Low-Cost Hourly Ambient Black Carbon Measurements at Multiple Cities in Africa.

There is a notable lack of continuous monitoring of air pollutants in the Global South, especially for measuring chemical composition, due to the high cost of regulatory monitors. Using our previously developed low-cost method to quantify black carbon (BC) in fine particulate matter (PM2.5) by analyzing reflected red light from ambient particle deposits on glass fiber filters, we estimated hourly ambient BC concentrations with filter tapes from beta attenuation monitors (BAMs). BC measurements obtained through this method were validated against a reference aethalometer between August 2 and 23, 2023 in Addis Ababa, Ethiopia, demonstrating a very strong agreement (R2 = 0.95 and slope = 0.97). We present hourly BC for three cities in sub-Saharan Africa (SSA) and one in North America: Abidjan (Côte d'Ivoire), Accra (Ghana), Addis Ababa (Ethiopia), and Pittsburgh (USA). The average BC concentrations for the measurement period at the Abidjan, Accra, Addis Ababa Central summer, Addis Ababa Central winter, Addis Ababa Jacros winter, and Pittsburgh sites were 3.85 µg/m3, 5.33 µg/m3, 5.63 µg/m3, 3.89 µg/m3, 9.14 µg/m3, and 0.52 µg/m3, respectively. BC made up 14-20% of PM2.5 mass in the SSA cities compared to only 5.6% in Pittsburgh. The hourly BC data at all sites (SSA and North America) show a pronounced diurnal pattern with prominent peaks during the morning and evening rush hours on workdays. A comparison between our measurements and the Goddard Earth Observing System Composition Forecast (GEOS-CF) estimates shows that the model performs well in predicting PM2.5 for most sites but struggles to predict BC at an hourly resolution. Adding more ground measurements could help evaluate and improve the performance of chemical transport models. Our method can potentially use existing BAM networks, such as BAMs at U.S. Embassies around the globe, to measure hourly BC concentrations. The PM2.5 composition data, thus acquired, can be crucial in identifying emission sources and help in effective policymaking in SSA.

Relative importance of VECTRI model parameters in the malaria disease transmission and prevalence.

In this study, a sensitivity analysis on a VECTRI dynamical model of malaria transmission is investigated to determine the relative importance of model parameters to disease transmission and prevalence. Apart from being most climatic prone, Odisha is a highly endemic state for malaria in India. The lack in sufficient modeling studies severely impacts the malarial process studies which further hinder the possibility of malaria early warning systems and preventive measures to be undertaken beforehand. Therefore, modeling studies and investigating the relationship between malaria transmission process studies and associated climatic factors are the need of the hour. Environmental conditions have pronounced effects on the malaria transmission dynamics and abundance of the poikilothermic vectors, but the exact relationship of sensitivity for these parameters is not well established. Sensitivity analysis is a useful tool for ascertaining model responses to different input variables. Therefore, in order to perform the requisite study, a dynamical model, VECTRI, is utilized. The study period ranges from 2000 to 2013, where several sensitivity tests are performed using different model parameters such as infiltration and evaporation rate loss of ponds, degree-days for parasite development, threshold temperature for parasite development, threshold temperature for egg development in the vector, and maximum and minimum temperature for larvae survival. The experiments suggest that the lower value of minimum temperature for larvae survival (rlarv_tmin), i.e., 16 °C, provides higher vector density and entomological inoculation rate (EIR) values. EIR reaches its maximum, when the threshold temperature for parasite development (rtsporo) is 22 °C and degree-days for parasite development (dsporo) is 8 degree-days. No change is observed in the vector density; even when rtsporo is 30 °C, values of EIR are close to 0. A successive increment of infiltration and evaporation rate loss of ponds (rwaterfrac evap126) values from 130 to 200 mm/day result in approximately 5% consistent decline in vector density and EIR. The study concludes that the most sensitive parameters are dsporo, rlarv_tmin, and rwaterfrac evap126. The VECTRI model is rather insensitive to maximum temperature for larvae survival (rlarv_tmin) for vector density and EIR variables. Further certain modifications and improvements are required in VECTRI to predict out variables like vector density and EIR more accurately in highly endemic region.

