Sustainable approach of La doped CuFe2O4 nanomaterial for electrochemical lead and paracetamol sensing action with multiple applications

This present research aimed to investigate the novel applications of synthesized La doped CuFe2O4 nanomaterial (LCF NMs) using renewable bio-fuel (Aegle Marmelos extract) by combustion process. The sensor applications were accomplished by modified electrode using LCF NMs with graphite powder and examined its excellent sensing action towards heavy metal (Lead content) and drug chemical (Paracetamol) substances. The thermodynamics of redox potential and super-capacitor behavior of LCF NMs were investigated through Cyclic Voltametric (CV) and Electrochemical Impedance Spectral (EIS) methods under specific conditions at scan rate of 1 to 5 mV/s. The heterogeneous photo-catalytic process of prepared NMs on Fast orange Red (FOR) dye-decolouration was investigated and noted its excellent degradation (91.7%) at 90 min using 20 ppm of dye solution and 40 mg of synthesized samples under Sun-light irradiation. Further, the antibacterial activity of synthesized NMs is investigated against various strains of gram positive (Bacillus subtillis) and gram negative bacteria (Pseudomonas aeruginosa), which confirms that the LCF NMs have higher activity towards gram positive bacteria with an average inhibition zone of 19 mm. This synthesized LCF NMs is a multi-functional material with stable and eco-friendly materials.

Estimating the Cost of Delivering Tobacco Cessation Intervention Package at Noncommunicable Disease Clinics in Two Districts of North India

INTRODUCTION

Integrated care is likely to improve outcomes in strained healthcare systems while limiting costs. NCD clinics were introduced under the "National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke" (NPCDCS) in India; however, there is limited literature on the costs of delivering tobacco cessation interventions within NPCDCS. One of the study's objectives was to estimate the cost of delivering a culturally specific patient-centric behavioral intervention package in two district-level NCD clinics in Punjab, India.

METHODS

Costing was undertaken using the health systems perspective. A top-down or financial costing approach and a bottom-up or activity-based approach were employed at each step of development and implementation. The opportunity cost was used to include the cost of human resources, infrastructure, and capital resources used. All infrastructure and capital costs were annualized using a 3% annual discount rate. Four additional scenarios were built up concerning three major components to reduce costs further when rolled out on a large scale.

RESULTS

The cost of intervention package development, human resource training, and unit cost of implementation were estimated to be INR 6,47,827 (USD 8,874); INR 134,002 (USD 1810); and INR 272 (USD 3.67), respectively. Based on our sensitivity analysis results, the service delivery cost varied from INR 184 (USD 2.48) to INR 326 (USD 4.40) per patient.

CONCLUSION

The development costs of the intervention package accounted for the majority proportion of the total cost. Of the total unit cost of implementation, the telephonic follow-up, human resources, and capital resources were the major contributory components.

IMPLICATIONS

The current study aims to fill gaps by estimating the unit-level health systems cost of a culturally sensitive, disease-specific, and patient-centric tobacco cessation intervention package delivered at the outpatient settings of NCD clinics at the secondary level hospital, which represents a major link in the health care system of India. Findings from this study could be used to provide supportive evidence to policymakers and program managers for rolling out such interventions in established NCD clinics through the NPCDCS program of the Indian Government.

Immunohistochemical Surrogates for Molecular Stratification in Medulloblastoma

BACKGROUND

The WHO classification of central nervous system neoplasms (2016) recognized 4 histologic variants and genetically defined molecular subgroups within medulloblastoma (MB). Further, in the 2021 classification, new subtypes have been provisionally added within the existing subgroups reflecting the biological diversity. YAP1, GAB1, and β-catenin were conventionally accepted as surrogate markers to identify these genetic subgroups.

OBJECTIVES

We aimed to stratify MB into molecular subgroups using 3 immunohistochemical markers. TP53 mutation was also assessed in Wingless (WNT), and Sonic Hedgehog (SHH) subgroups. Demographic profiles, imaging details, and survival outcomes were compared within these molecular subgroups.

PATIENTS AND METHODS

Our cohort included 164 MB cases diagnosed over the last 10 years. The histologic variants were identified on histology, and tumors were molecularly stratified using YAP1, GAB1, and β-catenin. Further, TP53 mutation was assessed using immunohistochemical in WNT and SHH subgroups. The clinical details and survival outcomes were retrieved from the records, and the mentioned correlates were evaluated statistically.

RESULTS

The age ranged from 1 to 52 years with M:F ratio of 2:1. Group 3/group 4 constituted the majority (48.4%), followed by SHH (45.9%) and WNT subgroups (5.7%). Desmoplastic/nodular and MB with extensive nodularity had the best survival, whereas large cell/anaplastic had the worst. The follow-up period ranged from 1 to 129 months. The best outcome was observed for the WNT subgroup, followed by the SHH subgroup; group 3/group 4 had the worst. Among the SHH subgroup, TP53 mutant tumors had a significantly poorer outcome compared with SHH-TP53 wildtype.

CONCLUSIONS

Molecular stratification significantly contributes to prognostication, and a panel of 3 antibodies is helpful in stratifying MB into its subgroups in centers where access to advanced molecular testing is limited. Our study reinforces the efficacy of incorporating this cost-effective, minimal panel into routine practice for stratification. Further, we propose a 3-risk stratification grouping, incorporating morphology and molecular markers.

