An Examination of Inter-State Variation in Utilization of Healthcare Services, Associated Financial Burden and Inequality: Evidence from Nationally Representative Survey in India.

This study examines the health care utilization pattern, associated financial catastrophes, and inequality across Indian states to understand the subnational variations and aid the policy makers in this regard. Data from recent National Sample Survey (2017-2018), titled, "Household Social Consumption: Health," covering 113,823 households, was employed in the study. Descriptive statistics, Erreygers concentration index (CI), and recentered influence function decomposition were applied in the study. We found that, in India, 7 percent of households experienced catastrophic health expenditure (CHE) and 1.9 percent of households were pushed below poverty line due to out-of-pocket expenditure on hospitalization. Notably, outpatient care was more burdensome (CHE: 12.1%; impoverishment: 4%). Substantial interstate variations were observed, with high financial burden in poorer states. Utilization of health care services from private health care providers was pro-rich (hospitalization CI 0.31; outpatient CI 0.10), while the occurrence of CHE incidence was pro-poor (hospitalization CI -0.10; outpatient CI -0.14). Education level, economic status, health insurance, and area of residence contributed significantly to inequalities in utilization of health care services from private providers and financial burden. The high financial burden of seeking health care necessitates the need to increase public health spending and strengthen public health infrastructure. Also, concerted efforts directed towards increasing awareness about health insurance and introducing comprehensive health insurance products (covering both inpatient and outpatient services) are imperative to augment financial risk protection in India.

Burden of Stomach Cancer Incidence, Mortality, Disability-Adjusted Life Years, and Risk Factors in 204 Countries, 1990-2019: An Examination of Global Burden of Disease 2019.

BACKGROUND: Stomach cancer is a global health problem and is one of the leading causes of cancer deaths worldwide. This study investigates the spatial and temporal patterns of stomach cancer burden in 204 countries in the last three decades. DATA AND METHODS: The estimates of stomach cancer burden and its risk factors were obtained from the Global Burden of Disease (GBD) 2019 study, covering the years 1990 to 2019, across 204 countries within 21 world regions. GBD employs the cause-of-death ensemble modeling framework to calculate disease-specific mortality estimates. Estimated average percent change (EAPC) of absolute counts (incidence, mortality, and disability-adjusted life years (DALYs)) and age-standardized rates (age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDALR)) was calculated in the regions to illustrate the relative changes between 1990 and 2019. Joinpoint regression was used to analyze global trends of stomach cancer burden in the last three decades. RESULTS: Incidence of stomach cancer globally increased from 883,396 cases in 1990 to 1.3 million cases in 2019 and number of deaths due to stomach cancer rose from 788,317 in 1990 to 957,185 in 2019. Between 1990 and 2019, the global ASIR decreased from 22.4 per 100,000 to 15.6 per 100,000, the ASMR decreased from 20.5 per 100,000 to 11.9 per 100,000 and the ASDALR declined from 493.4 per 100,000 to 290.6 per 100,000. Trend analysis using joinpoint regression revealed the slowest rise in incident cases and largest decline in ASIR between 2004 and 2016. In 2019, East Asia had the highest number of incident cases, totaling 626,489, followed by high-income Asia-Pacific (128,168) and South Asia (99,399). The ASIR was the highest in East Asia (30.2/100,000) followed by high-income Asia-Pacific (28.2/100,000) and Andean Latin America (22.4/100,000), while high-income North America had the lowest ASIR at 6.1/100,000. In terms of absolute counts, the top three countries in 2019 were China, India, and Japan together accounting for 61.5% of global incident cases, 58.6% of deaths, and DALYs. Mongolia had the highest ASIR (43.7 per 100,000), followed by Bolivia (34.0 per 100,000) and China (30.6 per 100,000) in 2019, while the lowest ASIR was 3.3 per 100,000 in Malawi. Globally, for both sexes combined, 7.8% of stomach cancer DALYs were associated with a diet high in sodium and 17.2% were linked to smoking. Among males, 24.0% of stomach cancer DALYs were attributable to smoking, compared to only 4.3% in females in 2019. CONCLUSION: Significant progress has been made globally in the fight against stomach cancer, with the ASIR decreasing by 30.3% and the ASMR by 41.2% between 1990 and 2019. To further reduce the burden of stomach cancer, it is essential to address factors such as Helicobacter pylori prevalence, obesity, and smoking. Additionally, improvements in early detection, socioeconomic development (including better public sanitation, hygiene, and drinking water), and dietary habits are imperative.

