An assessment of atmospheric concentrations and spatiotemporal variation of BTEX and associated pollutants in India.

Benzene, toluene, ethylbenzene, and xylene (BTEX) pollution poses a serious threat to public health and the environment because of its respiratory and neurological effects, carcinogenic properties, and adverse effects on air quality. BTEX exposure is a matter of grave concern in India owing to the growing vehicular and development activities, necessitating the assessment of atmospheric concentrations and their spatial variation. This paper presents a comprehensive assessment of ambient concentrations and spatiotemporal variations of BTEX in India. The study investigates the correlation of BTEX with other criteria pollutants and meteorological parameters, aiming to identify interrelationships and diagnostic indicators for the source characterization of BTEX emissions. Additionally, the paper categorizes various regions in India according to the Air Quality Index (AQI) based on BTEX pollution levels. The results reveal that the northern zone of India exhibits the highest levels of BTEX pollution compared to central, eastern, and western regions. In contrast, the southern zone experiences the least pollution with BTEX. Seasonal analysis indicates that winter and post-monsoon periods, characterized by lower temperatures, are associated with higher BTEX levels due to the accumulation of localized emissions. When comparing the different zones in India, high traffic emissions and localized activities, such as solvent use and solvent evaporation, are found to be the primary sources of BTEX. The findings of the current study aid in source characterization and identification, and better understanding of the region's air quality problems, which helps in the development of focused BTEX pollution reduction and control strategies.

Socioecological factors influencing the risk of developing hypertensive disorders of pregnancy in India: a rapid review.

BACKGROUND: The prevalence of hypertensive disorders of pregnancy (HDPs) in India is 11%, which is one of the highest rates globally. Existing research on HDPs in India primarily focuses on biological risk factors, with minimal research on how socioecological factors combine to increase risk of HDPs. We conducted a rapid review using Bronfenbrenner's Ecological Model to understand the social and cultural factors associated with HDPs among Indian pregnant women to identify possible intervention targets that may uniquely improve health in this population. Bronfenbrenner's Ecological Model is a framework that can be used to understand the complex relationship between multiple influences on health. METHODS: We reviewed studies published between January 2010 and January 2024 using PubMed, Science Direct, and Scopus databases. Search terms included variants of hypertension, pregnancy, and India. Inclusion criteria were: (1) peer-reviewed journal article; (2) published between January 2010 to January 2024; (3) participants consisted of Indian women living in India; (4) studies evaluated socioecological risk factors associated with HDPs. One independent reviewer performed searches, screening, data extraction, and quality assessment. Each included study was then organized within Bronfenbrenner's Ecological Model. RESULTS: A total of 921 studies were generated from the initial search, with 157 exclusions due to duplicates. Following screening for inclusion and exclusion criteria at the title/abstract and full text levels, 17 studies remained in the final review. Socioecological risk factors of HDPs were identified at each level, with the most commonly identified influences including: low socioeconomic status (SES), lacking community education and knowledge on HDP management and prevention, and lacking prenatal HDP screening. CONCLUSION: This study determined that the high risk for HDPs in India is influenced by many intertwined socioecological factors. Women in rural and low SES areas need more health education on HDP management and prevention. There also needs to be more adequate prenatal HDP screening, with at least 4 and ideally 8 prenatal visits. Prenatal screenings should be accompanied with culturally appropriate patient education, especially for low SES women who have limited literacy, so that they can effectively make individual and microsystemic lifestyle decisions aimed at either managing or preventing HDPs.

Cervical Cancer Prevention Among Rural Women in Gujarat, India: A Mixed Methods Study on Risk Factors and KAP (Knowledge, Attitude and Practice).