Culturally adapted psychosocial interventions (CaPSI) for early psychosis in a low-resource setting: study protocol for a large multi-center RCT

BACKGROUND

Psychosis treatment guidelines recommend cognitive behaviour therapy (CBT) and family intervention (FI), for all patients with first episode psychosis (FEP), though guidance borrows heavily from literature in adults from high income countries. To our knowledge, there are few randomized controlled trials (RCTs) examining the comparative effect of these commonly endorsed psychosocial interventions in individuals with early psychosis from high-income countries and no such trials from low and middle-income countries (LMICs). The present study aims to confirm the clinical-efficacy and cost-effectiveness of delivering culturally adapted CBT (CaCBT) and culturally adapted FI (CulFI) to individuals with FEP in Pakistan.

METHOD

A multi-centre, three-arm RCT of CaCBT, CulFI, and treatment as usual (TAU) for individuals with FEP (n = 390), recruited from major centres across Pakistan. Reducing overall symptoms of FEP will be the primary outcome. Additional aims will include improving patient and carer outcomes and estimating the economic impact of delivering culturally appropriate psychosocial interventions in low-resource settings. This trial will assess the clinical-efficacy and cost-effectiveness of CaCBT and CulFI compared with TAU in improving patient (positive and negative symptoms of psychosis, general psychopathology, depressive symptoms, quality of life, cognition, general functioning, and insight) and carer related outcomes (carer experience, wellbeing, illness attitudes and symptoms of depression and anxiety).

CONCLUSIONS

A successful trial may inform the rapid scale up of these interventions not only in Pakistan but other low-resource settings, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority groups with FEP.

TRIAL REGISTRATION

NCT05814913.

The effectiveness of prenatal and postnatal home visits by paramedical professionals and women's group meetings in improving maternal and child health outcomes in low and middle-income countries: a systematic review and meta-analysis

OBJECTIVE

To assess the effectiveness of prenatal and postnatal home visits (HVs) and women group meetings (WGMs) by paramedical professionals to improve maternal and child health outcomes in low- and middle-income countries (LMICs).

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

We conducted a systematic review of trials published till December 2020, as per registered protocol in The International Prospective Register of Systematic Reviews (PROSPERO) (CRD42018091968). Outcomes were neonatal mortality rate (NMR), maternal mortality ratio (MMR), the incidence of low birth weight, and still birth rate (SBR). The Cochrane Pregnancy and Childbirth Group's Trials Register, Cochrane Central Register of Controlled Trials, PubMed, and Excerpta Medica Database (EMBASE) were searched. Pooled results were estimated using random-effects meta-analysis in RevMan version 5.2.

RESULTS

Twenty-five trials met the inclusion criteria. HVs were the key intervention in 12, WGMs in 11, and both interventions in 2 trials. The pooled estimates have shown that NMR was significantly reduced by HVs (OR 0.77, confidence interval [CI]: 0.67-0.90, P = 0.0007, I² = 77%) and WGMs (OR 0.76, CI: 0.65-0.90, P = 0.001, I² = 71%). SBR was significantly reduced by HVs (OR 0.77, CI: 0.70-0.85; P < 0.001, I² = 0%). Subgroup analysis of studies in which more than 10% of pregnant women participated in the WGMs showed significant reduction in NMR (OR 0.67, CI 0.58-0.77, P = 0.00001, I² = 31%) and MMR (OR 0.55, CI 0.36-0.84, P = 0.005, I² = 27%). Two studies reported improvement in birth weight by HVs.

CONCLUSIONS

HVs and WGMs (with >10% pregnant women) by paramedical professionals are effective strategies in reducing the NMR and MMR in LMICs. HVs were also effective in reducing SBR.

Comprehensive assessment of age-specific mortality rate and its incremental changes using a composite measure: A sub-national analysis of rural Indian women

Background

Diverse socio-economic and cultural issues contribute to adverse health outcomes and increased mortality rates among rural Indian women across different age categories. The present study aims to comprehensively assess age-specific mortality rates (ASMR) and their temporal trends using a composite measure at the sub-national level for rural Indian females to capture cross-state differences.

Materials and methods

A total of 19 states were included in the study to construct a composite age-specific mortality index for 2011 (base year) and 2018 (reference year) and examine the incremental changes in the index values across these years at the sub-national level in India. Sub-index values were calculated for each component age group and were subsequently used to compute the composite ASMR index using the geometric mean method. Based on the incremental changes, the performance of states was categorized into four different typologies.

Results

Improvement in mortality index scores in the 0-4 years age group was documented for all states. The mortality rates for the 60+ age group were recorded to be high for all states. Kerala emerged as the overall top performer in terms of mortality index scores, while Bihar and Jharkhand were at the bottom of the mortality index table. The overall mortality composite score has shown minor improvement from base year to reference year at all India level.

Conclusion

An overall reduction in the mortality rates of rural Indian women has been observed over the years in India. However, in states like Bihar and Jharkhand, mortality is high and has considerable scope for improvement. The success of public health interventions to reduce the under-five mortality rate is evident as the female rural mortality rates have reduced sizably for all states. Nevertheless, there is still sizable scope for reducing mortality rates for other component age groups. Additionally, there is a need to divert attention toward the female geriatric (60+ years) population as the mortality rates are still high.

Measurement and mapping of maternal health service coverage through a novel composite index: a sub-national level analysis in India

BACKGROUND

Expansion of maternal health service coverage is crucial for the survival and wellbeing of both mother and child. To date, limited literature exists on the measurement of maternal health service coverage at the sub-national level in India. The prime objectives of the study were to comprehensively measure the maternal health service coverage by generating a composite index, map India by categorizing it into low, medium and high zones and examine its incremental changes over time.

