Let us take a walk to the sustainable tourism practices: a qualitative study through the lens of tourism experts.

The rising opportunities of sustainable tourism have brought many policies to control the exploitation of the environment and increase the reach of luxurious, safe, and authentic experiences to the different segments of tourists. This study seeks to prioritize the variables influencing the development of sustainable tourism and pinpoint key success factors that align with the Sustainable Development Goals (SDGs). It adopts a tri-dimensional framework encompassing economic, social, and environmental aspects, further delineated into eleven sub-dimensions, to provide a quantitative evaluation of sustainable tourism. We conducted interviews with 26 tourism industry experts hailing from eight countries, analyzing their responses using interval type-2 fuzzy sets. The results underscore the critical role of specific components in advancing sustainable tourism. In the economic dimension, "financial resources and tourism costs" emerge as vital factors. In the social dimension, "health and safety" takes center stage, while "green infrastructure" plays a pivotal role in the environmental dimension. These findings underscore the significance of these aspects in promoting sustainable tourism. Furthermore, this study explores the strategic importance of sustainable tourism equity in shaping tourism planning and development for emerging markets.

Mental health and satisfaction with partners: a longitudinal analysis in the UK.

BACKGROUND: Current UK health policy stresses treating health as an asset to underpin and promote a more inclusive and productive society. The quality of personal relationships is essential for overall quality of life. The social determinants of health (SDH) literature shows that poor mental health and well-being are linked to weaker personal and social connections for individuals, families, and society. The causal impact that mental health has on satisfaction with partners is less understood but requires investigation. METHODS: The causal relationship between mental health and satisfaction with partners is examined drawing on the United Kingdom's British Household Panel Survey from 1991 to 2008. A total sample of 9,024 individuals in dyadic couples comprising 42,464 observations was analysed using fixed-effects and instrumental variable fixed-effects panel data estimation. RESULTS: Lower mental health is associated with a lower satisfaction with partners. However, some causal evidence of lower mental health reducing satisfaction with partners is present for males. DISCUSSION: For females, relationship satisfaction is more likely to influence mental health. For males there is a potential 'vicious circle' between satisfaction with partners and mental health. CONCLUSIONS: Investment in mental health provision can improve satisfaction with partners which in turn will further enhance health and well-being.

Assessment of feasibility and acceptability of family-centered care implemented at a neonatal intensive care unit in India.

BACKGROUND: A family-centered care (FCC) parent participation program that ensures an infant is not separated from parents against their will was developed for the caring of their small or sick newborn at a neonatal intensive care unit (NICU) in Delhi, India. Healthcare provider sensitization training directed at psychosocial and tangible support and an audio-visual training tool for parent-attendants were developed that included: 1) handwashing, infection prevention, protocol for entry; 2) developmentally supportive care, breastfeeding, expression of breastmilk and assisted feeding; 3) kangaroo mother care; and 4) preparation for discharge and care at home. The study aimed to examine the feasibility and acceptability of the FCC model in a NICU in India. METHODS: A prospective cohort design collected quantitative data on each parent-attendant/infant dyad at enrollment, during the NICU stay, and at discharge. Feasibility of the FCC program was measured by assessing the participation of parent-attendants and healthcare providers, and whether training components were implemented as intended. Acceptability was measured by the proportion of parent-attendants who participated in the trainings and their ability to accurately complete program activities. RESULTS: Of 395 NICU admissions during the study period, eligible participants included 333 parent-attendant/infant dyads, 24 doctors, and 21 nurses. Of the 1242 planned parent-attendant training sessions, 939 (75.6%) were held, indicating that program fidelity was high, and the majority of trainings were implemented as intended. While 50% of parent-attendants completed all 4 FCC training sessions, 95% completed sessions 1 and 2; 60% of the total participating parent-attendants completed session 3, and 75% completed session 4. Compliance rates were over 96% for 5 of 10 FCC parent-attendant activities, and 60 to 78% for the remaining 5 activities. CONCLUSIONS: FCC was feasible to implement in this setting and was acceptable to participating parent-attendants and healthcare providers. Parents participated in trainings conducted by NICU providers and engaged in essential care to their infants in the NICU. A standard care approach and behavior norms for healthcare providers directed psychosocial and tangible support to parent-attendants so that a child is not separated from his or her parents against their will while receiving advanced care in the NICU.