BACKGROUND: Cervical cancer causes significant morbidity and mortality among women in India. Despite national screening guidelines, uptake of these tools remains poor, especially in rural areas where complex sociocultural factors are at play. Integrated mixed-methods designs can provide better insights into multilevel barriers influencing screening behaviours. This study aimed to assess the knowledge, attitudes, practices, and sociocultural factors associated with cervical cancer prevention among marginalized rural women. METHODS: A mixed-method study of 400 women aged older than 18 years was conducted using a pretested questionnaire on cervical cancer knowledge, attitudes, self-reported screening practices, and sociodemographic variables. An exploratory qualitative study also interviewed 30 women to explore perspectives on screening using semi-structured guides. The survey data were analyzed via logistic regression, and thematic analysis was performed for the qualitative data. The results were triangulated to enable nuanced interpretation. RESULTS: Only 27% (108/400) of participants had heard of cervical cancer, and 61% (244/400) were illiterate. Poor knowledge was observed in 83% (332/400) of participants, predicted by early marriage, high parity, low education, and socioeconomic status. Despite 64% (254/400) expressing positive attitudes, only 9% (36/400) reported undergoing cervical cancer screening. None of the participants were vaccinated against human papillomaviruses (HPV). Stigma, gender roles, spousal communication gaps, and access barriers emerged as key qualitative themes. The integrated results highlighted the intersections between villagers' worldviews and sociocultural norms and between access issues and prevention. CONCLUSIONS: Multifaceted sociocultural challenges underpin the cervical cancer prevention gap among marginalized rural women. Grassroots educational efforts respectfully addressing fears and stigma, along with increased male engagement, community health worker training, and integrated screening services, can promote informed screening decisions among underserved groups.

Clinical Implication of Time of Ischaemic Stroke Among Post-Stroke Survivors from Eastern India: A Circadian Perspective.

The circadian variation in stroke occurrence is a well-documented phenomenon. However, the circadian effect on stroke outcome, particularly on post-stroke cognition, has not yet been fully elucidated. We aim to evaluate the influence of diurnal variation of stroke onset upon post-stroke cognition and development of post-stroke depression. Based on 4-hourly time period of stroke occurrence, 249 recruited cohorts were categorized into 6 groups. Several clinical and cognitive parameters were compared among the groups. Then, the mRNA expression of core clock genes in Peripheral Blood Mononuclear Cells were quantified and correlated with post-stroke outcomes among 24 acute phase cases with day-time or night-time stroke occurrence. Furthermore, the genetic susceptibility towards a higher number of cases in the morning was examined by genotyping CLOCK (rs1801260T/C, rs4580704G/C) and CRY2 (rs2292912C/G) genes variants in cases and 292 controls. In our study, the peak for highest incidence although observed during the early morning from 4 to 8 am, the nocturnal-onset stroke cases showed more severity (12.2 ± 5.67) at the time of admission irrespective of arterial territory involved. The night onset cases were also found to be more susceptible to develop language impairment and post-stroke depression in due course of time. Upon transcript analysis, circadian genes (BMAL1 and CRY1) were found to be downregulated in night-time cases than day-time ones during the acute phase of onset. In addition, those mRNA levels also showed a correlation with raw scores for language and depression. However, the difference in incidence frequency along a day did not reveal any genetic correlation. Therefore, we suggest night-time stroke to be positively associated with higher immediate severity and poor cognitive outcome than day-time injury and propose downregulation of circadian genes during the acute phase could be the underlying molecular mechanism for this.

An Application of Yagna Pathy: A Spiritual, Cost-Effective, Indigenous Low-Intensity Psychological Intervention to Manage Common Mental Disorders: A Cross-Sectional Pilot Study in India.