METHODS

Utilising a nationally representative time series data of 15 key indicators spread across three domains of antenatal care, intranatal care and postnatal care, we constructed a novel 'Maternal Health Service Coverage Index' (MHSI) for 29 states and 5 union territories of India for the base (2017-18) and reference (2019-20) years. Following a rigorous procedure, MHSI scores were generated using both arithmetic mean and geometric mean approaches. We categorized India into low, medium and high maternal health service coverage zones and further generated geospatial maps to examine the extent and transition of maternal health service coverage from base to reference year.

RESULTS

India registered the highest mean percentage coverage (93.7%) for 'institutional delivery' and the lowest for 'treatment for obstetric complications' (9.3%) among all the indicators. Depending on the usage of arithmetic mean and geometric mean approaches, the maternal health service coverage index score for India exhibited marginal incremental change (between 0.015-0.019 index points) in the reference year. West zone exhibited an upward transition in the coverage of maternal health service indicators, while none of the zones recorded a downward movement. The states of Mizoram (east zone) and the Union Territory of Puducherry (south zone) showed a downward transition. Union territories of Dadra & Nagar Haveli (west zone) and Chandigarh (north zone), along with the states of Maharashtra (west zone), Assam, as well as Jharkhand (both from the east & north east zone), showed upward transition.

CONCLUSION

Overall, maternal health service coverage is increasing across India. Our study offers a novel summary measure to comprehensively quantify the coverage of maternal health services, which can momentously help India identify lagged indicators and low performing regions, thereby warranting the targeted interventions and concentrated programmatic efforts to bolster the maternal health service coverage at the sub-national level.

Trends in willingness to receive COVID-19 vaccines among healthcare workers in India: Findings from repeated cross-sectional national surveys

Background

COVID-19 vaccination of the healthcare workers (HCWs) is a key priority in the fight against the SARS-CoV-2 pandemic. India launched its COVID-19 vaccination program in January 2021. We aimed to understand the trends in willingness to receive COVID-19 vaccines and its associated factors among HCWs in India.

Methods

Using a repeated cross-sectional survey design, we collected information from HCWs in three critical time points: before (n = 937, October 2020), during (n = 1346, January 2021); and after (n = 812, May 2021) the introduction of COVID-19 vaccines in India. The third survey coincided with the peak of the second wave of COVID-19 pandemic in India.

Findings

Of the study participants, 43.7, 60.2, and 73.2% were willing to receive COVID-19 vaccines during the first, second and third rounds of surveys, respectively. In multivariable logistic regression analysis, participants who trusted the health care system were more likely to report willingness to receive a COVID-19 vaccine; medical trust emerged as a significant factor in all the three rounds of surveys (First survey-aOR: 2.24, 95% CI: 1.67-2.99; Second survey-aOR: 3.38, 95% CI: 2.64-4.33; Third survey-aOR: 2.54, 95% CI: 1.65-3.91). Having confidence in domestic vaccines (Second survey-aOR: 2.21, 95% CI: 1.61-3.02; Third survey-aOR: 2.05, 95% CI: 1.24-3.37); and high perceived risk of contracting COVID-19 (Second survey-aOR: 1.48, 95% CI: 1.13-1.93; Third survey-aOR: 2.02, 95% CI: 1.31-3.13) were found to be associated with willingness to receive vaccines. Among socio-demographic characteristics, being married (aOR: 1.71, 95% CI: 1.08-2.71) and having high socio-economic status (aOR: 3.01, 95% CI: 1.65-5.51) emerged as significant factors associated with willingness to receive COVID-19 vaccines in the third round of the surveys.

Interpretation

Willingness to receive COVID-19 vaccine increased with time, as the severity of the pandemic increased. To increase COVID-19 acceptance and coverage among HCWs, it is important to instill confidence in domestic vaccines and assist in accurate assessment of risk toward contracting COVID-19 infection.

Community health workers willingness to participate in COVID-19 vaccine trials and intention to vaccinate: A cross-sectional survey in India

Background

Vaccine hesitancy is of considerable concern as it threatens the great potential of a vaccine against COVID-19. This study aims to determine factors associated with community health workers’ willingness to participate in clinical trials of COVID-19 vaccine, and their vaccination intention, in India.

Methods

A cross-sectional study was conducted among 377 community health workers using self-administered anonymous questionnaire during the lockdown periods in India. Participant's socio-demographics, willingness-to-participate in COVID-19 vaccine trials, intention to accept COVID-19 vaccine were recorded in a Likert scale. Data were analysed descriptively, and a multivariate logistic regression model was used to investigate factors associated with willingness to participate and accept the vaccine.

Results

Among 377 CHWs, 70 (19%) intended to participate in COVID-19 vaccine trial, 151 (40%) responded positively regarding their intention to get vaccinated. Those with knowledge on development of COVID-19 vaccine [aOR 3.05 (95% CI: 1.18–7.88), p = 0.021], and men [aOR 3.69 (95% CI: 1.51–8.97), p = 0.004] were more willing to participate in clinical-trial, while an undergraduate degree, and trust in domestic vaccines were identified as deterrents for the same. Perceiving COVID-19 as risk [aOR 2.31 (95% CI: 1.24–4.31), p = 0.009], and male gender [aOR 2.39 (95% CI: 1.17–4.88), p = 0.017] were factors associated with intention to get vaccinated. Respondents who had knowledge about COVID-19 virus were less likely to uptake the hypothetical vaccine [aOR 0.32 (95% CI: 0.12–0.88), p = 0.027].

