged to poor households. Also, efforts should be taken by stakeholders to increase family wealth status.

Structural equation modeling on the relationship between maternal characteristics and pregnancy complications: A study based on National Family Health Survey

AIM

This study aimed to understand the complex relationship between maternal complications and women's characteristics in India.

METHODS

The present study builds structural equation modeling (SEM) using the data from the National Family Health Survey round 4 (2015-16) and includes 190, 898 women who had given their last birth during 5 years preceding the survey. Based on eight questions related to maternal complications, the SEM constructed two latent variables - complications during pregnancy (PREGCOMP) and delivery (DELCOMP).

RESULTS

Result shows that prolonged labor was highly prevalent (42%) among women, followed by vaginal bleeding (34%) and swelling in legs, body or face (32%). Women from affluent households (β = -0.02 for each-middle, richer and richest quantile), with higher education (β = -0.02), timing when they received first ANC (β = -0.003) and women who received full ANC (β = -0.01) had a lower risk of PREGCOMP. However, consanguineous marriage (β = 0.01) was positively related to PREGCOMP. Further, women with PREGCOMP (β = 0.20), rural residents (β = 0.02), having exposure to mass media (β = 0.01), and who had facility delivery (β = 0.04) were at high risk of DELCOMP. Women with pregnancy complications are more likely to have delivery complications. [Correction added on 27 November, after first online publication: The statement "who received full antenatal care (ANC) (β = -0.05)" has been removed.] CONCLUSION: Socioeconomic and demographic factors significantly affect both the latent variables. This study concludes that the use of intensive healthcare services reduces health complications. The paper recommends early visits and full ANC checkups to reduce pregnancy complications.

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

BACKGROUND

Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities.

METHODS

We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs.

FINDINGS

Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4-40·7) to 50·3% (50·0-50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1-46·5) in 2017, compared with 28·7% (28·5-29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2-89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664-711) of the 1830 (1797-1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6-80·7) of countries from 2000 to 2017, and in 53·9% (50·6-59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017.

INTERPRETATION

Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation.

FUNDING

Bill & Melinda Gates Foundation.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017

BACKGROUND

Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea.

METHODS

We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates.

FINDINGS

The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1-65·8), 17·4% (7·7-28·4), and 59·5% (34·2-86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage.

INTERPRETATION

By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health.

FUNDING

Bill & Melinda Gates Foundation.

Integrating HIV Pre-Exposure Prophylaxis into Family Planning Care: A RE-AIM Framework Evaluation

We aimed to systematically evaluate the feasibility of integrating HIV prevention services, including pre-exposure prophylaxis (PrEP), into a family planning setting in a high-prevalence community. We used the RE-AIM Framework (Reach, Efficacy, Adoption, Implementation, Maintenance) to evaluate the integration of HIV prevention services into a family planning clinic over 6 months. Before the integration, PrEP was not offered. We implemented a staff training program on HIV PrEP. We determined the proportion of women presenting to the clinic who were screened, eligible for, and initiated PrEP through chart review. We assessed staff comfort with PrEP pre- and post-integration. We compared planned and actual implementation, interviewed staff to determine barriers and facilitators, and tracked systems adaptations. We assessed maintenance of PrEP after the study concluded. There were 640 clinical encounters for 515 patients; the rate of HIV counseling and PrEP screening was 50%. The rate was 10% in month 1 and peaked to 65% in month 3. Nearly all screened patients were eligible for PrEP (98.4%) and 15 patients (6%) initiated PrEP. Staff knowledge and comfort discussing PrEP improved after education. Facilitators included partnering with local experts, continuing education, clinical tools for providers, and patient education materials. Barriers included competing priorities during clinical encounters, limited woman-centered patient education materials, and insurance-related barriers. Embedding HIV prevention services in the family planning setting was feasible in this pilot. The proportion of women screened for PrEP rapidly increased. In this high HIV prevalence community, nearly all screened women were eligible and 6% initiated PrEP.

Length of stay after childbirth in India: a comparative study of public and private health institutions

Background

This paper discusses length of stay (LOS) following childbirth as an indicator of quality of postnatal care in health institutions. This research aims to describe LOS according to both vaginal and cesarean deliveries in public and private health care institutions in India, and to identify any association of LOS with postnatal care and post-delivery complications.

Methods

We use recently released nationally-representative data from the National Family Health Survey-4 (2015–16) and apply the Cox proportional hazard model to determine the factors associated with LOS at the health facility after childbirth during a five-year period preceding the survey.

Results

Overall, the average LOS after childbirth is 3.4 days; 2.1 days for vaginal deliveries and 8.6 days for cesarean section (CS) deliveries. Strikingly, half of the women are discharged within 48 h. Women who give birth in private hospitals have a more prolonged stay than those who give birth in public health facilities. For vaginal birth in public hospitals, one-fourth of the women are discharged with insufficient LOS as against only 19.2% women in private hospitals. LOS is significantly related to the cost of delivery only in the case of private facilities. Uneducated women belonging to lower wealth quintile households and those living in rural areas stay for a shorter duration for vaginal deliveries but for a longer duration in case of cesarean deliveries. Women who get four or more antenatal check-ups (ANC) done have a longer stay, while those who receive benefits under the Janani Suraksha Yojna (JSY) have a shorter stay. Another key finding is that women who are discharged on the same day report lower levels of postnatal care and a higher proportion of post-delivery complications.