Factors affecting pregnancy registration in India: does the pregnancy intention matter?

BACKGROUND: Pregnancy registration is one of the most critical components of women's reproductive health because it is the gateway to entering the continuum of care services such as antenatal care, institutional delivery, and postnatal care. There is a lack of studies exploring the relationship between pregnancy intention and pregnancy registration, especially in the Indian context. METHOD: This study used the National Family Health Survey-5 (2019-21) data to explore the relationship between birth intention and failure of pregnancy registration. The bivariate and multivariate (binary logistic regression) analysis was carried out. RESULTS: Adjusting the effects of socio-demographic and economic characteristics, compared with women with an intended pregnancy, the odds of failure of pregnancy registration were significantly high among women with a mistimed pregnancy (OR = 1.60, 95% CI = 1.47-1.73) and unwanted pregnancy (OR = 1.38, 95% CI = 1.26-1.52). The study found pregnancy intention as a significant predictor of pregnancy registration. CONCLUSIONS: Results suggest strengthening the interaction of grassroots-level health workers with women, especially those with possibly lower healthcare autonomy and unintended pregnancy. Higher and earlier pregnancy registration will enhance maternal healthcare utilization and reduce adverse health consequences to mothers and children, thus ensuring better maternal and child health.

Exploring food insecurity and multimorbidity in Indian socially disadvantaged people: cross-sectional findings from LASI, 2017-18.

OBJECTIVES: The present study aimed to examine the association of multimorbidity status with food insecurity among disadvantaged groups such as Scheduled Castes (SCs), Scheduled Tribes (STs), and Other Backward Class (OBCs) in India. METHOD: The data for this study was derived from the first wave of the Longitudinal Ageing Study in India (LASI),2017-18, focusing on 46,953 individuals aged 45 years and over who belong to SCs, STs, and OBCs groups. Food insecurity was measured based on the set of five questions developed by the Food and Nutrition Technical Assistance Program (FANTA). Bivariate analysis was performed to examine the prevalence of food insecurity by multimorbidity status along with socio-demographic and health-related factors. Multivariable logistic regression analysis and interaction models were used. RESULTS: The overall prevalence of multimorbidity was about 16% of the study sample. The prevalence of food insecurity was higher among people with multimorbidity compared to those without multimorbidity. Unadjusted and adjusted models suggested that people with multimorbidity were more likely to be food insecure than people without multimorbidity. While middle-aged adults with multimorbidity and men with multimorbidity had a higher risk of food insecurity. CONCLUSION: The findings of this study suggest an association between multimorbidity and food insecurity among socially disadvantaged people in India. Middle-aged adults experiencing food insecurity tend to reduce the quality of their diet and consume a few low-cost, nutritionally deficient meals to maintain caloric intake, putting them again at risk for several negative health outcomes. Therefore, strengthening disease management could reduce food insecurity in those facing multimorbidity.

Inequalities in short-acting reversible, long-acting reversible and permanent contraception use among currently married women in India.

BACKGROUND: In India, the usage of modern contraception methods among women is relatively lower in comparison to other developed economies. Even within India, there is a state-wise variation in family planning use that leads to unintended pregnancies. Significantly less evidence is available regarding the determinants of modern contraception use and the level of inequalities associated with this. Therefore, the present study has examined the level of inequalities in modern contraception use among currently married women in India. METHODS: This study used the fourth round of National Family Health Survey (NFHS-4) conducted in 2015-16. Our analysis has divided the uses of contraception into three modern methods of family planning such as Short-Acting Reversible Contraception (SARC), Long-Acting Reversible Contraception (LARC) and permanent contraception methods. SARC includes pills, injectable, and condoms, while LARC includes intrauterine devices, implants, and permanent contraception methods (i.e., male and female sterilization). We have employed a concentration index to examine the level of socioeconomic inequalities in utilizing modern contraception methods. RESULTS: Our results show that utilization of permanent methods of contraception is more among the currently married women in the higher age group (40-49) as compared to the lower age group (25-29). Women aged 25-29 years are 3.41 times (OR: 3.41; 95% CI: 3.30-3.54) more likely to use SARC methods in India. Similarly, women with 15 + years of education and rich are more likely to use the LARC methods. At the regional level, we have found that southern region states are three times more likely to use permanent methods of contraception. Our decomposition results show that women age group (40-49), women having 2-3 children and richer wealth quintiles are more contributed for the inequality in modern contraceptive use among women. CONCLUSIONS: The use of SARC and LARC methods by women who are marginalized and of lower socioeconomic status is remarkably low. Universal free access to family planning methods among marginalized women and awareness campaigns in the rural areas could be a potential policy prescription to reduce the inequalities of contraceptive use among currently married women in India.

