Human resource shortage in India's health sector: a scoping review of the current landscape.

BACKGROUND: For healthcare delivery to be optimally effective, health systems must possess adequate levels and we must ensure a fair distribution of human resources aimed at healthcare facilities. We conducted a scoping review to map the current state of human resources for health (HRH) in India and the reasons behind its shortage. METHODS: A systematic search was conducted in various electronic databases, from the earliest available date till February 2024. We applied a uniform analytical framework to all the primary research reports and adopted the "descriptive-analytical" method from the narrative paradigm. Inductive thematic analysis was conducted to arrange the retrieved data into categories based on related themes after creating a chart of HRH problems. RESULTS: A total of 9675 articles were retrieved for this review. 88 full texts were included for the final data analysis. The shortage was addressed in 30.6% studies (n = 27) whereas 69.3% of studies (n = 61) addressed reasons for the shortage. The thematic analysis of data regarding reasons for the shortage yielded five kinds of HRH-related problems such as inadequate HRH production, job dissatisfaction, brain drain, regulatory issues, and lack of training, monitoring, and evaluation that were causing a scarcity of HRH in India. CONCLUSION: There has been a persistent shortage and inequitable distribution of human resources in India with the rural expert cadres experiencing the most severe shortage. The health department needs to establish a productive recruitment system if long-term solutions are to be achieved. It is important to address the slow and sporadic nature of the recruitment system and the issue of job insecurity among medical officers, which in turn affects their other employment benefits, such as salary, pension, and recognition for the years of service.

Menstrual hygiene practices and associated factors among Indian adolescent girls: a meta-analysis.

BACKGROUND: Menstrual hygiene management (MHM) and practices by adolescent females of low and middle-income countries (LMICs) are a severe public health issue. The current systematic review and meta-analysis aimed to estimate the pooled proportion of the hygiene practices, menstrual problems with their associated factors, and the effectiveness of educational interventions on menstrual hygiene among adolescent school girls in India. METHODS: PRISMA checklist and PICO guidelines were used to screen the scientific literature from 2011 to 2021. The Newcastle-Ottawa Scale was used to assess the quality of studies. Four themes were developed for data analysis, including hygiene practices, type of absorbent used, menstruation associated morbidities and interventions performed regarding menstruation. Eighty-four relevant studies were included and a meta-analysis, including subgroup analysis, was performed. RESULTS: Pooled data revealed a statistically significant increase in sanitary pad usage "(SMD = 48.83, 95% CI = 41.38-57.62, p < 0.00001)" and increased perineum practices during menstruation "(SMD = 55.77, 95% CI = 44.27-70.26, p < 0.00001)". Results also reported that most prevalent disorders are dysmenorrhea "(SMD = 60.24, 95% CI = 50.41-70.06, p < 0.0001)", Pre-menstrual symptoms "(SMD = 62.67, 95% CI = 46.83-78.50, p < 0.00001)", Oligomenorrhea "(SMD = 23.57, CI = 18.05-29.10, p < 0.00001), Menorrhagia "(SMD = 25.67, CI = 3.86-47.47, p < 0.00001)", PCOS "(SMD = 5.50, CI = 0.60-10.40, p < 0.00001)", and Polymenorrhea "(SMD = 4.90, CI = 1.87-12.81, p < 0.0001)". A statistically significant improvement in knowledge "(SMD = 2.06, 95% CI = 0.75-3.36, p < 0.00001)" and practice "(SMD = 1.26, 95% CI = 0.13-2.65, p < 0.00001)" on menstruation was observed. Infections of the reproductive system and their repercussions can be avoided with better awareness and safe menstruation practices. CONCLUSIONS: Learning about menstrual hygiene and health is essential for adolescent girls' health education to continue working and maintaining hygienic habits. Infections of the reproductive system and their repercussions can be avoided with better awareness and safe menstruation practices.