Conclusions

Increasing knowledge regarding COVID-19 is not enough to improve vaccine acceptance rates. Targeted interventions addressing socio-demographic determinants related to COVID-19 vaccination should help improve acceptance.

Sociodemographic Determinants of Willingness and Extent to Pay for COVID-19 Vaccine in India

Background

Responding to the fast transmission rates and increasing fatality rates, countries across the world expedited the development and deployment of the vaccine for coronavirus disease 2019 (COVID-19). Evaluation of individuals' willingness to pay (WTP) would provide pertinent information regarding future demand and financing preferences, which shall help to devise the effective payment strategy for COVID-19 vaccination.

Methods

A nationwide, cross-sectional, and self-administered online survey using a structured questionnaire was conducted to identify the sociodemographic determinants of willingness and extent to pay for COVID-19 vaccine in India. A non-probability convenience sampling followed by snowball sampling was employed to recruit participants (n = 3,341). The likelihood of sociodemographic determinants to predict willingness and extent to pay was modeled using the multivariate binary logistic regression analysis.

Results

Out of 3,341 participants, 68% (n = 2,271) were willingness to pay for COVID-19 vaccine. Results showed significantly higher odds for willingness to pay among participants who were single [adjusted odds ratio (aOR) = 1.394, p < 0.01] and having a family size of 4 members (aOR = 1.346, p < 0.01). The adjusted odds ratio sizably increased from 1.396 for participants whose monthly income was between INR 10,000 and 20,000/month to 2.240 for participants whose monthly income was above INR 50,000/month. Further, out of 2,271 of those participants who were willingness to pay for COVID-19 vaccine, majority (n = 1,246, 54.9%) of participants were willingness to pay below 50% of COVID-19 vaccine cost. This study found that those who are single (aOR = 0.688, p < 0.01), having an income between INR 20,000 and 50,000/month (aOR = 0.686, p < 0.05), and those who belonged to socially disadvantaged category (aOR = 0.450, p < 0.01) were estimated to have significantly lower odds of willingness to pay more than 50% of COVID-19 vaccine cost.

Conclusion

This study observed that majority of those participants who willingness to pay for COVID-19 vaccine were willingness to pay only up to 50% of COVID-19 vaccine and income was observed as a precursor predictor of the willingness and extent to pay for COVID-19 vaccine. The understanding on the willingness and extent to pay for COVID-19 vaccine and its sociodemographic determinants will be helpful for making the strategic decisions related to the financing of COVID vaccine in India.

Parents' Perceptions and Intention to Vaccinate Their Children Against COVID-19: Results From a Cross-Sectional National Survey in India

Background

Despite the success of adult vaccination against COVID-19, providing vaccines to children remains a challenge for policymakers globally. As parents are primary decision-makers for their children, we aimed to assess parents' perceptions and intentions regarding COVID-19 vaccination in India.

Methods

A cross-sectional web-based study was designed, parents or caregivers (N = 770) were recruited through snowball sampling using Google form. Cross-tabulation was performed by parents' intention to vaccinate their children against COVID-19 virus with sociodemographic characteristics and their risk perception toward COVID-19, trust in the healthcare system, and their history of vaccine hesitancy behavior. Multivariable logistic regression analysis was performed to compute the predictors of child vaccination intention among Indian parents.

Results

Seven hundred and seventy parents across the country have completed the survey. Of the 770 participants, 258 (33.5%) have shown intent to vaccinate their children. The stated likelihood of child vaccination was greater among parents who had a bachelor's degree or higher education (aOR: 1.98, 95% CI: 1.15-3.51); as well as among parents who intended to vaccinate themselves (aOR: 2.35, 95% CI: 1.30-4.67). Parental concerns centered around vaccine safety and side effects.

Conclusion

Indian parents reported high knowledge of the COVID-19 virus and were aware of the development of a vaccine. However, about one-third of parents intended to vaccinate their children, and about half of them were not sure whether to vaccinate their children or not against the COVID-19 virus. The study highlighted the need for health promotion strategies that promote vaccine uptake among parents.

Molecular subgrouping of ependymoma across three anatomic sites and their prognostic implications

The 2021 WHO classification stratifies ependymoma (EPN) into nine molecular subgroups according to the anatomic locations which outperforms histological grading. We aimed at molecularly reclassifying 200 EPN using immunohistochemistry (IHC) and sequencing for ZFTA fusions in supratentorial (ST) EPN. Further, we assessed the utility of L1CAM, cyclinD1, and p65 markers in identifying ZFTA fusion. Demographic profiles, histologic features, molecular subgroups and clinical outcome were retrospectively analyzed. IHC for L1CAM, cyclinD1, p65, H3K27me3, and H3K27M and sequencing for ZFTA fusion were performed. ZFTA fusions were identified in 44.8% ST EPN. p65 displayed the highest specificity (93.8%), while L1CAM had the highest sensitivity (92.3%) in detecting ZFTA fusions. The negative predictive value approached 96.6% and sensitivity improved to 96.2% with combinatorial IHC (L1CAM, cyclinD1, p65). H3K27me3 loss (PF-A) was noted in 65% PF EPN. Our results provide evidence that a combination of two of three (L1CAM, p65, and cyclinD1) can be used as surrogate markers for predicting fusion. ZFTA fusion, and its surrogate markers in ST, and H3K27me3 and younger age (< 5 years) in PF showed significant correlation with PFS and OS on univariate and Kaplan-Meier analysis. On multivariate analysis, H3K27me3 loss and younger age group are associated with poor clinical outcome.