Elements of Common Mental Disorders (CMD) like stress, depression and anxiety are significant contributors to the global burden of disease. Even though they affect people at all socioeconomic levels, most of those in the low-income and middle-income populations lack access to efficient psychological and pharmaceutical interventions. One potential solution to this issue is the application of indigenous low-intensity psychological interventions like Yagna Pathy. The current cross sectional pilot study includes a total of 426 heterogenous group of people suffering from Stress, Anxiety and Depression (both in normal and diseased range) received Yagna pathy for 30 days. The severity of the stress, anxiety and depression was evaluated using a validated depression, anxiety, and stress (DAS) score questionnaire. A significant association (chi square, p < 0.001) was found between the mental healing with gender and activity status of the participants. Strong inter-correlation (R2 > 0.7; p < 0.001) among features of stress, anxiety and depression also proved the manifoldness of the CMD. Improvements in DAS scores demonstrate the effectiveness of a well-directed Yagna practice maintained for a predetermined amount of time in managing stress, anxiety, and depression. The receiver operating characteristic (ROC) of the responses was also found to be "excellent". Therefore, the study showcased that indigenous practices like Yagna Pathy could effectively minimize the severity of CMD. This approach is non-medicated, non-invasive, and cost-effective, making it a practicable therapy for global implementation.

Trends in Road Traffic Injuries Mortality in India: An Analysis from the Global Burden of Disease Study 1990-2021.

Road traffic injury (RTI) is one of the most common causes of accidental deaths in India. The study investigates the changes in trends in age-standardised RTI mortality rates in India by sex and age groups, using data from the Global Burden of Disease (GBD) Study 2021. The trend segments are estimated from 1990 to 2021 employing a joinpoint regression model. Additionally, the influence of age, time period, and birth cohort on mortality rate trends was assessed using the age-period-cohort model. Over the past 32 years, the RTI mortality rates have experienced multiple trend segments. RTI mortality rate in the ≤ 14-year-old population has declined remarkably, dropping from 5.71 (4.65 to 6.88) per lakh population in 1990 to 3.66 (3.01 to 4.35) per lakh population in 2010, and further declining to 1.98 (1.65 to 2.37) per lakh population in 2021. The study found a positive correlation between RTI mortality rates and age, with rates consistently lower for women compared to men across all age groups. The variation in RTI mortality rates across Indian states has widened over time, with the coefficient of variation increasing from 30.58% in 1990 to 32.36% in 2010, and further to 35.11% in 2021. Despite efforts, Indian states are unlikely to achieve the goal of halving RTI deaths by 2030, based on 2010 levels. To address this, road conditions and road safety policies aimed at preventing the incidence of RTIs should be further intensified.

Invasive Fungal Infection in Hematopoietic Stem Cell Transplant Recipient from an Indian Oncology Setting.

Abdul GhafurObjective Invasive fungal infections (IFI) are one of the major causes of morbidity and mortality in post-hematopoietic stem cell transplant (HSCT) recipients. Data from India is limited. The objective of this study was to analyze the incidence, risk factors, and outcomes associated with IFI in our center. Materials and Methods Adult patients, who underwent marrow/stem cell transplantation between 2014 and 2018, in an oncology center in India, were included in this single-center retrospective observational study. The revised European Organization for Research and Treatment of Cancer/ Mycoses Study Group (EORTC/MSG) consensus group 2008 definition for IFI was considered to define cases. Incidence, risk factors, and outcomes associated with IFI were analyzed. Statistical Analysis All continuous variables were represented by mean ± standard deviation and categorical variables as percentage. Comparison of categorical variables was done by either the chi-squared test or Fisher's exact test. All " p " values less than 0.05 were considered statistically significant. Results Out of the 126 patients who underwent HSCT between January 2014 and December 2018, 56 (44.4%) patients had allo-HSCT, 64 (50.8%) had auto-HSCT, and 6 (4.8%) had haplo-identical HSCT. Eighty-three (63%) patients were male and 43 (34%) females, and 113 (83.9%) Asians and 13 (10.3%) Africans. Total 111 (88%) patients received myeloablative conditioning and 24 (19%) received total body irradiation. The hematological conditions were acute myeloid leukemia ( n = 23; 18.25%), acute lymphoblastic leukemia ( n = 16; 12.69%), chronic myeloid leukemia ( n = 4; 3.17%), Hodgkin lymphoma ( n = 17; 13.4%), non-Hodgkin lymphoma ( n = 11; 8.73%), myeloma ( n = 35; 27.7%), sickle cell disease ( n = 13; 10.31%), etc. Most patients received fluconazole (78; 61.9%) followed by micafungin (23; 18.25%), posaconazole (20; 15.87%), voriconazole (4; 3.17%), and liposomal amphotericin B (1; 0.79%) as antifungal prophylaxis. The overall rate of IFI (possible cases included) was auto-HSCT ( n = 5; 7.81%), and allo-HSCT ( n = 5; 8.92%). Among auto-HSCT, the IFI was proven = 0, probable n = 1 (1.5%), and possible n = 4 (6.25%) and among allo-HSCT the IFI was proven = 0, probable n = 2 (3.57%), and possible n = 3 (5.35%). No patients in haplo-HSCT had IFI. The 1-year survival rate among the IFI cases was 8/10(80%). A meaningful comparison of the risk factors and the impact of prophylactic regimens were difficult because of the very low number of IFI cases. Conclusion The overall rate of IFI in HSCT patients in our setting was low compared to global data on IFI in HSCT.