Evaluation of Microleakage Using Dye-penetration Method in Three Different Composite Resin Core Build-up Materials: An In Vitro Study.

AIM: Aim of the current research is to establish and assess the microleakage in bulk-fill composite, nanohybrid ormocer-based resins, and nanofilled composite resin core build-up materials employing the dye-penetration technique. MATERIALS AND METHODS: Sixty human mandibular first premolar teeth with a solitary root canal without dental caries were chosen for this research. Each specimen was subjected to decoronation of 2 mm from the cementoenamel junction (CEJ), following which the root canal treatment procedure was rendered complete. A space for the post was made for all the 60 samples. Following positioning of the post, specimens were allocated into one of the following three investigational groups (20 specimens in every group) on the basis of the core build-up materials used as group I: bulk-fill composites, group II: nanohybrid ormocer-based resins, and group III: nanofilled resin composites. Direct composite was used for core build-up and subjected to light-curing. Following this, the specimens were immersed in 1% methylene blue solution for 24 hours interval. Each section was evaluated for dye diffusion employing a stereomicroscope with software at a magnifying power of 40× and surface contact between dentin and base of the material was evaluated under scanning electron microscope. RESULTS: Nanohybrid ormocer-based composites exhibited the least microleakage at 1.12 ± 0.14, in pursuit by nanofilled composite resins at 1.79 ± 0.09, and finally the bulk-fill composites at 2.85 ± 0.11, amid the investigational groups studied. A statistically significant difference amid the three dissimilar cores buildup substances was found upon analysis of variance. CONCLUSION: Despite the study limitations, this research came to a conclusion that each of the three investigated core build-up substances exhibited microleakage. However, amid the three, nanohybrid ormocer-based composites depicted the lowest amount of microleakage in pursuit by the nanofilled resins and the bulk-fill composites. CLINICAL SIGNIFICANCE: Core build-up is an important requirement as the remaining tooth substance following root canal treatment reduces and needs reinforcement with core build-up to sustain the tooth structure and provide resistance. A vital mandate for enduring efficiency of the restoration in the mouth is high-quality adhesive bond of these agents to cavity walls with diminished microleakage.

Exactly Solvable Model for Strongly Interacting Electrons in a Magnetic Field.

States of strongly interacting particles are of fundamental interest in physics and can produce exotic emergent phenomena and topological structures. We consider here two-dimensional electrons in a magnetic field, and, departing from the standard practice of restricting to the lowest LL, introduce a model short-range interaction that is infinitely strong compared to the cyclotron energy. We demonstrate that this model lends itself to an exact solution for the ground as well as excited states at arbitrary filling factors ν<1/2p and produces a fractional quantum Hall effect at fractions of the form ν=n/(2pn+1), where n and p are integers. The fractional quantum Hall states of our model share many topological properties with the corresponding Coulomb ground states in the lowest Landau level, such as the edge physics and the fractional charge of the excitations.

Severe Immune Thrombocytopenia in a Patient with HIV-HCV Co-infection: Challenges in Management.