Predictors of COVID-19 positivity among patients presenting to screening clinic in a dedicated COVID-19 hospital, in chandigarh, India - A cross-sectional study

Background:

The aim of this study was to analyze the clinical features of patients attending the screening clinic of a dedicated COVID-19 hospital (DCH), including COVID-19 RT-PCR test positivity rate, symptom predictors for COVID-19 positivity, the proportion of recovery, and the mortality among COVID-19 positive cases.

Methods:

We conducted a cross-sectional study of the patients who reported in the screening clinic of a DCH. Data were retrieved from medical records. Step-wise binary logistic regression was applied to determine the symptom predictors for determining the likelihood of the suspects turning out to be COVID-19 positive.

Results:

A total of 573 patients reported to the screening clinic were enrolled, and their median age was 36 ± 14 years. Of the total patients, 237 (41%) were females and 112 (20%) patients were COVID-19 suspects. Fifty (45%) suspects tested COVID-19 positive. The majority of the positives had complaints of cough, fever, and sore throat. Running nose (OR = 7.951) and history of contact with a COVID-19-positive case (OR = 169.9) were found to be statistically significant symptom predictors for COVID-19 positivity. All patients recovered with nil case fatality.

Conclusion:

Running nose and history of contact with COVID-positive patients were significant predictors for COVID-19 positivity. In this pandemic state, patients who present with any of the upper respiratory infection (URI) symptoms such as cough, sore throat, running nose, headache, and loss of taste/smell should be tested for COVID-19 for early identification and isolation to break the chain of transmission. The public should be encouraged to undergo COVID-19 testing if they develop any of the URI symptoms.

Factors Influencing COVID-19 Vaccination Intentions Among College Students: A Cross-Sectional Study in India

Background: Students act as messengers in delivering effective messages for better uptake of health-promoting behavior. Understanding their knowledge about coronavirus disease 2019 (COVID-19), intentions to use the COVID-19 vaccine, and its associated factors will help develop promising strategies in vaccine promotion concerning the current COVID-19 pandemic. Methods: A cross-sectional online survey was carried out among students in the healthcare and non-healthcare sectors to assess their intentions to get vaccinated against the COVID-19. A non-probability snowball sampling technique was used to recruit study participants (N = 655) through social media platforms and emails. Study participants were recruited across the country, including six major geographical regions (Eastern, Western, Northern, Southern, North-east, and Central) in India between November 2020 and January 2021 before the introduction of the COVID-19 vaccine. Descriptive statistics were used to present the sociodemographic, and vaccine-related behaviors of the study participants. Key determinants that likely predict vaccine acceptance among students were modeled using logistic regression analysis. For each analysis, p < 0.05 was considered significant. Results: A total of 655 students were recruited, 323 from healthcare and 332 from non-healthcare sectors, to assess their intentions to receive the COVID-19 vaccine. Of the 655 students, 63.8% expressed intentions to receive the COVID-19 vaccine. The acceptance was higher among non-healthcare students (54.07 vs. 45.93%). At the time of the study, 27.8% of the students indicated that they had been exposed to a confirmed COVID-19 patient. A vast majority (93.4%) of the students knew about the COVID-19 virus, and most (89.3%) of them were aware of the development of a COVID-19 vaccine. The history of vaccine hesitancy was found to be low (17.1%). Only one-third (33.4%) of the students showed concern about contracting COVID-19. Trust in the healthcare system [adjusted odds ratio (aOR): 4.13; (95% CI: 2.83-6.04), p < 0.00] and trust in domestic vaccines [aOR: 1.46; (95% CI: 1.02-2.08), p < 0.05] emerged as the significant predictors of student's intention to get vaccinated. Higher acceptance for vaccine was observed among students in the non-healthcare [aOR: 1.982; 95% CI: 1.334-2.946, p < 0.00]. Conclusion: This study shows that the Indian college students had relatively high levels of positive intentions to receive COVID-19 vaccines, although about one-third were not sure or unwilling to receive the vaccine, highlighting possible vaccine hesitancy. Informational campaigns and other strategies to address vaccine hesitancy are needed to promote uptake of COVID-19 vaccines.

Heterologous expression of a substance which inhibits receptivity and calling in Helicoverpa armigera (Hübner)

The accessory glands of male moths secrete several proteins, which are known to affect post-mating behaviour in females such as calling, reduction in receptivity, rate of egg maturation and laying, sperm maintenance and release and formation of mating plug. Helicoverpa armigera (Hübner) is a polyphagous pest of numerous crops and it is widely distributed on the Indian subcontinent where it causes severe economic losses. In the present study, receptivity- and calling-inhibiting substance (RCIS), a peptide secreted from the accessory glands of male H. armigera, was sequenced, cloned and expressed in a prokaryote, Escherichia coli. RCIS is a peptide comprising 58 amino acids and had a theoretical molecular weight of 6.03 kDa. It showed 64% similarity with pheromonostatic peptide 1, identified in Helicoverpa zea (Kingan et al., 1995) but differed regarding deletion of four and one amino acids at positions 14-17 and 44, respectively, and insertion of one and five amino acids at position 38 and the terminal position of RCIS, respectively. H. armigera females injected with recombinant RCIS showed reduced receptivity and calling behaviour (in 70-80% of the treated individuals), and mating frequencies decreased by 80%. Recombinant RCIS may be employed to artificially induce non-receptivity in virgin females in order to prevent reproduction.