Comparison of homocysteine, vitamin B12 and folic acid between rural and urban ageing Indians and its association with mild cognitive impairment and cardiovascular risk factors: a cross-sectional analysis.

The relationship between blood levels of homocysteine (HCY), vitamin B12, folic acid and cognitive impairment is inconclusive. Since HCY is an independent risk factor for cardiovascular diseases, understanding its association with Framingham risk score (FRS) may provide insight into the shared underlying mechanism between cardiovascular disease and cognitive impairment. Cross-sectional analyses utilized baseline data from two ongoing longitudinal studies: the Tata Longitudinal Study of Ageing (n = 923), an urban cohort, and Srinivaspura Ageing, NeuroSenescence and COGnition (n = 4239), a rural cohort. The study compared the HCY, vitamin B12 and folic acid levels across cohorts and normal versus mild cognitive impairment (MCI) participants. The association between HCY and cognitive status was established using regression models. Three models were analysed: model 1-unadjusted; model 2-adjusted for age, gender, smoking, alcohol consumption, diet, hypertension, cardiac illness, diabetes; and model 3-adjusted for variables in model 2 plus vitamin B12 and folic acid. Correlation was calculated between HCY and FRS. The urban cohort exhibited a significantly higher level of HCY [median (IQR) (17.70 (10.2) versus 14.70 (9.7); P < 0.001)], vitamin B12 (251 (231) versus 219 (138); P < 0.001) and folic acid (8.21 (8) versus 5.48 (4); P < 0.001) levels compared to rural cohort. HCY, vitamin B12 and folic acid levels did not differ significantly between normal and MCI participants in the urban cohort. In the rural cohort, among the age-gender matched MCI-normal, participants with normal cognition had higher levels of vitamin B12 (≥60 years) [227 (152) versus 217 (175); P = 0.03] and folic acid (<60 years) [5.91 (4) versus 5.40 (4); P = 0.04] compared to MCI. There was no association between HCY and cognitive status in both the cohorts, but there was a significant positive relationship between vitamin B12 deficiency and Clinical Dementia Rating-Sum of the Boxes (CDR-SOB), as well as folic acid deficiency and CDR-SOB in rural and urban cohorts, respectively, within a specific age group. A significant correlation was observed between FRS and HCY in the rural cohort (r = 0.17, P < 0.001), but not in the urban cohort. This study revealed significant differences in HCY, vitamin B12 and folic acid levels between the cohorts. In the rural cohort, participants with MCI had lower vitamin B12 and folic acid levels in a certain age group. Association between HCY and cognitive status was insignificant in both the cohorts. A small significant correlation between FRS and HCY was seen in the rural cohort.

Swallowing the Litigation Pill: The Future of Medical Lawsuits in India.