Conclusion

The study concludes that early discharge has a negative association with maternal health outcomes, which has important program implications. Therefore, it is essential to maintain an adequate LOS at a facility after childbirth. We recommend that government programs should strengthen the JSY scheme not only to improve delivery care, but also to provide effective postnatal care by promoting sufficient LOS at facilities.

Are Linear Measurements of the Nucleus Basalis of Meynert Suitable as a Diagnostic Biomarker in Mild Cognitive Impairment and Alzheimer Disease?

BACKGROUND AND PURPOSE

Cell loss within the nucleus basalis of Meynert is an early event in Alzheimer disease. The thickness of the nucleus basalis of Meynert (NBM) can be measured on structural MR imaging. We investigated NBM thickness in relation to cognitive state and biochemical markers.

MATERIALS AND METHODS

Mean bilateral nucleus basalis of Meynert thickness was measured on coronal T1-weighted MR imaging scans from the Alzheimer's Disease Neuroimaging Initiative dataset. Three hundred and fifteen scans (80 controls, 79 cases of early mild cognitive impairment, 77 cases of late mild cognitive impairment and 79 cases of Alzheimer disease) were assessed. Alzheimer's Disease Assessment Scale-Cognitive scores, CSF tau, and amyloid quantification were extracted. Group differences in NBM thickness, their correlates and measurement reliability were assessed.

RESULTS

Mean NBM thickness ± SD progressively declined from 2.9 ± 0.3, 2.5 ± 0.3, and 2.3 ± 0.3 to 1.8 ± 0.4 mm in healthy controls, patients with early mild cognitive impairment, late mild cognitive impairment and Alzheimer disease respectively (P < .001). NBM thickness was negatively correlated with Alzheimer's Disease Assessment Scale-Cognitive scores (r = -0.53, P < .001) and weakly positively correlated with CSF amyloid (r = 0.250, P < .001) respectively. No association with CSF tau was found. NBM thickness showed excellent diagnostic accuracy to differentiate Alzheimer disease (area under the curve, 0.986) and late mild cognitive impairment from controls (area under the curve, 0.936) with excellent sensitivity, but lower specificity 66.7%. Intra- and interrater reliability for measurements was 0.66 and 0.47 (P < .001).

CONCLUSIONS

There is progressive NBM thinning across the aging-dementia spectrum, which correlates with cognitive decline and CSF markers of amyloid-β pathology. We show high diagnostic accuracy but limited reliability, representing an area for future improvement. NBM thickness is a promising, readily available MR imaging biomarker of Alzheimer disease warranting diagnostic-accuracy testing in clinical practice.

Feasibility and Results of Cancer Registry and Noncommunicable Disease Cohort Data Linkages in India

Background: Cancer registries worldwide are vital to determine cancer burden, plan cancer control measures, and facilitate research. Population-based cancer registries are a priority for LMICs by the UICC; the National Cancer Registry Program (NCRP) of India oversees 28 such registries. A primary function of registries is to combine data for the same individual from multiple sources. For other disease cohorts where cancer is an outcome of interest, registries can potentially connect information by linking datasets together. Barriers to successful registration and linkages include systems in which cancer is not a notifiable disease, no universal unique individual identifier exists, and lack of trained personnel. This study utilizes technology and infrastructure to develop better linkages, surveillance, and outcomes. Aim: To assess the feasibility of linking large cohorts designed for cardio-metabolic disease research with cancer registries in New Delhi and Chennai; determine additional steps required for linkage accuracy and completeness; and develop detailed protocols for future applications. Methods: A pilot protocol for linkage between a large diabetes cohort and cancer registries in Delhi and Chennai was developed using MatchPro, a probabilistic record linkage program developed for cancer registries. Probabilistic software links datasets together in the presence of uncertainty (eg misspelled or abbreviated names) to identify record pairs with high probability of representing the same individual. For this study, algorithms were developed to address unique aspects of names and demographics in India. The software and algorithms focused on: detecting duplicates in cancer registries; and linking registries with external files from diabetes cohorts. In Delhi, 3 1-year datasets covering 3 years (2010, 2011, 2012) were linked with the diabetes cohort; in Chennai, the linkage included 3 5-year datasets covering 15 years (2000-04, '05-'09, '10-'14). The unique ID (Aadhaar) is not collected or linked systematically between different systems at this point in time. Results: Linkage attempts yielded potential matches ranked according to probabilistic scores; highest scores were reviewed to determine true matches. In Chennai, this process yielded: (2010-2014) 21% self-reported (SR) cases matching perfectly, 36% requiring follow-up, 13 nonreported (NR) cases found; 2005-2009: 33% SR cases matched perfectly, 1 NR case found; 2000-2004: 1 NR case. Also, 2 training workshops on data linkages and software were held. Conclusion: Linkages between cancer registries and other data sources are feasible in LMICs using probabilistic record linkage software augmented by manual matching. Future efforts to use existing epidemiologic resources (cohorts) and cancer research infrastructure (registries and clinical centers) can enhance research including understanding shared risk factors and pathophysiologic mechanisms e.g., between cancer and other NCD.