Development and evaluation of the digital-screen exposure questionnaire (DSEQ) for young children

Background

Over the last three decades, the accessibility and usage of mobile devices have increased among young children. This study’s objective was to develop a validated caregiver-reported digital-screen exposure questionnaire (DSEQ) for children aged 2–5 years.

Methods

DSEQ was developed in five phases. Phase 1, a draft questionnaire was developed by reviewing the literature on existing tools (n = 2) from 2009–2017. Phase 2, face-to-face interviews with primary caregivers (n = 30) were conducted in a tertiary-care-hospital for acculturation. Nine experts assessed the face and content validity of the draft Hindi and English questionnaire. Phase 3, a pilot study conducted among randomly selected families (n = 40) to evaluate the feasibility of DSEQ in field settings. Phase 4, test-retest reliability was done among 30 primary caregivers selected randomly in another urban cluster. Phase 5, the internal consistency of DSEQ was checked by conducting a cross-sectional study among randomly selected 400 primary caregivers in Chandigarh, North India. IBM SPSS Statistics for Macintosh, version 25.0, was for data management and analysis.

Results

A valid DSEQ with 86 items under five domains, including sociodemographic, screen-time exposure and home media environment, level of physical activity, media-related behaviors, and parental perceptions was developed. The pilot study showed that it was feasible to use the DSEQ in the field. DSEQ was reliable with kappa value ranging from 0.52 to 1.0, and intra-class coefficient of 0.62–0.99 (p<0.05). A strong internal consistency was observed for three domains including, screen-time exposure and home media environment (Cronbach’s alpha of 0.82), media-related behaviors (Cronbach’s alpha of 0.74) and physical activity (Cronbach’s alpha 0.73).

Conclusions

The developed DSEQ has good face and content validity and acceptable evidence of internal consistency and test-retest reliability. The DSEQ can be used for measuring digital screen exposure and its correlates among children aged 2 to 5 years.

Biological attributes of age and gender variations in Indian COVID-19 cases: A retrospective data analysis

Background

The associated risk factors, co-morbid conditions and biological differences varying with gender and age might be the cause of higher COVID-19 infection and deaths among males and older persons. The objective of this study was to predict and specify the biological attributes of variation in age and gender-based on COVID-19 status (deceased/recovered).

Methods

In this retrospective study, the data was extracted from a recognised web-based portal. A total of 112,860 patients' record was filtered out and an additional 9131 records were separately analysed to examine age and gender relationship with patient's COVID-19 status (recovered/deceased). Chi-square, t-test, binary logistic regression, and longitudinal regression analysis were conducted.

Results

The male COVID-19 cases (65.39%) were more than females (34.61%) and mean age of infected and recovered patients was 39.47 ± 17.59 years and 36.85 ± 18.51 years respectively. The odds for infection was significantly higher among females for lower age categories, which declines with age. The age-adjusted odds for recovery were significantly higher among females (O.R. = 1.779) and odds for recovery was highest in 5–17 years age category (O.R. = 88.286) independent of gender.

Conclusion

The chances of being COVID-19 infected was higher for females of lower age categories (<35 years) which decreases with age. The odds for recovery among females was significantly higher than males. The chances of recovery declines with increasing age and the variation could be attributed to the biological differences between age categories and gender.

The successful containment of COVID-19 outbreak in Union Territory of Ladakh, India, 2020

Objectives:

A three-member central Rapid Response Team (RRT) was deputed to Union Territory of Ladakh on 26^th March 2020, to assess the situation and support the preparedness measures including implementation of cluster containment plan and social distancing measures for coronavirus disease 2019 (COVID-19).

Methods:

Central RRT addressed the panchayat sarpanch and religious leaders, sensitized doctors and paramedical staff on COVID-19 situation; conducted situational analysis, review of records and logistics, key informant interviews of senior administrative and healthcare officials, focus group discussions with local community people and field visits to various hospitals, isolation centers, quarantine facilities, and containment zones.

Results:

A total of 14 COVID-19 cases with no deaths were reported and nine patients had recovered till 4 April 2020. The median (range) age of positive cases was found to be 32.5 (6 months–76 years) years and overall attack rate was 1.65 per 1000 population. Ladakh Government declared Chuchot Gongma, Yokma and Sankoo as the containment zones and deputed surveillance teams. A total of 2397 persons were quarantined and 496 samples were tested from Ladakh. COVID-19 sample testing, Srinagar-Leh highway opening and Iran pilgrimage returnees were the major challenges identified.

Conclusions:

The Ladakh government must continue the robust surveillance system and stringent strategies in key areas for management of COVID-19 namely – aggressive screening and testing, isolation, quarantine, hand hygiene, respiratory etiquettes and social distancing.

Estimates of malnutrition and risk of malnutrition among the elderly (≥60 years) in India: A systematic review and meta-analysis

BACKGROUND

Death is inevitable, but healthy ageing is possible with proper nutrition and health care. This systematic review and meta-analysis conducted to estimate the nation-wide prevalence and malnutrition and risk of malnutrition among the elderly in India.

METHODS

PubMed, EMBASE, Web of Science, Cochrane`s library, Google Scholar were searched for the articles reporting the prevalence of malnutrition among the elderly using MNA or MNA-SF tools. The study published between the year 2010-2019 were included. Sensitivity analysis, quality assessment was done using standard methods. The publication biasness was also determined using Doi plot and LFK index. The pooled prevalence was reported with effect size and considering the random effect model and quality effect model. The subgroup analysis was also conducted for gender, study setting, study area and study regions.