Immune thrombocytopenia is a well-known complication of both HIV and Hepatitis C virus infections. Management becomes challenging when a patient with HCV-HIV co-infection presents with severe thrombocytopenia. Adverse drug reactions and drug interactions has to be considered while choosing treatment options for such patients. We report such a case which illustrates the difficulty in managing severe thrombocytopenia in HCV-HIV co-infected patients where evidence based clinical decision making helped in choosing the right therapy for the patient.

Prospective evaluation of the setup errors and its impact on safety margin for cervical cancer pelvic conformal radiotherapy.

AIM: The primary objective was to assess set-up errors (SE) and secondary objective was to determine optimal safety margin (SM). BACKGROUND: To evaluate the SE and its impact on the SM utilizing electronic portal imaging (EPI) for pelvic conformal radiotherapy. MATERIAL AND METHODS: 20 cervical cancer patients were enrolled in this prospective study. Supine position with ankle and knee rest was used during CT simulation. The contouring was done using consensus guideline for intact uterus. 50 Gy in 25 fractions were delivered at the isocenter with ≥95% PTV coverage. Two orthogonal (Anterior and Lateral) digitally reconstructed radiograph (DRR) was constructed as a reference image. The pair of orthogonal [Anterior-Posterior and Right Lateral] single exposure EPIs during radiation was taken. The reference DRR and EPIs were compared for shifts, and SE was calculated in the X-axis, Y-axis, and Z-axis directions. RESULTS: 320 images (40 DRRs and 280 EPIs) were assessed. The systematic error in the Z-axis (AP EPI), X-axis (AP EPI), and Y-axis (Lat EPI) ranged from -12.0 to 11.8 mm, -10.3 to 7.5 mm, and -8.50 to 9.70 mm, while the random error ranged from 1.60 to 6.15 mm, 0.59 to 4.93 mm, and 1.02 to -4.35 mm. The SM computed were 7.07, 6.36, and 7.79 mm in the Y-axis, X-axis, and Z-axis by Van Herk's equation, and 6.0, 5.51, and 6.74 mm by Stroom's equation. CONCLUSION: The computed SE helps defining SM, and it may differ between institutions. In our study, the calculated SM was approximately 8 mm in the Z-axis, 7 mm in X and Y axis for pelvic conformal radiotherapy.

Resection of subaortic membrane for discrete subaortic stenosis.

BACKGROUND: We reviewed the long-term results of surgery for discrete subaortic membrane (SubAM) from a single institute. METHODS: A retrospective review of medical records of all patients (n = 146) who underwent resection of a SubAM for discrete subaortic stenosis between 1990 and 2015 at the All India Institute of Medical Sciences, New Delhi, India was undertaken. RESULTS: Median age at surgery was 9.0 years (9 months-47 years). There was one early death. Preoperative peak left ventricular outflow tract (LVOT) Doppler gradient was 83.4 ± 26.2 mmHg (range: 34-169 mmHg). On preoperative echocardiography, aortic regurgitation (AR) was absent in 69 (47.3%), mild in 35 (24%), moderate in 30 (20.5%), and severe in 12 (8.2%). After surgery, the LVOT gradient was reduced to 15.1 ± 6.2 mmHg (P < 0.001). Fourteen patients (9.6%) who had residual/recurrent significant gradients are currently being followed-up or awaiting surgery. There was improvement in AR for operated patients with freedom from AR of 92.6 ± 0.03% at 15 years. Kaplan-Meier survival at 25 years was 93.0 ± 3.9% (95% confidence interval: 79.6, 97.7). Freedom from re-operation at 25 years was 96.9 ± 1.8%. CONCLUSIONS: Long-term results of surgery for discrete SubAM are good. Resection of the membrane along with septal myectomy decreases the risk of recurrence.

Impact of diabetes on healthcare utilization and expenditure among older adults in India.