Assessment of health infrastructure in tackling COVID-19: A case study of European and American scenario.

The COVID-19 coronavirus pandemic is an unparalleled threat intoday's quickly developing climate, and we face it as a global community. Like climate change, it is challenging our resilience from environmental health, social security, and government, to knowledge exchange and economic policy in all sectors of the economy and all fields of growth. So much as climate change, everybody's coming together would require the initiative. Throughout Europe and America, several organizations have mobilized to ensure that the neediest are not left behind, encouraging emergencies and disruptions avoidance and preparedness. The coronavirus outbreak has highlighted the growing community's strengths and vulnerabilities that it has influenced, and has provided us with the ability to benefit from each other's accomplishments and shortcomings. The comparison graph has also been shown in this paper displaying European and American scenarios. The globe might feel smaller amid disaster states and global travel bans, but it is a period when teamwork and looking outward were never more relevant.

An Assessment of Implementation of Family Participatory Care in Special Newborn Care Units in Three States of India.

OBJECTIVE: To study special newborn care units (SNCUs) in terms of family participatory care (FPC) quality initiative as per Government of India guidelines in select public health facilities, and to document the perspectives of the doctors and mothers. DESIGN: Cross-sectional. SETTINGS: SNCUs with functional FPC units in the states of Odisha, Madhya Pradesh and Rajasthan. PARTICIPANTS: 38 SNCUs; doctors and nurses in-charge of the unit; and two eligible mothers per unit, one inside the step-down unit and second outside the step-down unit whose newborns were admitted to special new-born care unit, having a stable baby weighing above 1500 g. INTERVENTION: The states implemented FPC as per Government of India guidelines using National Health Mission funds across special newborn care units. This assessment involved onsite observation and interviews of key providers. OUTCOME: Proportion of facilities providing regular counselling sessions, enabling support to mothers, recording FPC information; perspectives of health providers on improvement of breastfeeding and kangaroo mother care; proportion of eligible mothers practicing FPC, exclusively breastfeeding, and providing kangaroo mother care services. RESULTS: Out of 38 SNCUs, we found that FPC sessions for mothers were happening in 36 (95%) facilities. SNCUs provided enabling support to mothers on FPC (74.2%), held regular sessions for the families (70.6%), nurses assisted mothers and family members for breastfeeding and kangaroo mother care (76.4%) and FPC information were recorded (70.6%). CONCLUSIONS: The assessment of facilities where FPC was implemented showed that SNCUs were equipped to implement FPC in public health settings.

Health, subjective financial situation and well-being: a longitudinal observational study.

BACKGROUND: An individual's financial situation is a key contributor to their overall well-being. Existing research has examined the direct economic consequences of changes in health upon out-of-pocket healthcare expenditure, participation in the labour force and potential earnings. There is also research exploring an individual's concern about their subjective financial situation regardless of the level of their income or work status on their health. In contrast, this paper conducts a causal analysis of the effects of general and mental health on an individual's subjective evaluation of their financial situation controlling for their work status and income. This is of importance because current health policy in the United Kingdom (UK) stresses the role of health as an asset which can mediate the wider flourishing of individuals. Moreover, subjective financial situation comprises a key component of well-being now being measured and sought in social welfare policy. METHODS: Fixed effects instrumental variable panel data regression analysis is applied to 25 years of longitudinal data, from 1991, drawn from the harmonised British Household Panel Survey (BHPS) and Understanding Society Survey (USS). RESULTS: Improved general health and reduced mental illness both improve the subjective financial situation of males and females. However, these affects diminish across older cohorts of males and females. CONCLUSIONS: Investing in and improving general and mental health can improve the subjective financial situation and hence well-being of individuals. The targeting of health also needs to take account of an individuals' life-stage.

The effect of health on social capital; a longitudinal observation study of the UK.