RESULTS

The prevalence of malnutrition and risk of malnutrition among the elderly was 18.29% and 48.17% respectively. The prevalence of malnutrition was higher among female (16.67%), clinic setting (28.87%), urban areas (19.29%) and northern region (27.37%) of India. This trend differs with the prevalence of risk of malnutrition. Meta-regression analysis shows a region-based prediction of malnutrition and setting based prediction of risk of malnutrition.

CONCLUSION

The prevalence of malnutrition was not considerably higher among the elderly population but about half of the elderly population were at risk of malnutrition. This trend differs with the gender, study setting, study area and study region. Additional study using other nutritional assessment tools were needed. Intervention studies among the elderly were recommended.

Feasibility study of culturally adapted cognitive behaviour therapy for psychosis in Pakistan

Background

It is becoming well established that CBT is both effective and cost efficient in the treatment of positive and negative symptoms of schizophrenia. However, there is a need to adapt CBT to the cultural, linguistic, and socioeconomic context of diverse cultural groups. We aimed to establish the feasibility of culturally adaptive cognitive behavior therapy for treatment of psychosis in a low-income country.

Methods

This is a rater-blind, randomized, controlled trial of the use of CBT in patients with psychosis from a low-income country. Patients with a DSM-IV diagnosis of schizophreniform disorder were assessed using Positive and Negative Syndrome Scale for Schizophrenia (PANSS), PSYRATS (Psychotic Symptom Rating Scales), and the Insight Scale. Participants were randomized into the intervention group (n = 18) and TAU group (n = 18). The intervention group received 12 weekly sessions of culturally adapted CBT for psychosis (CaCBTp).

Results

There were no significant differences between the two groups at baseline. At three months follow-up, there was a statistically significant improvement in the CaCBTp group on PANSS general Psychopathology subscale, PANSS overall score and Insight scale, as compared to the TAU group. The CaCBTp group had lower scores on PANSS positive, PANSS negative sub-scales, and the two subscales of Psychotic Symptom Rating Scale, but differences were not statistically significant.

Conclusion

Culturally adapted CBT added to pharmacological treatment as usual was acceptable to patients and was helpful in reduction of severity of psychotic symptoms. Adjunctive culturally adapted CBT should be further investigated in this population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The diagnostic ability of core needle biopsy in nodular thyroid disease

INTRODUCTION Non-diagnostic results of fine needle aspiration biopsy (FNAB) remain an important limitation of this technqiue. The aim of our study was to evaluate the results of core needle biopsy (CNB) of thyroid nodules and its effectiveness in non-diagnostic FNAB cases. METHODS CNBs were performed in 1,000 patients (154 male, 846 female; mean age: 50.2 years, range: 18-86 years) with a spring loaded 20G needle. Of these, 143 had initially had FNABs that were insufficient for evaluation. The CNB reports were reviewed. Patients with suspicious or malignant CNB results underwent total thyroidectomy. RESULTS When considering all 1,000 CNBs, the non-diagnostic rate was 1.5% (15/1,000). However, when the first 100 cases were eliminated as a learning curve, this reduced to 0.9% (8/900). Of the 143 cases with initial FNABs that were non-diagnostic, 0.7% (1/143) were also non-diagnostic on CNB. Twelve patients underwent surgery because of malignant CNB reports and all of these cases were confirmed as malignant by the postoperative pathology specimen results (100% accuracy). There were no major complications although three self-limiting minor complications were observed. CONCLUSIONS CNB is a safe and accurate method. It is more diagnostic than FNAB for nodular thyroid disease.

Using self-reported data on the social determinants of health in primary care to identify cancer screening disparities: opportunities and challenges

Background

Data on the social determinants of health can help primary care practices target improvement efforts, yet relevant data are rarely available. Our family practice located in Toronto, Ontario routinely collects patient-level sociodemographic data via a pilot-tested survey developed by a multi-organizational steering committee. We sought to use these data to assess the relationship between the social determinants and colorectal, cervical and breast cancer screening, and to describe the opportunities and challenges of using data on social determinants from a self-administered patient survey.

Methods

Patients of the family practice eligible for at least one of the three cancer screening types, based on age and screening guidelines as of June 30, 2015 and who had answered at least one question on a socio-demographic survey were included in the study. We linked self-reported data from the sociodemographic survey conducted in the waiting room with patients’ electronic medical record data and cancer screening records. We created an individual-level income variable (low-income cut-off) that defined a poverty threshold and took household size into account. The sociodemographic characteristics of patients who were overdue for screening were compared to those who were up-to-date for screening for each cancer type using chi-squared tests.

Results

We analysed data for 5766 patients for whom we had survey data. Survey participants had significantly higher screening rates (72.9, 78.7, 74.4% for colorectal, cervical and breast cancer screening respectively) than the 13, 036 patients for whom we did not have survey data (59.2, 65.3, 58.9% respectively). Foreign-born patients were significantly more likely to be up-to-date on colorectal screening than their Canadian-born peers but showed no significant differences in breast or cervical cancer screening. We found a significant association between the low-income cut-off variable and cancer screening; neighbourhood income quintile was not significantly associated with cancer screening. Housing status was also significantly associated with colorectal, cervical and breast cancer screening. There was a large amount of missing data for the low-income cut-off variable, approximately 25% across the three cohorts.

Conclusion

While we were able to show that neighbourhood income might under-estimate income-related disparities in screening, individual-level income was also the most challenging variable to collect. Future work in this area should target the income disparity in cancer screening and simultaneously explore how best to collect measures of poverty.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-017-0599-z) contains supplementary material, which is available to authorized users.