Background and aims: The present study aims to investigate the disparities in healthcare utilization and healthcare burden among individuals with and without diabetes. The prevalence of diabetes is more pronounced among older adults, which can detrimentally influence their health and quality of life while also restricting their capacity to self-manage and giving rise to competing healthcare demands. Thus, it is crucial to understand the implications of diabetes on healthcare demands and expenditures to mitigate its detrimental consequences. Methods: Data was used from the initial round of the Longitudinal Aging Study in India (LASI), conducted in 2017-18. The analytical sample included 65,562 individuals aged 45 or above, and 8429 individuals were identified as having diabetes. The primary outcome variable was the out-of-pocket expenditure (OOPE) in the most recent hospitalization. Descriptive statistics and logistic regression are used to find the trend in the prevalence of morbidities both in diabetic and nondiabetic groups. Additionally, quantile regression was used to study the association between the presence of diabetes and the risk of excess healthcare expenditure calculated through out-of-pocket expenditure for hospitalization and expenditure on medicines. Results: 16% of people with diabetes were hospitalized in the past year, compared to 9% without diabetes. The mean hospitalization length for diabetics was 13.6 days, compared to 6.5 for nondiabetics. Diabetes is significantly associated with higher OOPE for hospitalization across all quintiles, and its effect on hospitalization is weakest in the highest quintile. Having diabetes is also found to be significantly associated with the expenditure on medicines across all quintiles. Conclusion: The study highlights the need for diabetes awareness programs and interventions integrated into national health policies. The quantile regression model provides crucial insights into the association between diabetes and OOPE for hospitalization and medicine The increase of OOPE for hospitalisation and medicine due to the presence of diabetes emphasizes the need to address the financial burden faced by people with diabetes, highlighting the urgency of prioritizing measures to improve access to affordable care. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01319-w.

Exploring the financial burden due to additional mobility among cancer patients: A cross-sectional study based on National Sample Survey.

BACKGROUND: Cancer imposes a substantial economic burden due to treatment costs, supportive care, and loss of productivity. Besides all the affecting factors, major concerns lead to significant financial burdens of cancer treatment, bringing unwanted huge unbearable direct and indirect treatment costs. The aim was to explore the nature of additional mobility/travel required for accessing health care for cancer patients and also to assess financial burden due to additional mobility/travel costs for cancer treatment. METHODS: This study employed unit-level cross-sectional data from the 75th round (2017-18) of India's National Sample Survey (NSS). The primary analysis commenced with descriptive and bivariate analyses to explore mean health spending and out-of-pocket expenses. Subsequently, multivariable logistic regression models were utilized to estimate the associations between catastrophic health expenditure, distress financing, and the treatment location. RESULTS: The findings highlight distinct healthcare utilization patterns: inpatient treatments predominantly occur within the same district (50.4 %), followed by a different district (38.8 %), and a smaller share in other states (10.8 %). Outpatients largely receive treatment in the same district (65.5 %), followed by a different district (26.8 %), and around 8 % percent in other states. Urban areas show higher inpatient visits within the same district (41.8 %) and different districts (33.5 %). Outpatients, particularly those seeking treatment in other states, experience higher total expenditures, notably with higher out-of-pocket expenses. Distress financing is more common among inpatients (20.6 %) and combined inpatient/outpatient cases (23.9 %), while outpatients exhibit a lower rate (6.8 %). CONCLUSION: The findings collectively suggest the importance of developing local healthcare infrastructures to reduce the additional mobility of cancer patients. The policy should focus to train and deploy oncologists in non-urban areas can help bridge the gap in cancer care proficiency and reduce the need for patients to travel long distances for treatment.

Modern Contraception and Anaemia Among Reproductive-age Women in India: Results From a Household Survey.