Menstrual hygiene management (MHM) and practices by adolescent females of low and middle-income countries (LMICs) are severe problems for girls, parents, society, and policymakers. Menstrual-related problems are widespread among adolescent girls in India. Different menstrual abnormalities are found in different populations, suggesting socio-cultural and regional variation. Menstrual abnormalities and disorders are frequently linked to physical, mental, social, psychological, and reproductive issues, affecting adolescents' daily lives and their families lives by various psychosocial problems such as anxiety. We have the intention to compile, summarise, and critically analyse peer-reviewed and published scientific evidence from 2011 to 2021 on menstrual hygiene management methods used, most typical menstrual morbidities and their associated factors among Indian adolescent girls, and to evaluate the evidence for existing interventions like educational programs and absorbent distribution. Program planners and policymakers could use the findings of this study to build relevant initiatives to incorporate safe MHM in the country so that interventions can be designed taking into account the current needs of adolescent girls to reduce menstrual morbidities and improve their quality of life. A statistically significant improvement in knowledge and practice on menstruation was observed. Learning about menstrual hygiene and health is an essential aspect of adolescent girls' health education to continue working and maintaining hygienic habits. Infections of the reproductive system and their repercussions can be avoided with better awareness and safe menstruation practices.

Ranking the strategies for Indian medical tourism sector through the integration of SWOT analysis and TOPSIS method.

Purpose Organizations have to evaluate their internal and external environments in this highly competitive world. Strengths, weaknesses, opportunities and threats (SWOT) analysis is a very useful technique which analyzes the strengths, weaknesses, opportunities and threats of an organization for taking strategic decisions and it also provides a foundation for the formulation of strategies. But the drawback of SWOT analysis is that it does not quantify the importance of individual factors affecting the organization and the individual factors are described in brief without weighing them. Because of this reason, SWOT analysis can be integrated with any multiple attribute decision-making (MADM) technique like the technique for order preference by similarity to ideal solution (TOPSIS), analytical hierarchy process, etc., to evaluate the best alternative among the available strategic alternatives. The paper aims to discuss these issues. Design/methodology/approach In this study, SWOT analysis is integrated with a multicriteria decision-making technique called TOPSIS to rank different strategies for Indian medical tourism in order of priority. Findings SO strategy (providing best facilitation and care to the medical tourists at par to developed countries) is the best strategy which matches with the four elements of S, W, O and T of SWOT matrix and 35 strategic indicators. Practical implications This paper proposes a solution based on a combined SWOT analysis and TOPSIS approach to help the organizations to evaluate and select strategies. Originality/value Creating a new technology or administering a new strategy always has some degree of resistance by employees. To minimize resistance, the author has used TOPSIS as it involves group thinking, requiring every manager of the organization to analyze and evaluate different alternatives and average measure of each parameter in final decision matrix.

Pharmacist's knowledge and attitude towards self-medication practices: a cross-sectional study for the development and validation of questionnaire.

BACKGROUND: Pharmacists play an essential role in self-medication by providing guidance and counselling services to consumers; hence, it is necessary to assess pharmacists' awareness and attitude towards self-medication to promote responsible self-medication practices. OBJECTIVE: To develop a valid and reliable instrument to assess the knowledge and attitude of pharmacists towards self-medication practices and their role in promoting responsible self-medication. METHOD: A questionnaire was developed in English after a relevant literature review, which was further administered to a sample of 105 community pharmacists. The reliability of the questionnaire was assessed using the Karl-Pearson correlation and Cronbach alpha statistics. Content validity was evaluated by subject experts. The dimensional structure of items was assessed through exploratory factor analysis and confirmatory factor analysis (CFA). KEY FINDINGS: The final questionnaire comprises 27 items for knowledge and attitude with a Karl-Pearson correlation value of 0.896 and Cronbach alpha value of 0.814 (24 items), indicating good internal consistency and reproducibility. Factor analysis identified five factors: namely, (i) attitude towards providing guidance and advice to consumers to promote responsible SMP, (ii) attitude towards shared responsibility for promoting rational medicine supply and use, (iii) knowledge of the advantages and disadvantages of SMP, (iv) knowledge of the definition of self-medication, (v) attitude towards professional competency of a pharmacist as a healthcare provider. CFA results demonstrate good model fit with the value of Chi-square (184.56), CFI (0.937), RMSEA (0.054), and SRMR (0.075). Model validity measures ensure satisfactory validity and reliability. CONCLUSIONS: The findings demonstrate a valid and reliable measure for assessing the knowledge and attitude of pharmacists towards self-medication.