As the tide of medical lawsuits rises, doctors in India find themselves navigating increasingly treacherous waters. What drives this surge in litigation? Can we chart a course through these challenging times, or are we destined to face relentless legal battles? In this editorial, we unravel the complexities of this pressing issue and glimpse what lies on the horizon for India's medical community.

Cancer screening uptake by women from India's largest state Uttar Pradesh: district-wise analysis from the fifth round of National Family Health Survey (2019-2021).

The Government of India (GOI) has launched a nationwide cervical, breast and oral cancer prevention and control program. However, the fifth round of the National Family Health Survey (NFHS-5), a nationwide survey conducted by the Ministry of Health and Family Welfare (MoHFW), GOI, has shown concerning results on screening uptake by both men and women across India. This study was conducted to describe the uptake of cancer screening by women residing in Uttar Pradesh (UP), the largest state of India. We analyzed NFHS-5 data available in public domain to determine the number of women (aged 30-49 years) participating in cancer screening across the 71 districts in UP state. We utilized population projections for the year 2021 provided by the population projections for India and states for calculating the number of women. The district-wise estimation was done using a projection of district-level annual population. Although the GOI has made screening available for common cancers, NFHS-5 results indicated that the screening uptake among women aged 30-49 years is a cause for concern. The data revealed less than 1% of women underwent screening, and some of the districts showed no screening uptake. GOI has laid down a framework for cancer screening; however, poor participation among women calls for research to understand the barriers to cancer screening and to develop interventions to address these barriers.

Cobalamin Intake in North Indians by Food Frequency Questionnaire (COIN-FFQ) - A Development and Validation Study.

Background: Vitamin B12 deficiency is widely prevalent in all age groups which is of major concern. However, there is no valid Food Frequency Questionnaire (FFQ) for dietary vitamin B12 estimation. Hence, we aimed to develop and validate an FFQ for the estimation of dietary intake of Vitamin B12. Materials and Methods: Commonly consumed B12-rich food items were selected from literature and filtered using a market survey. For concordant and discriminant validation, B12 and homocysteine levels were estimated. To establish convergent validity, the Cobalamin Intake in North Indians by Food Frequency Questionnaire (COIN-FFQ) and 72-hour dietary recall (72HrDR) were both administered to the same subjects. The COIN-FFQ was readministered after initial administration for test-retest reliability. Internal consistency of the FFQ was then tested using Cronbach's alpha. Results: We enrolled 115 adults with a mean age and weight of 31.9 ± 8.7 years and 66.0 ± 11.8 kg, respectively. In total, 19.1% were vegetarian. The dietary B12 using COIN-FFQ (n = 60; mean = 4.3 ± 1.8 µg/d) was significantly correlated (r = 0.255; P = 0.049) with serum levels (mean = 120.1 ± 62.6 pmol/L) establishing concordant validity. A significant difference was noted between the dietary, serum B12, and homocysteine levels of vegetarians versus nonvegetarians establishing discriminant validity (mean diff 1.4 (0.5-2.4), P = 0.004; Z-statistic -2.182, P value 0.029, and Z-statistic -2.438; P value 0.015), respectively. FFQ was strongly correlated with 72HrDR and test-retest FFQ (n = 27; r = 0.814, P < 0.001 and r = 0.869, P < 0.001, respectively) establishing convergent validity and test-retest reliability. The internal consistency with Cronbach's alpha was in the acceptable range, 0.631 (n = 115). Conclusion: The newly developed COIN-FFQ is valid and reliable in estimating dietary B12 intake.

Real World Outcome of High-Risk Multiple Myeloma: An Indian Tertiary Care Centre Experience.