Objectives: Chronic anaemia is a significant health concern, particularly among women of childbearing age. Factors such as menstrual blood loss, childbirth, inadequate nutrition, closely spaced pregnancies, and recurrent gastrointestinal bleeding increase the risk of anaemia. This study investigated whether current contraceptive methods are associated with anaemia in Indian women of reproductive age. Methods: Cross-sectional data from the fifth round of the National Family Health Survey, conducted in 2019-21, were used for this investigation (NFHS-5). We included only non-pregnant and non-amenorrhoeic women in our analysis, resulting in a final analytical sample of 673,094 women aged 15-49. Bivariate cross-tabulations and multivariable logistic regression were employed to analyse the data. Results: The prevalence of anaemia was 57%, and the adjusted regression models found no significant association between the use of any contraceptive methods and women's haemoglobin status. Women using traditional contraceptive methods had 1.08 (95% confidence interval, 1.048-1.113) times higher odds of having anaemia. Among the modern methods, other than injectables, all other methods-such as an intrauterine device (IUD), barrier use, and sterilisation-were associated with higher odds of anaemia compared to women who used contraceptive pills. Conclusions: This study explored the relationship between modern contraceptives and haemoglobin levels in India, revealing that injectables were associated with a notable reduction in the odds of anaemia, whereas traditional contraceptives and other modern methods exhibited positive associations with anaemia. These findings prompt policymakers to focus on anaemia reduction and safe contraceptives. More research is needed to inform decisions, given the scant literature.

Bilateral acute macular neuroretinopathy associated with COVID-19 infection presenting with central scotoma.

Purpose: To report a case of bilateral acute macular neuroretinopathy (AMN) associated with COVID-19 infection presenting with central scotoma. Observation: A 26-year-old female presented with a chief complaint of bilateral central scotomas for the last seven days. She had a history of fever over the past ten days, and RT-PCR test for COVID-19 was positive on the second day of fever. She had been vaccinated against COVID-19 eight months prior. Her best corrected visual acuity was 6/6 in both eyes on the Snellen chart. Dilated fundus evaluation revealed subtle bilateral perifoveal grey macular lesions. Optical coherence tomography (OCT) demonstrated focal hyperreflectivity at the level of the outer nuclear and plexiform layer consistent with bilateral AMN. Near-infrared reflectance (NIR) and red-free (RF) imaging showed large, confluent hyporeflective lesions in the right eye and discrete petaloid lesions with apices pointing toward the fovea in the left eye. OCT angiography (OCTA) revealed decreased flow signal at the level of the deep capillary plexus (DCP) and choriocapillaris (CC) in both eyes. Automated visual field testing (Humprey Field Analyzer (HFA) 24-2) revealed bilateral central scotoma with depression of adjacent points. After two weeks, the patient had depressed visual fields on HFA 10-2. At two months of final follow-up, OCT macula, NIR and RF images revealed resolving AMN lesions in both eyes. OCTA showed an increase in perfusion at the level of the DCP. There was a decrease in scotoma density on HFA 10-2, suggestive of resolving AMN. Conclusion and importance: AMN with central scotoma as presenting feature of COVID-19 is rare. Fundus findings may be very subtle in AMN, but NIR and RF imaging delineate the lesions well. OCT, NIR imaging, OCTA and HFA 10-2 can be used to assess the clinical course of AMN.

Age Estimation of Children and Young Adults of Jharkhand Using Mineralization of Third Molars and Its Relation to Chronological Age: A Retrospective Analysis.

Background Dental age estimation plays an enormous role in the determination of an individual's identity and age in forensic and anthropological fields. The estimation of the chronological age of the individual is also important in the diagnosis, treatment planning, and treatment outcomes in the dental field. The third molar has some inimitable characteristics in terms of its size, shape, formation, and long path of eruption and usually erupts after puberty, which seems to be a reliable method of age estimation in adulthood. To establish the individual's identity, inference of age has gained considerable attention in forensics, and the aspect of dentistry has broadened nowadays. Thus the present study was conducted. Methodology The digital orthopantomograms of 720 patients who were exposed to X-rays for routine examination were assessed, and calcification of the tooth was observed. In order to ensure the blinding of the examiners, radiographs were numerically coded. Clinical stages of the tooth were categorised into erupted, pre-erupted, and missing. Statistical analysis was performed by IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY), with a level of significance set below 5%. Results The age of the patients whose OPGs were assessed ranged from 6 to 22 years, with a mean age of 18.93±3.129 years. Among the 720 participants, 370 (51.4%) were male and 350 (48.6%) were female. When the clinical status of the third molar among all the participants was assessed, in 148 (20.6%) subjects, third molars had erupted; in 188 (26.1%) subjects, the third molars were in the pre-erupted stage; and in 384 (53.30%), third molars were missing. When comparing the clinical status of the third molar in both arches and between genders, it was found that missing molars were common in females and the mandible arch, with statistically significant p-values. A comparison of Demirjian's stages between genders showed that the mean age to attain stage H was 21.37±0.774 years among males and 21.69±0.616 years among females. This means that the calcification of third-molar attainment occurs earlier in males compared with females. In a similar comparison between the upper and lower arches, it was found that calcification of the third molar was attained earlier in the maxillary arch compared to the mandibular arch. Conclusion It was concluded that the third molar is a versatile tooth and its path of mineralization can be used in orthodontics, pedodontics, and forensics to estimate chronological age, and chronological age significantly follows Demirjian's stages of third molar calcification. Third molar calcification occurred earlier in the maxillary arch and males, whereas several impacted molars were higher in females.