Effect of immersive virtual reality-based training on cognitive, social, and emotional skills in children and adolescents with autism spectrum disorder: A meta-analysis of randomized controlled trials.

BACKGROUND: Virtual Reality (VR) based diagnostic and therapeutic interventions have opened up new possibilities for addressing the challenges in identifying and treating individuals with Autism Spectrum Disorders (ASD). AIM: To conduct a systematic review and meta-analysis of Randomized Controlled Trials to investigate the impact of Immersive VR techniques on the cognitive, social, and emotional skills of under-18 children and adolescents with ASD. METHODS AND PROCEDURES: Four databases were systematically searched as per "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines and assessed six RCTs for further analysis. The Cochrane Risk of Bias tool was used to assess the methodological quality of the studies. OUTCOMES: Pooled results favoured VR and reported significant differences between experimental and control groups concerning social skills (SMD:1.43; 95 % CI: 0.01-2.84; P: 0.05), emotional skills (SMD: 2.45; 95 % CI: 0.21-4.18; P: 0.03) and cognitive skills. CONCLUSION: VR offers an array of benefits that make it a promising tool for children and adolescents with ASD to improve their cognitive, social and emotional skills in a safe and supportive setting. However, accessibility, affordability, customization, and cost are also significant aspects to consider when developing and implementing VR-based interventions for ASD.

Prevalence of Sensory Processing Deficits in Children with Spastic Cerebral Palsy - An Indian Caregiver's Perspective.

This study aims to analyze the prevalence and patterns of sensory processing deficits (SPD) in Indian children with spastic cerebral palsy (CP) using child sensory profile-2 (CSP-2) caregiver questionnaire. The authors surveyed 230 caregivers of children aged 3 to 14 y with spastic CP, using CSP-2. The difference in prevalence and distribution of SPDs among the CP subtypes and Gross Motor Function Classification System (GMFCS) levels was done. Overall prevalence of "Definite" (>2 SD) SPDs was 83%. Forty-seven percent had definite SPDs in more than one sensory subsection. Prevalence of definite SPDs was similar among the spastic CP subtypes. "Conduct" domain had more affection among hemiplegics and quadriplegics. "Avoiding" pattern was observed more in quadriplegics and "Seeking" pattern was observed less in diplegics. Severe GMFCS levels had more definite sensory processing deficits. SPDs are highly prevalent in children with spastic CP with unique patterns of affection among the spastic CP subtypes.

Effect of loss-of-function CYP2C19 variants on clinical outcomes in coronary artery disease patients treated with clopidogrel: A systematic meta-analysis approach.

For many years, clopidogrel has been a commonly utilised antiplatelet drug in the management of coronary artery disease (CAD). It's thought that the CYP2C19 loss of function (LoF) polymorphism causes clopidogrel's poor metabolism, which eventually leads to resistance. Previous research produced extremely divergent and inconsistent results, making it impossible to draw definitive conclusions. Therefore, current, investigation was carried out to obtain definitive evidence from an updated meta-analysis on the connection between CYP2C19 LoF polymorphism and coronary artery event in patients treated with clopidogrel. 52,542 individuals with coronary artery disease who were receiving clopidogrel treatment were included in 87 carefully chosen trials from reliable databases that we used for our meta-analysis. According to our data, those who carry one or more CYP2C19 LoF alleles worldwide are much more likely to experience composite events and coronary artery events than people who do not carry these alleles, especially in Asian populations. Our meta-analysis observed that the global population, particularly Asians receiving clopidogrel treatment, is at risk of recurrent coronary artery events and composite events if they carry the CYP2C19 LoF alleles. Additional research is essential on alternative antiplatelet therapies for individuals who exhibit poor or intermediate metabolic activity. OBJECTIVES: 1.To systematically analyze the current evidence regarding the association of CYP2C19 variants with coronary artery disease (CAD). 2.To conduct a meta-analysis to investigate the association between loss of function (LoF) CYP2C19 modifications and CAD.

Health and Fitness of Postmenopausal Women in Urban versus Rural Gurugram: A Cross-Sectional Study.