A Systematic Review of the World's Largest Government Sponsored Health Insurance Scheme for 500 Million Beneficiaries in India: Pradhan Mantri Jan Arogya Yojana.

BACKGROUND AND OBJECTIVE: In pursuit of universal health coverage, India has launched the world's largest government-sponsored health insurance scheme, Pradhan Mantri Jan Arogya Yojana (PM-JAY) in 2018. This study aims to provide a holistic review of the scheme's impact since its inception. METHODS: We reviewed studies (based on interviews or surveys) published from September 2018 to January 2023, which were retrieved from PubMed, Web of Science, and Scopus database. The main outcomes studied were: (1) awareness; (2) utilization of scheme; (3) experiences; (4) financial protection; and (5) challenges encountered by both beneficiaries and healthcare providers. RESULTS: A total of 18 studies conducted across 14 states and union territories of India were reviewed. The findings revealed that although PM-JAY has become a familiar name, there remains a low level of awareness regarding various facets of the scheme such as benefits entitled, hospitals empanelled, and services covered. The scheme is benefitting the poor and vulnerable population to access healthcare services that were previously unaffordable to them. However, financial protection provided by the scheme exhibited mixed results. Several challenges were identified, including continued spending by beneficiaries on drugs and diagnostic tests, delays in issuance of beneficiary cards, and co-payments demanded by healthcare providers. Additionally, private hospitals expressed dissatisfaction with low health package rates and delays in claims reimbursement. CONCLUSIONS: Concerted efforts such as population-wide dissemination of clear and complete knowledge of the scheme, providing training to healthcare providers, addressing infrastructural gaps and concerns of healthcare providers, and ensuring appropriate stewardship are imperative to achieve the desired objectives of the scheme in the long-run.

Is health insurance really benefitting Indian population? Evidence from a nationally representative sample survey.

BACKGROUND: Universal health coverage (UHC) is the centrepiece of the sustainable development goals and aims to ensure access to essential and quality healthcare services to all without facing financial hardships. Several health insurance programmes have been launched in India to progress towards UHC. OBJECTIVE: This study aims to assess the impact of health insurance (overall health insurance, government sponsored health insurance (GSHI), and private voluntary health insurance) on accessibility and utilization of inpatient care, out-of-pocket health expenditure (OOPE), catastrophic health expenditure (CHE), and impoverishment in India. DATA AND METHODOLOGY: The 75th round of National Sample Survey Office was used in the study, which covered 555,115 individuals, 113,823 households, and 91,445 hospitalization incidence all over India. Descriptive statistics, multivariable logistic regression, and propensity score matching (PSM) methods were employed. RESULTS: Enrolment under health insurance has impacted the accessibility and utilization pattern of hospitalization to some extent for the insured. PSM showed that enrolment under GSHI schemes reduced OOPE by INR 3314 (USD 49) and CHE incidence by 1%-4% at various thresholds. Among poor persons, there was a marginal but statistically significant reduction of OOPE among those enrolled under GSHI schemes (p < 0.05). However, GSHI schemes did not statistically significantly reduce the CHE burden for poor persons enrolled (p > 0.05). Furthermore, enrolment under private voluntary health insurance reduced OOPE by INR 13,511 (USD 198) and CHE by 13.47% at 10% threshold, 4.61% at 25% threshold, and 2.65% at 40% threshold. However, its uptake was primarily confined to richer economic quintiles and urban areas that exacerbates equity concerns. All the results were confirmed through robustness measures employed. CONCLUSIONS: There is a necessity to increase awareness and uptake of health insurance, along with introducing comprehensive insurance packages covering both inpatient and outpatient care. Also, increasing public health spending, strengthening public healthcare facilities, and improving regulatory implementation of private healthcare providers are imperative to augment financial protection.

Burden of AML, 1990-2019: Estimates From the Global Burden of Disease Study.