Mature ovarian cystic teratoma containing well-differentiated cerebellar tissue

A 38-year-old female patient experienced groin pain; ultrasound imaging revealed a dermoid cystic mass in the right ovary and a cystectomy was then performed. Unusually, a mature cerebellum is found in the cyst wall. The pathological diagnosis was 'mature cystic teratoma with well-differentiated cerebral and cerebellar tissue'. Glial tissue is a common neural component of teratomas, but a cerebellum is extremely rare in mature ovarian cystic teratomas. The authors report the case because of its rare component; they acknowledge that a cystic teratoma is the most common neoplasm of ovarian germ cells.

Cognitive function in early psychosis patients from a low-income country

Background

Cognitive impairments are well established findings in schizophrenia and are associated with significant impairment of social functioning. Episodic memory, working memory and executive function test scores are typically 1 standard deviation below healthy controls. There are reports suggesting the presence of neurocognitive deficits prior to illness onset, opening the possibility of using cognitive profiles as disease markers. Interest in exploring cognitive functioning in early stages schizophrenia has continued to grow, as earlier treatments could possibly lead to improved outcomes.

Methods

This is a cross-sectional assessment of cognitive profiles in patients with early psychosis. A total of 51 patients suffering from psychosis in the age group of 18–65 years were recruited and matched with 51 healthy controls. A wide range of neurocognitive domains were assessed using standardised neuropsychological tests.

Results

There was evidence of statistically significant impairments in cognitive functioning across a broad range of cognitive domains in early-psychosis patients, as compared to healthy controls. More pronounced deficits were seen in executive function tests.

Conclusions

To our knowledge, this is the first study to report cognitive deficits across a range of domains in patients with first episode psychosis from a low-income country. This study found deficits across multiple domains, including language, memory, attention, executive function, and visuospatial function in patients with early psychosis. Evidence of neuropsychological deficits in the early course of the disease may highlight crucial therapeutic windows for both pharmacological treatments and cognitive rehabilitation. This may improve functional outcomes in this patient group in the longer term.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Development and assessment of a mobile phone-based intervention to reduce maternal depression and improve child health

Introduction

Postnatal depression is known to cause disability and suffering in women and negative consequences both for their infants and their families, with huge costs globally. Several studies from low and middle income countries (LAMIC) have demonstrated that effectively delivered psychological interventions are cost effective for improving maternal and child health, but access to these interventions is limited in both the low and high income countries.

Objective

The objective of the study is to develop and test a mobile phone-based intervention (TechMotherCare), which will include components of cognitive behavioural therapy (CBT) and child development related psychoeducation.

Aim

The aim of the study is to examine the feasibility and acceptability of the TechMotherCare intervention.

Methods

A total of 36 participants will be recruited from health centers in Karachi, Pakistan for this 2-arm randomized pilot study. The TechMotherCare App intervention will be based on principles of CBT and learning-through-play (LTP) a parenting intervention and will assess the real-time depressive symptoms of participants and respond, using intelligent real time therapy (iRTT) dependent on symptoms reported by participants.

Results

Outcome assessments will be completed after 3 months (end of intervention). In-depth qualitative interviews will also be conducted with participants pre- and post-intervention. The trial is ongoing and we will present both the qualitative and quantitative results.

Conclusions

The results of this pilot trial will inform the design of a larger randomised controlled trial using a mobile based technology platform to address the huge treatment gap in LAMICs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Gastric xanthoma with hyperplastic polyp: a case report

Gastric xanthoma is uncommon lesion with a variably reported frequency. Hyperplastic polyps are commonest epithelial polyps in stomach. A rare case of simultaneous presence of xanthoma with hyperplastic polyp is reported. A 70-year-old female presented with dyspepsia and heartburn. Upper gastro-intestinal endoscopy showed multiple sessile small whitish polyps in stomach. Histopathological examination of the polyps-showed features of xanthoma with hyperplastic polyp in the mucosa with areas of intestinal metaplasia and occasional H pylori. There was no evidence of malignancy in the present case.

The association between quality of primary care, deprivation and cardiovascular outcomes: a cross-sectional study using data from the UK Quality and Outcomes Framework

BACKGROUND

The Quality and Outcomes Framework, a financial incentive scheme for general practitioners in the UK, seems to have improved the quality of primary care and reduced inequalities in primary care delivery. It remains unclear, however, whether higher-quality primary care improves health outcomes or reduces health inequalities.

METHODS

We conducted a cross-sectional study examining the association between quality of cardiovascular care and coronary heart disease (CHD) outcomes in 1531 general practices in London. We calculated CHD quality achievement scores (ranging from 0 to 100) for each practice using the 2006-2007 data from the Quality and Outcomes Framework. We used weighted linear regression models to assess the practice-level association between the CHD quality score and CHD admissions and deaths.

FINDINGS

Overall, practices with higher CHD quality achievement scores had better CHD outcomes. Each one point increase in the CHD quality achievement score was associated with 4.28 (95% CI 1.19 to 7.38; p=0.007) fewer admissions per 100,000 for practices serving highly deprived populations and 2.11 (95% CI 0.68 to 3.55; p=0.004) fewer admissions per 100 000 for practices serving populations of average deprivation. There was no association between the CHD quality achievement score and the CHD admissions for practices serving affluent populations (p=0.906). We observed a similar deprivation-dependent gradient between quality achievement and CHD deaths.

INTERPRETATION

High-quality primary care is associated with improved health outcomes. This association is strongest in deprived areas, suggesting that high-quality primary care may play an important role in reducing health inequalities.