INTRODUCTION: High risk myeloma is heterogeneous with significant variation in risk stratifications. Real world outcomes differ from controlled clinical trials and affected by socioeconomical determinants. MATERIAL AND METHODS: This retrospective study was performed in a North Indian teriarty care cancer hospital. Out of 384,76(19.7%) high risk myeloma patients (median age 58 years) were analyzed. RESULT AND CONCLUSION: Most common HRCA was 1 q gain 36(47.4%) followed by del17p 32(42.1%). 61/76(80.2%) received bortezomib based triplets and 15(19.74%) daratumumab based quadruplets induction, 31(40.79%) received ASCT. Median duration of follow up was 19.5 months. The 2 year OS and PFS was 73.8%, 52.6% respectively. Estimated 3 year OS was 74.7% in ASCT cohort versus 52.9% (P = .0067) without. Estimated 3-year PFS in the ASCT cohort was 72.1% versus 30.3% (P = .0026) without. Estimated 3-year OS for single hit and multi hit ultra HRMM was 67.7% and 61.9% (P = .642) whereas PFS was 58.2% and 35.2% (P = .486) respectively. In multivariate analysis ASCT correlated with better OS (HR 0.3, P = .041) and PFS (HR 0.35, P = .012). Absence of baseline renal impairment correlated with better OS (HR 4.12, P = .004) only. Early aggressive therapy with prompt ASCT translates to a better survival in high risk myeloma. Emphasis on real world clinical outcome is the need of the hour for addressing practical issues and improving global myeloma outcome.

Silicosis predicts drug resistance and retreatment among tuberculosis patients in India: a secondary data analysis from Khambhat, Gujarat (2006-2022).

BACKGROUND: India, with the highest global burden of tuberculosis (TB) and drug-resistant TB, aims to eliminate TB by 2025. Yet, limited evidence exists on drug resistance patterns and retreatment among patients with silico-tuberculosis. This study explores these patterns and assesses the impact of silicosis on TB retreatment in India. METHODS: This secondary data analysis stems from a larger retrospective cohort study conducted in Khambhat, Gujarat, between January 2006 and February 2022. It included 138 patients with silico-tuberculosis and 2,610 TB patients without silicosis. Data from the Nikshay TB information portal were linked with silicosis diagnosis reports from the Pneumoconiosis Board using the unique Nikshay ID as the linking variable. Drug-resistant TB was defined as resistance to any anti-TB drug recorded in Nikshay. Retreatment refers to TB patients who have previously undergone anti-TB treatment for one month or more and need further treatment. Recurrent TB denotes patients who were previously declared cured or had completed treatment but later tested positive for microbiologically confirmed TB. Multivariable logistic regression was used to determine the impact of co-prevalent silicosis on drug resistance and retreatment. RESULTS: Patients with silico-tuberculosis showed a higher proportion of retreatment compared to those without silicosis (55% vs. 23%, p < 0.001). Notably, 28% of patients with silico-tuberculosis were recurrent TB cases, compared to 11% among those without silicosis. Regarding drug resistance, the silico-tuberculosis group exhibited a higher rate (6% vs. 3%), largely due to rifampicin resistance (5% vs. 2%, p = 0.022). Co-prevalent silicosis was associated with a 2.5 times greater risk of drug-resistant TB (adjusted OR 2.5, 95% CI, 1.1-5.3; p = 0.021). Additionally, patients with silico-tuberculosis had a fourfold increased risk of retreatment for TB (adjusted OR 4, 95% CI, 3-6; p < 0.001). CONCLUSIONS: Co-prevalent silicosis significantly elevates the risk of drug resistance, recurrence, and retreatment among TB patients in India. This study indicates a need for improved treatment protocols and suggests that future research should focus on randomized controlled trials to evaluate appropriate anti-TB regimen and duration of therapy for this high-risk group. Given India's goal to eliminate TB by 2025, addressing the challenges posed by silico-tuberculosis is critical.

Talking morphine: Pain and prognosis in Indian cancer care.