PURPOSE: AML accounts for 80% of acute leukemia in adults. While progress has been made in treating younger patients in the past 2 decades, there has been limited improvement for older patients until recently. This study examines the global and European Union (EU) 15+ trends in AML between 1990 and 2019. METHODS: We extracted age-standardized incidence rates (ASIRs), age-standardized death rates (ASMRs), and disability-adjusted life years, stratified by sex from the Global Burden of Disease Study database, and mortality-to-incidence ratio (MIR) were computed. Trends were compared using Joinpoint regression. RESULTS: The findings show a global increase in AML incidence for both sexes from 1990 to 2019. In the EU15+ countries, most countries exhibited an increase in ASIR for both sexes. Joinpoint revealed that globally for male patients, ASIR steadily increased until 2010, remained stable until 2015 followed by a decline till 2019. Similar trends were observed in female patients. For ASMR, although there was an increase globally and in most EU15+ countries, there was a statistically significant decrease in mortality rates globally and in the majority of EU15+ countries in recent years. MIR improved in both sexes globally. On age stratification, AML burden was highest among older groups (55 years and older), while the lowest rates were observed in younger than 20 years. CONCLUSION: The findings from our study indicate a global rise in AML incidence and mortality in both sexes and decrease in MIR from 1990 to 2019 suggesting a better survival. However, on Joinpoint analysis, there is no change in MIR in women in the past decade and past 4 years in men indicating plateau in survival trends despite recent advances.

Gender differences in leukemia outcomes based on health care expenditures using estimates from the GLOBOCAN 2020.

BACKGROUND: Leukemia contributes significantly to the global cancer burden. Due to the importance of evaluating improvements in leukemia outcomes, the current study aimed to examine the variations in mortality-to-incidence ratio (MIR) between genders and association of MIR with the health expenditures in selected countries. METHODS: The leukemia incidence and mortality rates were extracted from the GLOBOCAN 2020 database. In total, 56 countries were included based on the data quality reports and the exclusion of missing data. The associations of MIR and changes in MIR over time ([Formula: see text]MIR) with the human development index (HDI), current health expenditure (CHE) per capita, and current health expenditure as a percentage of gross domestic product (CHE/GDP) were investigated using Spearman's rank correlation coefficient. RESULTS: In 2020, an estimated 474,519 new cases of leukemia were diagnosed globally, and 311,594 deaths occurred due to the disease. Male patients exhibited a higher incidence and mortality of leukemia compared to females on a global scale. Our analysis revealed that the MIRs were the highest and lowest in Egypt (0.79) and the United States (0.29), respectively. Remarkably, countries with greater HDI, higher CHE per capita, and a higher CHE/GDP tended to have lower MIR in both genders and within gender-specific subgroups. The δMIR demonstrated a significant negative correlation with HDI and CHE per capita, whereas no significant associations were observed among female patients for CHE/GDP. Besides, all three indicators showed trends towards negative correlations with δMIR among males, though these trends were not statistically significant (p>0.05). CONCLUSIONS: Generally, leukemia MIRs tended to be most favorable (i.e., lower) in countries with high HDI and high health expenditure. The gender differences observed in leukemia outcomes may reflect the potential influence of social, material, behavioral, and biological factors.

A comprehensive examination of the economic impact of out-of-pocket health expenditures in India.

More than 50% of health expenditure is financed through out-of-pocket payments in India, imposing a colossal financial burden on households. Amidst the rising incidence of non-communicable diseases, injuries, and an unfinished agenda of infectious diseases, this study examines comprehensively the economic impact of out-of-pocket health expenditure (OOPE) across 17 disease categories in India. Data from the latest round of the National Sample Survey (2017-18), titled 'Household Social Consumption: Health', were employed. Outcomes, namely, catastrophic health expenditure (CHE), poverty headcount ratio, distressed financing, foregone care, and loss of household earnings, were estimated. Results showed that 49% of households that sought hospitalization and/or outpatient care experienced CHE and 15% of households fell below the poverty line due to OOPE. Notably, outpatient care was more burdensome (CHE: 47.8% and impoverishment: 15.0%) than hospitalization (CHE: 43.1% and impoverishment: 10.7%). Nearly 16% of households used distressed sources to finance hospitalization-related OOPE. Cancer, genitourinary disorders, psychiatric and neurological disorders, obstetric conditions, and injuries imposed a substantial economic burden on households. OOPE and associated financial burden were higher among households where members sought care in private healthcare facilities compared with those treated in public facilities across most disease categories. The high burden of OOPE necessitates the need to increase health insurance uptake and consider outpatient services under the purview of health insurance. Concerted efforts to strengthen the public health sector, improved regulation of private healthcare providers, and prioritizing health promotion and disease prevention strategies are crucial to augment financial risk protection.