Health and disability status among middle-aged and older adult cancer survivors: a case-control study.

PURPOSE: The objective of this study is to evaluate whether the presence of a cancer history constitutes a risk for encountering unfavourable health outcomes and functional limitations. Moreover, the study also aims to identify specific attributes of cancer survivors that are associated with an increased risk of experiencing poor health and disability. METHODS: This study has utilized data from Longitudinal Ageing Study in India (LASI) conducted in 2017-18. The analytical sample size for this study was 65,562 older individuals of age 45 years and above. We have focused on individuals diagnosed with cancer, i.e., cancer survivors, and compared their health outcomes to those of a similar group (without a cancer history) with similar socioeconomic and demographic features. Descriptive statistics and logistic regression models were used to assess the adjusted effect of explanatory variables on cancer survivors. RESULTS: The result shows that the overall number of cancer survivors is 673 per 100.000 older adults and is higher in Urban areas (874 per 100.000) than in rural areas (535 per 100.000). 43.7% of the survivors reported poor self-rated health, and around 34.0% of cancer survivors reported depression, while this prevalence was much lower among older adults without a cancer history. Individuals who were diagnosed with cancer a long time ago have a significantly lower likelihood of experiencing poor SRH, depression, and diminished life satisfaction in comparison to those diagnosed more recently. CONCLUSION: The study highlights the importance of factors such as time since diagnosis and the number of cancer sites in influencing health outcomes among survivors. Additionally, socioeconomic factors, such as wealth and access to health insurance, appear to play a role in the health status of cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Healthcare policies should recognize the long-term impact of cancer and prioritize the provision of long-term survivorship care. This may involve establishing survivorship clinics or dedicated healthcare centres that provide specialized care for cancer survivors, addressing their unique needs throughout the survivorship continuum.

Changes in Socioeconomic Inequalities in Unintended Pregnancies Among Currently Married Women in India.

Background: Despite the consistent prevalence of unintended pregnancies in India and its adverse impact on maternal and neonatal mortality, the literature discussing socioeconomic inequality remains scarce. This study aims to assess the change in wealth-related inequalities in unintended pregnancy in India from 2005-2006 to 2019-20 and to quantify the contribution of various factors towards inequality. Methods: The present study analyzed cross-sectional data from the third and fifth rounds of the National Family Health Survey (NFHS). The information on fertility preferences and pregnancy intention of most recent live birth during the five years preceding the survey was collected from eligible women. The concentration index and Wagstaff decomposition were used to analyze wealth-related inequality and the contributing factors. Results: Our results show that the prevalence of unintended pregnancy has declined in 2019-20 to 8% from 22% in 2005-2006. With the increase in education and wealth status, unintended pregnancy decreases significantly. The results of the concentration index depict that unintended pregnancy is more concentrated among the poor than the rich in India, and the individual's wealth status has the highest contribution to unintended pregnancy inequality. Other factors like mothers' BMI, place of residence and education also contribute majorly to the inequality. Conclusions: The study results are critical and increase the need for strategies and policies. Disadvantaged women need education and family planning information, plus access to reproductive health resources. Governments should improve accessibility and quality of care in family planning methods to prevent unsafe abortions, unwanted births, and miscarriages. Further research is needed to investigate the impact of social and economic status on unintended pregnancies.