Pain can be a pervasive feature of cancer, particularly in regions such as India, where the disease is rarely detected in its early stages. Yet over recent decades, morphine, a "gold standard" pain medicine, has been rarely used in India. This article draws on anthropological discussions of clinical disclosure in Indian cancer care to complicate assertions that this is because pain is missed or ignored by healthcare workers. Instead, in a context where the disclosing of prognoses is partial and indirect, I argue that morphine has gained a communicative function. Typically withheld until the "end of life", the drug has come to be read as a death sentence. It has become an analgesic and a prognosis. It is an object that talks in situations where direct communication is often avoided.

Morphometric characteristics and spatiotemporal heterogeneity of microplastics on the north-east coast of India.

The study analysed microplastics (MPs) in surface waters along the north-east coast of India and focused on the spatiotemporal distribution and morphometric characteristics of 800 particles for environmental insights. The MPs were consistently present in all water masses, with an average abundance of 0.67 ± 0.66 particles/m3 during the monsoon and 0.12 ± 0.08 particles/m3 post-monsoon. Fragments and fibers were dominant in both seasons, comprising over 83 % and 12 %, respectively. In terms of colours, blue was significantly dominant during the post-monsoon (H, χ2 (5) = 15.38, p < 0.01); however, such variation was absent during the monsoon. Spatially, significant variance in abundance (F4, 34 = 8.542; p < 0.01) and across colours and forms during the monsoon was correlated with land-based inputs from the Hooghly River. FTIR analysis revealed ten polymer types, predominantly polyethylene (44 %). SEM observations indicated that 80 % of particles exhibited polymer ageing from oxidative weathering. The size distribution of MPs varied notably, with a higher proportion of < 0.3 mm (16.7 %) during the monsoon, possibly due to increased particle disintegration. The study noted MPs had low to moderate circularity, with increased irregularity during the monsoon due to heavy precipitation and river flushing. An initial risk assessment of MP pollution in surface waters on the north-east coast revealed a low-risk state. Acrylonitrile butadiene styrene (ABS) was identified as the most hazardous MP polymer. A wide range of toxic trace elements were found in MPs in these waters. The findings from the study deepen our knowledge of MPs and their fate in the pelagic zone, which supports the development of science-based policies that effectively reduce MP pollution.

The Ayushman Bharat Digital Mission of India: An Assessment.

India launched the Ayushman Bharat Digital Mission (ABDM) in 2021 to strengthen the digital health ecosystem by developing and integrating health data records and registries. We apply the health system control knob framework to assess the progress of ABDM by analyzing five indicators. Data from the ABDM dashboard reveal notable progress in beneficiary registration (400 million, as of June 3, 2023) and health records linkage (273 million). The registrations of over 208,000 health facilities and 190,000 health care professionals have been verified by ABDM. However, inter-state variation in progress is significant, particularly in health facility and health professional registration. Going forward, ABDM should expand its strategic framework to ensure that more health facilities and health professionals are registered, as registration is important to influence the payment, organization, and regulation control knobs. These actions are related to the achievement of final health system goals: improved health status, financial risk protection, and beneficiary satisfaction.

Analyzing the Maharashtra Ambulance Service "108": The Prospect and Challenges.

The utilization of digital health in India is playing a crucial role in enhancing healthcare services by transitioning from the current inadequate public health structure to a more efficient and patient-centric system. Digital health includes various digital tools, such as electronic health records (EHRs), telemedicine, mobile health applications, health information exchange systems, and other technological advancements to improve access, efficiency, and quality of healthcare delivery. This study investigates the prospects and challenges encountered by the newly-digitized Maharashtra Emergency Medical Services (MEMS). Utilizing the 38,823 MEMS calls from November 2022, this study investigates the current status of emergency service delivery mechanisms in Maharashtra. Through spatial analyses, this study also explores the causes behind calls. The findings of the study show that calls for 108 ambulance services were distributed across the districts and had variable service delivery time periods. Current challenges to the system arise from various urban and healthcare infrastructure problems, as well as socio-cultural challenges. Implementation of the digitized MEMS system reveals key factors that influence the service's success, assisting the policymakers and health administrators in identifying and further improving the service.