Global burden of cancers attributable to tobacco smoking, 1990-2019: an ecological study.

Aim and background: Identifying risk factors for cancer initiation and progression is the cornerstone of the preventive approach to cancer management and control (EPMA J. 4(1):6, 2013). Tobacco smoking is a well-recognized risk factor for initiation and spread of several cancers. The predictive, preventive, and personalized medicine (PPPM) approach to cancer management and control focuses on smoking cessation as an essential cancer prevention strategy. Towards this end, this study examines the temporal patterns of cancer burden due to tobacco smoking in the last three decades at global, regional, and national levels. Data and methods: The data pertaining to the burden of 16 cancers attributable to tobacco smoking at global, regional, and national levels were procured from the Global Burden of Disease 2019 Study. Two main indicators, deaths and disability-adjusted life years (DALYs), were used to describe the burden of cancers attributable to tobacco smoking. The socio-economic development of countries was measured using the socio-demographic index (SDI). Results: Globally, deaths due to neoplasms caused by tobacco smoking increased from 1.5 million in 1990 to 2.5 million in 2019, whereas the age-standardized mortality rate (ASMR) decreased from 39.8/100,000 to 30.6/100,000 and the age-standardized DALY rate (ASDALR) decreased from 948.9/100,000 to 677.3/100,000 between 1990 and 2019. Males accounted for approximately 80% of global deaths and DALYs in 2019. Populous regions of Asia and a few regions of Europe account for the largest absolute burden, whereas countries in Europe and America have the highest age-standardized rates of cancers due to tobacco smoking. In 8 out of 21 regions, there were more than 100,000 deaths due to cancers attributable to tobacco smoking led by East Asia, followed by Western Europe in 2019. The regions of Sub-Saharan Africa (except southern region) had one of the lowest absolute counts of deaths, DALYs, and age-standardized rates. In 2019, tracheal, bronchus, and lung (TBL), esophageal, stomach, colorectal, and pancreatic cancer were the top 5 neoplasms attributable to tobacco smoking, with different burdens in regions as per their development status. The ASMR and ASDALR of neoplasms due to tobacco smoking were positively correlated with SDI, with pairwise correlation coefficient of 0.55 and 0.52, respectively. Conclusion: As a preventive tool, tobacco smoking cessation has the biggest potential among all risk factors for preventing millions of cancer deaths every year. Cancer burden due to tobacco smoking is found to be higher in males and is positively associated with socio-economic development of countries. As tobacco smoking begins mostly at younger ages and the epidemic is unfolding in several parts of the world, more accelerated efforts are required towards tobacco cessation and preventing youth from entering this addiction. The PPPM approach to medicine suggests that not only personalized and precision medicine must be provided to cancer patients afflicted by tobacco smoking but personalized and targeted preventive solutions must be provided to prevent initiation and progression of smoking. Supplementary Information: The online version contains supplementary material available at 10.1007/s13167-022-00308-y.

Financial burden of seeking diabetes mellitus care in India: Evidence from a Nationally Representative Sample Survey.