Context: Throughout that process of menopause, a slew of health and fitness problems arise, all of which have a major effect on a woman's standard of living. Health-related physical fitness has been described as an individual's cardiac fitness (aerobic capacity), musculoskeletal fitness, and body composition. Aim: To investigate and compare the health and fitness of postmenopausal women in rural and urban Gurugram. Settings and Design: The postmenopausal women of Gurugram, both urban (n = 175) and rural (n = 175), who attended the outpatient department of SGT Hospital in the urban area and a house-to-house survey in the rural area, were the subjects of a cross-sectional survey that was carried out using interviews and a pretested semi-structured questionnaire. Levels of physical activity (PA) were assessed using the International PA Questionnaire (short form). The evaluation of body composition, which was the following step, included determining one's body mass index, waist circumference, and waist-hip ratio. Six-minute Walk Distance Test was used to assess cardiopulmonary fitness. Through chair squat tests, sit-and-reach tests, and grip tests, researchers were able to measure the lower limb strength, flexibility, and upper limb strength of participants. Results: The mean age of subjects was 53.61 ± 5.08 years. Most commonly reported health problems were hypertension (31.3%), hyperlipidemia (21.2%), and diabetes (13.4%). Odds of urban women developing hypertension, hyperlipidemia, and myocardial infarction (MI) were found to be 0.61, 0.42, and 0.96 times higher than rural women. There was a statistically significant difference for the squat test, grip test, body composition parameters, and aerobic capacity; however, no statistically significant difference was seen for sit-and-reach test (P > 0.05). Conclusions: The current research shows that postmenopausal women living in metropolitan areas may face higher health risks since they are more prone to develop hypertension, hyperlipidemia, and MI. Furthermore, all fitness metrics - aside from flexibility - were higher for rural women. The results of the current study highlight the urgent need for health promotion initiatives to enhance the health and fitness of urban postmenopausal women.

Impact of telehealth interventions on physiological and psychological outcomes in breast cancer survivors: A meta-analysis of randomised controlled trials.

Introduction: The use of telehealth interventions has been evaluated in different perspectives in women and also supported with various clinical trials, but its overall efficacy is still ascertained. The objective of the present review is to identify, appraise and analyze randomized controlled trials on breast cancer survivors who have participated in technology-based intervention programs incorporating a wide range of physical and psychological outcome measures. Material and methods: We conducted electronic search of the literature during last twenty years i.e., from 2001 till August 10, 2021 through four databases. Standardized mean difference with 95% confidence interval was used. Results: A total of 56 records were included in the qualitative and 28 in quantitative analysis. Pooled results show that telehealth interventions were associated with improved quality of life (SMD 0.48, 95% CI 0.03 to 0.92, p=0.04), reduced depression (SMD -1.27, 95% CI =-2.43 to -0.10 p=0.03), low distress and less perceived stress (SMD -0.40, 95% CI =-0.68 to -0.12, p=0.005). However, no significant differences were observed on weight change (SMD -0.27, 95% CI =-2.39 to 1.86, p=0.81) and anxiety scores (SMD -0.09, 95% CI =-0.20 to 0.02, p=0.10) between the two groups. Improvement in health care competence and fitness among participants was also reported. Conclusion: Study concludes that telehealth care is a quick, convenient and assuring approach to breast cancer care in women that can reduce treatment burden and subsequent disturbance to the lives of breast cancer survivors.

Effects of Yogic Interventions on Patients Diagnosed With Cardiac Diseases. A Systematic Review and Meta-Analysis.