BACKGROUND: UK health policy increasingly focusses on health as an asset. This represents a shift of focus away from specific risk factors towards the more holistic capacity by which integrated care assets in the community support improvements in both health and the wider flourishing of individuals. Though the social determinants of health are well known, relatively little research has focussed on the impact of an individual's health on their social outcomes. This research investigates how improved health can deliver a social return through the development of social capital. METHODS: An observational study is undertaken on 25 years of longitudinal data, from 1991, drawn from the harmonised British Household Panel Survey (BHPS) and Understanding Society Survey (USS). Fixed effects instrumental variable panel data regression analysis is undertaken on individuals. The number of memberships of social organisations, as a measure of structural social capital, is regressed on subjectively measured general health and GHQ12 (Likert) scores. Distinction is drawn between males and females. RESULTS: Improved general health increases social capital though differences exist between males and females. Interaction effects, that identify the impacts of health for different age groups, reveal that the effect of increased health on social capital is enhanced for males as they age. However, in the case of females increases in general health increase social capital only in connection with their age group. In contrast mental illness generally reduces social capital for males and females, and these effects are reduced through aging. CONCLUSIONS: Investing in health as an asset can improve the social outcomes of individuals. Increasing the outcomes requires tailoring integrated care systems to ensure that opportunities for social engagement are available to individuals and reflect age groups. Targeting improvements in mental health is required, particularly for younger age groups, to promote social capital. The results suggest the importance of ensuring that opportunity for engagement in social and civic organisation be linked to general and mental health care support.

A computed tomography-based classification of Hoffa fracture: Surgical treatment considerations and prognostic outcome with assessment of reproducibility.

INTRODUCTION: Isolated fracture of femoral condyle in the coronal plane (Hoffa fracture) is rare and surgically challenging to treat. The purpose of this study is to introduce a new classification for this fracture, evaluating its utility in treatment guidelines and its reproducibility. MATERIALS AND METHODS: 103 patients with Hoffa fracture were operated in our tertiary care centre from 2004 to 2014. Computed tomography (CT) was done in all cases preoperatively. Many fractures had variable patterns which could not be defined and categorized as per Letennuer's classification. A pilot study with first 25 cases were analysed and certain morphological fracture patterns were observed in CT. The fixation methods and failure models were also noted. This resulted in development of a new classification specifying the fracture patterns and the preferred fixation methods for a better outcome. Next 78 consecutive fractures were then classified preoperatively as per our CT classification and treatment executed according to the protocol. Outcomes were measured using Neer's scoring system and International Knee Society Documentation Committee (IKDC) Functional Score. RESULTS: Out of 78 patients, 69 had excellent outcome, 7 had satisfactory and 2 had unsatisfactory outcome which corresponded with the specified fracture severity pattern. Uniformly excellent results were obtained in all simple pattern fractures, whereas comminuted fractures especially posterior cortex comminution and articular comminution yielded less favourable outcomes. CONCLUSION: We conclude that therapeutic outcome is significantly affected by articular comminution, posterior cortex comminution, achieving anatomical reduction and stable fixation. Pre-operative fracture classification and treatment guidelines gives a predictable outcome with least complications and has good interobserver reliability thus instrumental in surgical planning. LEVEL OF EVIDENCE: III.

Comparative Study of Micronuclei Count in Patients with Different Tobacco-related Habits using Exfoliated Buccal Epithelial Cells: A Tool for Assessment of Genotoxicity.

AIM: To study and compare the genotoxic effects of tobacco using micronuclei count in individuals with different tobacco-related habits. MATERIALS AND METHODS: A cross-sectional study was done comprising 200 individuals, divided into four groups. Group I: 50 subjects with history of tobacco chewing, group II: 50 subjects with a history of smoking tobacco, group III: 50 subjects with a history of both tobacco chewing and smoking, and group IV: 50 subjects without any habits as controls (age-matched). The study groups were individually further divided into three subgroups which comprised of subjects with history of substance abuse for less than 5, 5 to 10, and greater than 10 years. Exfoliated cells from the buccal mucosa of the subjects were collected and stained using Giemsa stain. A total of 1,000 cells were examined for each case and micronuclei frequency was scored according to the guidelines given by Tolbert et al. Results: The mean number of micronuclei count was 18.28 ± 10.0 in group I (smokeless tobacco users), 11.38 ± 6.3 in group II (subjects with history of tobacco smoking), 22.44 ± 9.8 in group III (subjects with history of using both smokeless and smokable form of tobacco), and 4.86 ± 2.4 in the control group. The statistical difference was found to be highly significant (p < 0.001). Similarly, based on the duration, highly significant difference was notable in the mean number of micronuclei in subjects who had a history of substance abuse for more than 10 years. CONCLUSION: A significantly higher micronucleus frequency was found in smokeless tobacco users than in smokers and controls. Micronuclei assay in the exfoliated buccal cells is a useful and minimally invasive method for monitoring early genotoxic damage. CLINICAL SIGNIFICANCE: Micronuclei assay can be used to detect genotoxic damage at the earliest and, if intervened at this point, may prevent frank malignancy, morbidity, and mortality.