Improvement in symptoms of anxiety and depression in individuals with type 2 diabetes: retrospective analysis of an intensive lifestyle modification program.

BACKGROUND: Type 2 diabetes (T2D) is a chronic metabolic disorder that has a notable influence on mental well-being, contributing to elevated morbidity and mortality rates. Depression and anxiety disorders are the most common mental health concerns among patients with T2D worldwide. Therefore, the present study aimed to assess the impact of an online intensive lifestyle intervention (ILI) on mental health outcomes (depression and anxiety) in patients with T2D in India. MATERIALS AND METHODS: This retrospective pre-post analysis included adult patients (aged > 18 years) diagnosed with T2D who were enrolled in a diabetes management program in India between June 2021 and June 2023. The intervention consisted of lifestyle modifications such as a customized plant-based diet, regular physical activity, psychological support through group and individual therapy, and medical management. Data were extracted from the electronic database of the clinic, including anthropometry, medical history, biochemical parameters, symptoms of depression, and anxiety (assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorders-7 (GAD-7) scale) at the start and end of the six-month intervention period. RESULTS: Of the 1061 eligible patients (177 with prediabetes), 40.3% were female. The mean age, duration of diabetes, and HbA1c levels were 52 ± 10.4 years, 9.8 ± 7.8 years, and 8 ± 1.7%, respectively. The prevalence of symptoms of depression and anxiety (ranging from mild to severe) was 46% and 44.3%, respectively, which reduced to 28.7% and 29.2%, respectively, post-intervention. CONCLUSION: Integrated ILI successfully improved the symptoms of anxiety and depression, highlighting the importance of a multidisciplinary approach that includes diet, physical activity, psychological support, and medical management in enhancing mental health outcomes among patients with T2D. Future prospective studies are needed to explore the long-term effects of such interventions and develop effective strategies for promoting mental health in diverse populations. TRIAL REGISTRATION: The study was approved by the Freedom from Diabetes Research Foundation Institutional Ethics Committee (approval number FFDRF/IEC/2024/7) and registered in the Clinical Trials Registry of India (CTRI/2024/03/064596, registered on March 21, 2024).

The nexus between maternal antenatal care attendance, newborn postnatal care and neonatal mortality in India: a matched case-control study.

INTRODUCTION: Our study examines the relationship between newborn postnatal care and neonatal mortality stratified by maternal antenatal care attendance under a matched case-control framework. METHODS: Data from the fifth round of the National Family Health Survey was used. A total of 172,079 recent births to eligible women (15-49 years) in five years preceding the survey were included in the study. We used the conditional logistic regression model, a commonly used regression model to fit matched case-control data to examine the effects of newborn postnatal care on neonatal mortality. The mother's age at birth of the newborn, previous birth intervals, birth order of the newborn, and birthsize of the newborn were included as the matching variables. RESULTS: Newborns receiving postnatal care within two days or more than two days of birth are less likely to die during the neonatal period. Preferences for newborn postnatal care were also observed to increase with more maternal antenatal care visits. Our study also found a lower risk of neonatal mortality among those newborns whose umbilical cord was examined within two days of birth, regardless of the number of maternal antenatal care visits. Similarly, the risk of newborn deaths was lower among babies whose body temperature was measured within two days of birth. The tendency to breastfeed their newborns within an hour after delivery was considerably higher among those births that occurred to mothers who had a higher number of maternal antenatal care visits. The risk of newborn deaths was also observed to be lower among those born in public or private healthcare facilities. CONCLUSION: Considering the cohesive nature of the relationship between neonatal mortality and maternal and child healthcare utilisation, strategic planning and management of the existing policies and programmes related to accessibility, availability, and affordability of maternal and child healthcare services is needed to achieve goal 3.2 of the Sustainable Development Goals. Promoting cost-effective measures such as continuous monitoring of the baby's body temperature and umbilical cord care could also effectively help reduce neonatal mortality.