Exploring multimorbidity clusters in relation to healthcare use and its impact on self-rated health among older people in India.

The conventional definition of multimorbidity may not address the complex treatment needs resulting from interactions between multiple conditions, impacting self-rated health (SRH). In India, there is limited research on healthcare use and SRH considering diverse disease combinations in individuals with multimorbidity. This study aims to identify multimorbidity clusters related to healthcare use and determine if it improves the self-rated health of individuals in different clusters. This study extracted information from cross-sectional data of the first wave of the Longitudinal Ageing Study in India (LASI), conducted in 2017-18. The study participants were 31,373 people aged ≥ 60 years. A total of nineteen chronic diseases were incorporated to identify the multimorbidity clusters using latent class analysis (LCA) in the study. Multivariable logistic regression was used to examine the association between identified clusters and healthcare use. A propensity score matching (PSM) analysis was utilised to further examine the health benefit (i.e., SRH) of using healthcare in each identified cluster. LCA analysis identified five different multimorbidity clusters: relatively healthy' (68.72%), 'metabolic disorder (16.26%), 'hypertension-gastrointestinal-musculoskeletal' (9.02%), 'hypertension-gastrointestinal' (4.07%), 'complex multimorbidity' (1.92%). Older people belonging to the complex multimorbidity [aOR:7.03, 95% CI: 3.54-13.96] and hypertension-gastrointestinal-musculoskeletal [aOR:3.27, 95% CI: 2.74-3.91] clusters were more likely to use healthcare. Using the nearest neighbor matching method, results from PSM analysis demonstrated that healthcare use was significantly associated with a decline in SRH across all multimorbidity clusters. Findings from this study highlight the importance of understanding multimorbidity clusters and their implications for healthcare utilization and patient well-being. Our findings support the creation of clinical practice guidelines (CPGs) focusing on a patient-centric approach to optimize multimorbidity management in older people. Additionally, finding suggest the urgency of inclusion of counseling and therapies for addressing well-being when treating patients with multimorbidity.

Factors associated with delayed initiation and non-exclusive breastfeeding among children in India: evidence from national family health survey 2019-21.

BACKGROUND: In India, more than half of the newborns experience delayed breastfeeding, and non-exclusive breastfeeding is practiced in 63% of babies below the age of six months. The goal of this study is to investigate the extent to which external environment, demographic and socioeconomic, pregnancy and birthing characteristics, as well as utilization of maternal care services, are associated with delayed initiation and non-exclusive breastfeeding among children in India. METHODS: Data was gathered from the fifth round of the National Family Health Survey (NFHS), which was conducted in 2019-21. This study used information on 85,037 singleton infants aged 0-23 months and 22,750 singleton infants aged 0-5 months. Delayed initiation of breastfeeding and non-exclusive breastfeeding was used as outcome variables in this study. Unadjusted and adjusted multivariable binary logistic regression was performed to analyse the association of delayed breastfeeding and non-exclusive breastfeeding with selected background characteristics. RESULTS: Factors significantly associated with increased risks of delayed initiation of breastfeeding included infants from in the central region (OR 2.19; 95% CI 2.09, 2.29), mothers in the 20 to 29 years age group at the time of childbirth (OR 1.02; 95% CI 0.98, 1.05), caesarean deliveries (OR 1.97; 95% CI 1.90, 2.05). The likelihoods for non-exclusive breastfeeding significantly increased among children belonging to the richest household status (OR 1.30; 95% CI 1.17, 1.45), mothers who had less than nine months of pregnancy period (OR 1.15; 95% CI 1.06, 1.25), and mothers who gave birth in non-health facility (OR 1.17; 95% CI 1.05, 1.31). CONCLUSIONS: The connections between several different categories of factors and non-exclusive breastfeeding and delayed breastfeeding initiation show the need for comprehensive public health programmes using a multi-sectoral approach to promote breastfeeding behaviours in India.