Background: Diabetes mellitus (DM) is a major public health concern in India, and entails a severe burden in terms of disability, death, and economic cost. This study examined the out-of-pocket health expenditure (OOPE) and financial burden associated with DM care in India. Methods: The study used data from the latest round of the National Sample Survey on health, which covered 555,115 individuals from 113,823 households in India. In the present study, data of 1216 individuals who sought inpatient treatment and 6527 individuals who sought outpatient care for DM were analysed. Results: In India, 10.04 per 1000 persons reported having DM during the last 15 days before the survey date, varying from 6.94/1000 in rural areas to 17.45/1000 in urban areas. Nearly 38% of Indian households with diabetic members experienced catastrophic health expenditure (at the 10% threshold) and approximately 10% of DM-affected households were pushed below the poverty line because of OOPE, irrespective of the type of care sought. 48.5% of households used distressed sources to finance the inpatient costs of DM. Medicines constituted one of the largest proportion of total health expenditure, regardless of the type of care sought or type of healthcare facility visited. The average monthly OOPE was over 4.5-fold and 2.5-fold higher for households who sought inpatient and outpatient care, respectively, from private health facilities, compared with those treated at public facilities. Notably, the financial burden was more severe for households residing in rural areas, those in lower economic quintiles, those belonging to marginalised social groups, and those using private health facilities. Conclusion: The burden of DM and its associated financial ramifications necessitate policy measures, such as prioritising health promotion and disease prevention strategies, strengthening public healthcare facilities, improved regulation of private healthcare providers, and bringing outpatient services under the purview of health insurance, to manage the diabetes epidemic and mitigate its financial impact.

Carpet industry irrigational sources risk assessment: Heavy metal contaminated vegetables and cereal crops in northern India.

Wastewater is often discharged to natural water bodies through an open channel as well as used by marginal farmers to irrigate the agricultural fields, particularly in sub-urban areas of developing countries. In the present study, the samples of irrigation water, soil, vegetables (i.e., palak; Beta vulgaris L. var All green H1, radish; Raphanus sativus L., garlic; Allium sativum L., cabbage; Brassica oleracea L. var. capitata, brinjal; Solanum melongena L.) and crops (i.e., paddy; Oryza sativa L. and wheat; Triticum aestivum L.) were collected from the agricultural areas receiving untreated wastewater from a carpet industrial and residential areas since a decade. The contents of Cd, Cr, Cu, Ni, and Zn in the filtrates of water, soil, and crops were determined using an Atomic Absorption Spectrophotometer (Perkin-Elmer AAnalyst 800, USA). Daily intake, hazardous quotient and heavy metal pollution index were computed to assess the health risk associated with consumption of heavy metal contaminated crops. The mean concentrations of Cd and Zn in B. vulgaris (5.35 µg g-1 dw and 58.41 µg g-1 dw, respectively) and Cr, Cu, and Ni in grains of T. aestivum (16.02 µg g-1 dw, 27.97 µg g-1 dw and 40.74 µg g-1 dw, respectively) were found highest and had exceeded the Indian safety limit. Daily intake of Cu, Ni, and Cr via consumption of tested cereal crops was found higher than the vegetables. The health quotient revealed that health of local residents is more linked to vegetables than cereal crops. The present findings may be helpful to the policymakers and regulatory authorities to modify the existing policy of wastewater uses in the agriculture and disposal to the natural water bodies. The regular monitoring of heavy metals in the wastewater should also be ensured by the regulatory authorities for their safe disposal to natural water bodies/agriculture in order to reduce the human health risk associated with the degree of heavy metal contaminated suburban food systems.

Type-2 Diabetes Mellitus (T2DM): Spatial-temporal Patterns of Incidence, Mortality and Attributable Risk Factors from 1990 to 2019 among 21 World Regions.

PURPOSE: Type-2 diabetes Mellitus (T2DM) is one of the leading causes of death and disability worldwide. This study examines temporal patterns of the global, regional, and national burden of T2DM in the last three decades. DATA AND METHODS: The estimates of age, sex and location-wise incident cases, deaths, prevalent cases, and disability-adjusted-life-years (DALYs) and risk factors for 21 regions and 204 countries are retrieved from the Global Burden of Disease 2019 study from 1990 to 2019. Socio-demographic index (SDI) is used as the indicator of the development status of countries, and quadratic regression is employed to examine the relationship between country-level age-standardized rates and SDI. RESULTS: Globally, incident cases of T2DM more than doubled from 8.4 million[95% uncertainty interval, 7.8-9.1 million] in 1990 to 21.7 million[20.0-23.5 million] in 2019, and deaths more than doubled from 606,407[573,069-637,508] to 1.5 million[1.4-1.6 million] between 1990 and 2019. Global T2DM prevalence increased from 148.4 million[135.5-162.6 million] in 1990 to 437.9 million[402.0-477.0 million] in 2019. In 2019, global age-standardized prevalence rate stood at 5282.8/100,000[4853.6-5752.1], varying from 2174.5/100,000[1924.3-2470.5] in Mongolia to 19876.8/100,000[18211.1-21795.3] in American Samoa. SDI exhibited inverted-U shaped relationship with country-level age-standardised rates. Globally, high body-mass-index (51.9%), ambient particulate matter pollution (13.6%), smoking (9.9%) and secondhand smoke (8.7%) were the major contributing risk factors towards T2DM DALYs in 2019. CONCLUSION: With ubiquitously rising prevalent cases globally, particularly in low and middle-income countries and regions, T2DM requires immediate attention and targeted policy response worldwide centered on lifestyle interventions (e.g., physical activity, smoking, diet, and obesity), air pollution control and cost-effective timely treatment.