Norbixin, an apocarotenoid derivative activates PPARγ in cardiometabolic syndrome: Validation by in silico and in vivo experimental assessment.

The increased prevalence of cardio-metabolic disorders worldwide prompted the exploration of new strategies for its treatment. Peroxisome Proliferator activated receptor (PPAR) play major role in regulation of lipid as well as glucose metabolism and thus, natural PPARγ activators seem to be drug of choice. AIMS: In the present work, we studied norbixin which is a natural apocarotenoid derivative for its agonistic activity for PPAR γ followed by in vivo studies for amelioration of cardio-metabolic syndrome (CMetS). MAIN METHODS: The methods include computational studies, TR-FRET binding analysis and in vivo studies on high fat diet induced rats. KEY FINDINGS: Molecular docking and molecular dynamics (MD) simulation studies showed that norbixin could be embedded into hydrophobic pocket of PPARγ and stable hydrogen bonding interactions were found with residues Glu273, Tyr327, Ser289, His323, His449 and Tyr473 of PPARγ. These results were substantiated by significant in vitro PPAR agonistic activity of norbixin in TR-FRET binding assay studies. The experimental results of norbixin in high fat diet induced CMetS in rats further confirmed that norbixin decreased insulin resistance (IR), hyperglycemia and dyslipidemia. These results were accompanied by reduced inflammatory marker hs-CRP as well as decreased oxidative stress and arterial pressure. The histopathology of heart sections also showed that norbixin could prevent the abnormal fibrotic changes in heart. Furthermore, PPARγ protein expressions were increased, whereas NF-κB expression was decreased by norbixin treatment in western blot studies. SIGNIFICANCE: These results validate norbixin as a novel PPARγ agonist and prove therapeutic potential of norbixin in treatment of CMetS.

Deciphering PPARγ activation in cardiometabolic syndrome: studies by in silico and in vivo experimental assessment.

Cardiometabolic syndrome (CMetS) is a consolidation of metabolic disorders characterized by insulin resistance, dyslipidemia and hypertension. Curcumin, a natural bioactive compound, has been shown to possess notable anti-oxidant activity and it has also been included as a super natural herb in the super natural herbs database. Most of the beneficial effects of Curcumin are possibly due to activation of the nuclear receptor, peroxisome proliferator-activated receptor gamma (PPARγ). The present study investigates molecular interactions of curcumin with PPARγ protein through molecular docking and molecular dynamics (MD) simulation studies. Further, effect of curcumin on high fat diet induced CMetS was studied in rats along with western blot for PPARγ and nuclear factor-κB (NF-κB) expressions and histopathological studies. Computational studies presented several significant molecular interactions of curcumin including Ser289, His323, His449 and Tyr473 of PPARγ. The in vivo results further confirmed that curcumin was able to ameliorate the abnormal changes and also, increased PPARγ expressions. The results confirm our hypothesis that activation of PPARγ by curcumin possesses the therapeutic potential to ameliorate the altered levels of metabolic changes in rats in the treatment of CMetS. This is the first report of CMetS treatment by curcumin and study of its underlying mechanism through in silico as well as in vivo experiments.

Assessment of the in vitro cytotoxicity and in vivo anti-tumor activity of the alcoholic stem bark extract/fractions of Mimusops elengi Linn.