Ageing and changing patterns in familial structure for older persons in India: a decomposition analysis

Purpose

– At the turn of twenty-first century, India is facing rapid population ageing coupled with consequential socio-economic development changes. Against the backdrop of such changes, its traditional familial support system of living arrangements for older persons is swiftly changing, undergoing rapid transition towards nuclear family systems. The paper aims to discuss these issues.

Design/methodology/approach

– This paper examined: first, the changing trends and patterns in joint family systems defined in terms of households with older persons and total households; and second, socio-economic and demographic determinants of changes in the proportion of nuclear households with older adults. The decomposition analysis segregated the contribution of determinants of the change in nuclear households with older persons in three different components: propensity, composition, and interaction. The study used data from three successive rounds of the National Family Health Survey.

Findings

– Results indicate that a lower proportion of households with older persons were nuclear compared to total households. However, for both types of households, nuclear households increased by nine percentage points during 1992-2006. Households with older persons that were headed by old aged persons, illiterates or females, situated in urban area, not owned agriculture land, lower affluent level, and from Southern India were at most risk of being nuclear than their counterparts.

Originality/value

– This study provided ample evidence of the increase in nuclear familial structure for older persons in the course of population ageing. Population ageing, urbanization and increase in education, primarily contributed to the increase in nuclear family households of older persons.

Informing the scaling up of voluntary medical male circumcision efforts through the use of theory of reasoned action: survey findings among uncircumcised young men in Swaziland

Assessing predictors of intention to circumcise can help to identify effective strategies for increasing uptake of voluntary medical male circumcision (VMMC). Grounded in the theory of reasoned action (TRA), the current study of uncircumcised males ages 13-29 in Swaziland (N = 1,257) employed multivariate logistic regression to determine predictors of VMMC intention. The strongest predictors were strongly disagreeing/disagreeing that sex was more painful for a circumcised man (odds ratio [OR] = 4.37; p = < .007), a Christian man should not get circumcised (OR = 2.47; p < .001), and circumcision makes penetration more painful and difficult (OR = 2.44; p = .007). Several beliefs about enhanced sexual performance, normative beliefs (parents, sexual partner, and friends), and non-TRA-related factors (e.g., importance of plowing season to daily schedule) were also statistically significant predictors. TRA proved a useful theory to explore young men's intention to circumcise and can help inform interventions aimed at increasing uptake of VMMC.

Assessing the impact of family planning advice on unmet need and contraceptive use among currently married women in Uttar Pradesh, India

BACKGROUND

Counseling/advice is one of the key interventions to promote family planning (FP) in developing countries, including India. It helps to improve the quality of care and reduce maternal deaths. This paper investigates the continuity of maternal health (MH) service utilization from antenatal care to post-natal care and the impact this service utilization has on contraceptive use and on meeting the demand for family planning among currently married women in rural Uttar Pradesh, India.

METHODS AND FINDINGS

The study assesses the impact of FP advice on unmet need and contraceptive use by adopting the propensity score matching method. It uses data from the District Level Household Survey (DLHS) (2007-08) that covered 76,147 currently married women (CMW) in the age group 15-44 years in Uttar Pradesh. Results show that the utilization of MH services [Antenatal care (ANC), institutional delivery, Postnatal care (PNC)] and FP advice during ANC and PNC has led to increase in current use of contraception by 3.7% (p<.01), 7.3% (p<.01) and 6.8% (p<.01), respectively. However, a greater utilization of these services has not translated into a reduction of unmet need for contraception at a similar manner.

CONCLUSION

MH service utilization including FP advice is more effective in increasing current use of spacing methods as compared to limiting methods. Findings support the need for "effective FP advice" interventions to reduce unintended births and unmet need. However, women from Scheduled Caste/Scheduled Tribe communities are less likely to receive MH services. Thus, efforts are required to ensure that currently married women across socio-economic backgrounds have equal opportunity to receive MH services and information on contraceptive use to meet the demand for family planning methods.

Development of an adhesive surgical ward round checklist: a technique to improve patient safety

Checklists have been shown to improve patient outcomes. Checklist use is seen in the pre-operative to post-operative phases of the patient pathway. An adhesive checklist was developed for ward rounds due to the positive impact it could have on improving patient safety. Over an eight day period data were collected from five consultant-led teams that were randomly selected from the surgical department and divided into sticker groups and control groups. Across the board percentage adherence to the Good Surgical Practice Guidelines (GSPG) was markedly higher in the sticker study group, 1186 (91%) in comparison with the control group 718 (55%). There was significant improvement of documentation across all areas measured. An adhesive checklist for ward round note taking is a simple and cost-effective way to improve documentation, communication, hand-over, and patient safety. Successfully implemented in a tertiary level centre in Dublin, Ireland it is easily transferable to other surgical departments globally.