The burden of chronic kidney disease in Asia, 1990-2019: Examination of estimates from global burden of disease 2019 study.

BACKGROUND: Chronic kidney disease (CKD) is a global public health issue, with Asia accounting for one of the highest CKD prevalence worldwide. This study examines the burden of CKD in Asian continent in the last three decades. DATA AND METHODS: The estimates of age, sex and year wise burden of CKD for 49 countries in Asia for 1990 to 2019 were procured from the Global Burden of Disease 2019 study. FINDINGS: In 2019, there were 9.8 million [9.0-10.6 million] new cases and 763 024 [696 050-823 829] deaths due to CKD in Asia. Between 1990 and 2019, CKD prevalence doubled from 202.4 million [186.5-219.1 million] to 431.2 [400.3-462.0 million]. Although age-standardized incidence rate (ASIR) of CKD increased from 170.6 [156.7-186.2] in 1990 to 206.3 [190.4-223.4] per 100 000 person-years in 2019, the age-standardized mortality rate (ASMR) witnessed a modest reduction from 18.4/100 000 [17.0-20.1] to 17.3/100 000 [15.7-18.7]. In 2019, the ASIR spanned from 141.9/100 000 [126.2-159.2] in Tajikistan to 561.4/100 000 [524.6-598.6] in Saudi Arabia, and ASMR varied from 8.9/100 000 [7.2-9.8] in Japan to Saudi Arabia (52.9 [42.8-63.1]). Between 1990 and 2019, absolute count of CKD incident cases, deaths, prevalent cases and disability-adjusted life years (DALYs) increased 100% or more in 48/49, 32/49, 43/49 and 23/49 countries, respectively. INTERPRETATION: CKD is widespread in the Asian region, with an alarming burden in resource-constrained countries. Strategies such as promoting awareness, screening among high-risk individuals, provision of cost-effective therapies, and increased healthcare coverage could help deal with the CKD epidemic in Asia.

A comparative examination of colorectal cancer burden in European Union, 1990-2019: Estimates from Global Burden of Disease 2019 Study.

AIM: This study examines the burden of colorectal cancer (CRC) in European Union (EU) countries in the last 3 decades. METHODS: The data pertaining to CRC burden were procured from the Global Burden of Disease 2019 Study for 28 EU countries (including United Kingdom) for the period 1990-2019. The age-standardized rates of CRC were utilized to compare the country-wise burden and joinpoint regression models were applied to examine the trends. RESULTS: In EU, CRC incident cases increased by 70.2% from 261,306 to 444,872 and deaths increased by 36.8% from 155,823 to 213,174 between 1990 and 2019. The age-standardized incidence rate (ASIR) increased by 11.9% from 37.8/100,000 to 42.3/100,000 between 1990 and 2019; in contrast, the age-standardized mortality rate (ASMR) decreased by 16.9% (1990: 22.4/100,000; 2019: 18.6/100,000) and age-standardized DALYs rate (ASDALR) decreased by 18.6% (1990: 472.9/100,000; 2019: 385.1/100,000) in the study period. In 2019, Hungary was the leading country in terms of ASMR (28.6/100,000) and ASDALR (630.3/100,000), and Lithuania (29.2/100,000) had the lowest ASIR, whereas Finland had the lowest ASMR (12.3/100,000) and ASDALR (253.6/100,000) in 2019. CONCLUSION: CRC incidence is increasing in EU and mortality rates, although decreasing, are still unacceptably high. CRC control efforts must be focused around early detection using screening and prevention through reduction of modifiable risk factors. Increasing CRC incidence rates in young adults in recent years requires more research to pinpoint risk factors, and there must be more awareness of this recent development among general public and clinicians.