Various parts of Mimusops elengi Linn. (Sapotaceae) have been used widely in traditional Indian medicine for the treatment of pain, inflammation and wounds. The study was conducted to explore the use of stem bark of M. elengi on pharmacological grounds and to evaluate the scientific basis of cytotoxic and anti-tumor activity. Extract/fractions were prepared and in vitro cytotoxicity was assessed using SRB assay. Most effective fractions were subjected to fluorescence microscopy based acridine orange/ethidium bromide (AO/EB) and Hoechst 33342 staining to determine apoptosis induction and DNA fragmentation assay. Comet and micronuclei assay were performed to assess genotoxicity. Cell cycle analysis was also performed. In vivo anti-tumor potential was evaluated by Ehrlich ascites carcinoma (EAC) model in mice. The alcoholic stem bark extract of M. elengi along with four fractions showed potential in vitro cytotoxicity in SRB assay. Of these, dichloromethane and ethyl acetate fractions were selected for further studies. The fractions revealed apoptosis inducing potential in AO/EB and Hoechst 33342 staining, which was further confirmed by DNA fragmentation assay. Genotoxic potential was revealed by comet and micronuclei assay. Fractions also exhibited specific cell cycle inhibition in G0/G1 phase. In EAC model, ethyl acetate fraction along with the standard (cisplatin) effectively reduced the increase in body weight compared to control and improved mean survival time. Both fractions were able to restore the altered hematological and biochemical parameters. Hence, M. elengi stem bark may be a possible therapeutic candidate having cytotoxic and anti-tumor potential.

An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh.

BACKGROUND: Quality hospital care is important in ensuring that the needs of severely ill children are met to avert child mortality. However, the quality of hospital care for children in developing countries has often been found poor. As the first step of a country road map for improving hospital care for children, we assessed the baseline situation with respect to the quality of care provided to children under-five years age in district and sub-district level hospitals in Bangladesh. METHODS: Using adapted World Health Organization (WHO) hospital assessment tools and standards, an assessment of 18 randomly selected district (n=6) and sub-district (n=12) hospitals was undertaken. Teams of trained assessors used direct case observation, record review, interviews, and Management Information System (MIS) data to assess the quality of clinical case management and monitoring; infrastructure, processes and hospital administration; essential hospital and laboratory supports, drugs and equipment. RESULTS: Findings demonstrate that the overall quality of care provided in these hospitals was poor. No hospital had a functioning triage system to prioritise those children most in need of immediate care. Laboratory supports and essential equipment were deficient. Only one hospital had all of the essential drugs for paediatric care. Less than a third of hospitals had a back-up power supply, and just under half had functioning arrangements for safe-drinking water. Clinical case management was found to be sub-optimal for prevalent illnesses, as was the quality of neonatal care. CONCLUSION: Action is needed to improve the quality of paediatric care in hospital settings in Bangladesh, with a particular need to invest in improving newborn care.

Assessment of hand functions in rheumatoid arthritis using SF-SACRAH (short form score for the assessment and quantification of chronic rheumatoid affections of the hands) and its correlation to disease activity.

Rheumatoid arthritis activity is generally evaluated by using DAS-28 score. But this does not reflect the extent of functional hand impairment, a decisive parameter for patient wellbeing as well as for work disability. Several questionnaires to quantify the hand involvement in RA have been elaborated, amongst which SACRAH has been popular since 2003. But this requires evaluating 23 questions on a visual analogue scale. The questions were reduced to 12 in modified-SACRAH (M-SACRAH) and to only five questions in short form SACRAH (SF-SACRAH) so as to make it easily applicable in daily clinical practice. A study was planned to compare M-SACRAH (already validated) to SF-SACRAH in Indian population as no Indian data are available on the same. A total of 100 patients of RA were evaluated for disease activity using DAS-28 score and hand functions using M-SACRAH and SF-SACRAH. The M-SACRAH and SF-SACRAH were then compared based on DAS-28 scores; also M-SACRAH was compared to SF-SACRAH using Spearman's correlation coefficient. The mean value of DAS-28 score was 3.15 ± 0.86. The mean value of SF-SACRAH was 8.065 ± 7.44, and mean value of M-SACRAH was 201.7 ± 201.1008. The correlation of DAS-28 score to SF-SACRAH and M-SACRAH was significant in moderate and high disease activity but insignificant in remission and low disease activity state. The correlation between M-SACRAH and SF-SACRAH showed a spearman's coefficient of 0.998 with a P value of <0.001 (significant correlation). Correlation was significant for all disease activity states and for remission. The study suggests that the disease activity of rheumatoid arthritis (as assessed by DAS-28 score) has a poor correlation with hand functions (as assessed by M-SACRAH and SF-SACRAH) especially in low disease activity and remission states. Further, M-SACRAH and SF-SACRAH are significantly correlated. Therefore, it is suggested that RA patients should be assessed by SF-SACRAH (which includes five questions only) in addition to DAS-28 scoring for better evaluation of hand functions, a detrimental factor in day to day performance of RA patients.