Objective: Presently, evidence-based research studies on the efficacy of complimentary therapies like yoga for patients with different cardiac diseases are limited and conflicting. The objective of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) on yogic interventions compared with usual care or non-pharmacological treatment in patients diagnosed with cardiac diseases. Methods: We conducted an electronic search of literature published from 2006 to May 2021 through five databases. PRISMA statement was used to develop and report a systematic review and meta-analysis protocol. Sixteen RCTs were included in the systematic review and 11 RCTs were used for meta-analysis. Outcome measures were blood pressure, lipid profile, and psychosocial measures. The Cochrane collaboration tool was used to assess bias risk. Results: The results show that yogic interventions resulted in significant reduction in systolic (d = 046; 95% CI.08-0.84; I2 = 81.86%) and diastolic blood pressures (d = 0.56; 95% CI.13-0.99, I2 = 84.84%). A medium statistically significant increase in HDL (d =0.67; 95% CI 0 to 1.33; I2 79.7%) and a low but significant effect on LDL (d = 0.23; 95% CI -0.08-0.54; I2 32.61%), total cholesterol (d =0.28; 95% CI -0.14-0.7; I2 63.72%), and triglycerides (d = 0.43; 95% CI -0.1-0.97; I2 76.64%) were observed. Pooled effect sizes showed a medium to low statistically significant effect on psychosocial indicators viz., QoL, stress, anxiety, and depression. Conclusion: The meta-analysis found strong evidence of effectiveness of yogic interventions on lipid profile, blood pressure, and psychosocial outcomes in patients with diagnosed cardiac diseases.

Delineating clinical characteristics and comorbidities among 206 COVID-19 deceased patients in India: Emerging significance of renin angiotensin system derangement.

AIM: While there are rampant deaths reported worldwide due to novel corona virus (COVID-19) on one side, hypertension, diabetes and renal failure are emerging comorbidities with mortality risk due to respiratory failure on the other side. The link of these morbidities with renin angiotensin system (RAS) and angiotensin converting enzyme-2 (ACE2) as the site of the multiplication of COVID-19 has widely been accepted. The objective of this research report was to delineate the clinical characteristics with COVID-19 infection with RAS and to consider its significance not just for the search of novel antiviral drugs, but for the management and prevention of death of patients with COVID-19. METHODS: It was a retrospective case series analysis of demographic and clinical data with associated comorbidities of 206 deaths reported in India up to 10th April 2020. The data were available from the official release from Ministry of Health and Family welfare, Government of India. This was followed by a literature search to correlate the available evidence for their possible relationship with RAS. RESULTS: The demographic data were consistent with those reported from other countries. The death (53.4%) was more common in patients with age above 60 years and men (69.3%) were more susceptible as compared to women (30.68%).We found that 50.5% of the deceased patients had pre-existing comorbidities. Diabetes and hypertension were the major comorbidities in 27.8% and 22.1% of the deceased cases respectively. Although respiratory and cardiac problems were prevalent at the time of death, the pre-existing pulmonary disease was comparatively less prevalent. Only 13.6% of the deceased were having pre-existing respiratory problems and 6.2% had cardiac ailments. We could correlate the reports that RAS plays a significant role in the prognosis of the disease. CONCLUSIONS: Patients with cardiovascular diseases, diabetes mellitus and hypertension are at greater risk for developing COVID-19 infection. There may be massive derangement of the entire RAS after the attack of COVID-19 and hence, patients with these pre-existing comorbidities and on ACE inhibitors or angiotensin receptor blockers should be monitored carefully considering the role of RAS in the prognosis of COVID-19 infections.

Economic evaluation of human papillomavirus vaccination in the Global South: a systematic review.

OBJECTIVES: Many reviews have been conducted on the economic evaluation of the HPV vaccine in global north countries. But there is a dearth of such reviews in the Global South countries. Hence, this systematic review aims to summarize studies done in these countries. METHODS: Four databases PubMed, Embase, Cochrane Library, and Google Scholar from 2009 to 2019 were searched for economic evaluations on HPV vaccination in the Global South countries. PRISMA guidelines were followed to include full-text articles. 40 original articles were shortlisted for full-text review. RESULTS: Studies had varied models, assumptions, and results according to different scenarios. Most studies concluded HPV vaccination to be cost-effective under varied scenarios and vaccine cost was the most influential parameter affecting the sensitivity analyses, consequently incremental cost-effectiveness ratio. A wide range in the cost-effectiveness ratio was observed in the included studies due to different study settings, populations, and inconsistencies in modeling practices (variations in methodological approaches). CONCLUSIONS: This review suggests the introduction of HPV vaccination alone or in combination with screening according to different countries. The price of the vaccine should be economical and funds for the vaccine should be provided by public sector firms.