Cross-Sectional Study on Assessment of Frequency of Intestinal Helminth Infections and Its Related Risk Factors among School Children from Adola Town, Ethiopia.

The three main intestinal helminth infections (IHIs), ascariasis, trichuriasis, and hookworm, are common clinical disorders worldwide. These IHIs are more prevalent in tropics and subtropical countries especially in developing countries like sub-Saharan Africa responsible for morbidity, mortality, and physical as well as intellectual growth retardation in children. In Ethiopia, the burden of IHIs appears in all ages mainly due to factors like lack of education, low socio-economic status, and inadequate supply of drugs and proper awareness. The present study was carried out to access the prevalence of intestinal helminth infections and associated risk factors among school children in Adola town from Guji Zone, Oromia, Ethiopia, from August 2019 to December 2019. 404 stool samples were collected in a clean, dry, screw-capped, and wide-mouthed plastic container, fixed with 10% formal-saline solution, and transported to the Adola Hospital laboratory for further microscopic analysis by wet mount following formal ether concentration technique. Data were analyzed using SPSS version 20 by binary logistic regression model using odd ratio with 95% CI. The overall prevalence of IHIs among school children was found to be 33.91% (137/404). Rate of double infection was noted to be 2.72% (11/404). Most dominant species was Ascaris lumbricoides (8.9%) followed by Hymenolepis nana (7.7%), Taenia saginata (5.4%), hookworm (4.7%), Trichuris trichiura (2.5%), Schistosoma mansoni (2.2%), Enterobius vermicularis (1.7%), and Strongyloides stercoralis (0.7%), respectively. Highest prevalence was observed in male students (39.6%) compared to female students (28.8%) (P < 0.05). The prevalence of IHIs among school children in the age group of 6-10, 11-15, 16-20, and above 20 was 49.6%, 35.8%, 10.9%, and 3.6%, respectively (P < 0.05). IHI was significantly associated with some of the risk factors such as gender, educational level of students', toilet usage habit, habit of hand washing, hand washing habit before feeding and after defecation, purpose of hand washing, and awareness to intestinal helminths (P < 0.05). In the study area, the prevalence of IHIs is moderately high and represents a public health problem in the school children. Therefore, all stakeholders should pay attention to raise awareness about health education programs such as proper personal hygiene, environmental sanitation, improving the quality of drinking water, and treatment to reduce the consequences of intestinal helminths.

Non invasive assessment of human oocytes and embryos in assisted reproduction: Review on present practices and future trends.

Oocyte and embryo grading is one of the most important steps in assisted reproductive technology to identify the best among cultured embryos for transfer or vitrification. The most commonly used non-invasive method is morphological assessment of gametes and embryos using a microscope. This method despite being simple and cost-effective has interobserver and intraobserver variability and subjectivity and has little to offer about the physiological state of embryos. This review sourced research articles and reviews pertaining to other non-invasive assessment methodologies from Medline and PubMed to collate latest technologies in vogue and identify novel methodologies of the future. The review assesses the current understanding in oocyte and embryo grading and touches upon novel non-invasive techniques and potential biomarkers to identify the best embryo. The latest available literature on time-lapse imaging, hierarchical algorithms, omics (consisting of proteomics and secretomes), miRNAs, mitochondrial RNAs and artificial intelligence has been accessed to summarize the enormous information available, to identify gaps in current interpretations, to identify emerging technologies and to provide direction for future research. This review will greatly benefit anyone practicing assisted reproduction and clinical embryology.

Antioxidant properties, phenolics and flavonoids content of some economically important plants from North-west Indian Himalaya.

The present study investigated antioxidant properties, total phenolic and flavonoid contents in methanol extract of the leaf, stem bark, and fruit of Olea ferruginea Royle, Olea europaea L., and Tilia europaea L. grow naturally in the north-west Indian Himalaya. Phenolics and flavonoids content was found to be maximum in methanol extracts of stem bark and leaf (9.28 mg GAE/g fw and 14.73 mg QE/g fw, respectively) of O. ferruginea plants. Ferric reducing antioxidant power and DPPH radical scavenging activity were found to be maximum in leaf and stem bark (38.88 mM AAE/g fw and 20.31 mM AAE/g fw, respectively) of O. ferrugenia plants, whereas maximum ABTS radical scavenging activity (4.52 mM AAE/g fw) was recorded with stem bark of T. europaea plants. These tree species were found rich in natural compounds and also possess antioxidant activities. Therefore, their pharmaceutical and local uses for the health benefits are suggested.

Examining the temporal impact of stock market development on carbon intensity: Evidence from South Asian countries.

The growing size of stock market in the South Asian countries might have contributed to raising the level of industrial production and energy consumption. This upturned energy usage might have widened the scope for carbon emissions because these nations heavily rely on fossil fuels. In this milieu, therefore, in the present study, we assessed the impacts of stock market development, per capita income, trade expansion, renewable energy solutions, and technological innovations on carbon intensity in the four South Asia countries from 1990 to 2016. The empirical results based on the CS-ARDL approach revealed that stock market development, per capita income, and trade expansion invigorated carbon intensity in the South Asian countries. On the contrary, the increased usage of renewable energy solutions and technological advancement helped in reducing the energy-led carbon intensity. Further, the interaction of stock market with renewable energy, and subsequently with technological advancement delivered insignificant coefficients, which indicates the inefficacy of renewable energy and technological advancement in regulating stock market-led carbon intensity during the study period. Therefore, by considering the need for complementarity between economic growth and environmental targets, we proposed a multipronged policy framework, which may help the selected countries to attain the Sustainable Development Goals, with a special focus on SDG 7, 8, 9, and 13.

Does energy consumption reinforce environmental pollution? Evidence from emerging Asian economies.

Steadily improving per capita income level, energy consumption, and delivery of financial services in South and Southeast Asian countries has remained a subject of discussion among policymakers. Because these endeavors have not only elevated their growth trajectory but also widened the scope for carbon emissions, especially in the preceding two decades. In order to confirm this argument, therefore, in the present study, we intended to examine their dynamic impacts on carbon emissions. In this pursuit, by using the second-generation unit-root test, cointegration test, and panel regression procedures, we investigated the moderating impact of energy solutions on the association between per capita income and CO2 emissions and financial development and CO2 emissions from 1976 to 2015. The computed results revealed that the energy's interaction with the linear per capita income significantly escalated carbon emissions in the long run. However, the impact of energy's interaction with the squared per capita income on carbon emissions is found insignificant but positive in the long run. On the other hand, the interaction of energy with financial development provided a negative but insignificant coefficient. Based on the outcomes, we can ascertain that, at the lower level of income, energy consumption leads to environmental pollution, whereas at the higher level of income, its harmful effect on carbon emissions becomes weak in the given regions. By taking a cue from the computed results, we proposed a policy framework that might help these regions to navigate the energy-led environmental challenges in the coming years.

Examining the nexus between export diversification and environmental pollution: evidence from BRICS nations.

In recent years, industrial growth has enabled the BRICS nations to increase their export earnings from both traditional and new products. However, in terms of modernization of industries, these nations can be considered as laggards, because the present production processes appear to be carbon-intensive and energy-inefficient. In this backdrop, the present study, by using the second-generation econometric procedures, is intended to examine the impact of industrialization, export diversification, technological innovation, income inequality, and resource rents on the carbon dioxide emissions in the BRICS nations from 1990 to 2018. The long-run coefficients revealed that the industrial expansion, reduction in export diversification, low concentration on traditional exports, and high concentration on new exports exacerbated the air quality in the BRICS nations. On the other hand, technological advancement contributed to restoring environmental quality during the study period. Furthermore, it is observed that the present research endeavors in the BRICS nations are insufficient in circumventing industrial pollution, as the value of the joint coefficient of technological advancement and industrialization is found insignificant but negative. Hence, based on the computed results, a multipronged policy framework is proposed, so that these nations can achieve the targeted sustainable development goals (SDGs) in the coming years.