Charting a roadmap for heart failure research in India: Insights from a qualitative survey.

Background & objectives: Heart failure (HF) is emerging as a major health problem in India. The profile of HF in India is divergent from elsewhere in the world. While cardiologists must equip themselves with the requisite clinical management tools, scientists and health policymakers would need epidemiological data on HF and information on the resources required to meet the challenges ahead. The aim of this study was to identify the lacunae and to suggest recommendations to improve HF research. Methods: We surveyed a multidisciplinary group of HF experts using a two stage process. An email-based survey was conducted using a structured questionnaire, followed by an online discussion. The experts prioritized the major challenges in convergence research in India and inter-rater agreement values were calculated. In addition, they enlisted potential research gaps and barriers in the domains of epidemiology, diagnostics, management and technology and suggested recommendations to overcome those barriers. Results: The experts identified a paucity of data on HF burden, lack of state-of-the-art diagnostic facilities and trained personnel, overt dependence on imported devices/equipment/reagents, lack of interaction/awareness/information among stakeholders and lack of biobanks, as major barriers in HF research. Three fourths of the experts agreed that lack of interaction among stakeholders was the major challenge with the highest inter-rater agreement in both stages (19 out of 25 and 11 out of 17, respectively). The experts recommended the creation of multidisciplinary taskforces dedicated to population sciences, data sciences, technology development and patient management with short-, intermediate- and long-term strategies. Interpretation & conclusions: The study generated a wish list for advances in HF research and management, and proposed recommendations for facilitating convergence research as a way forward to reduce the burden of HF in India.

Remote sensing and climate services improve irrigation water management at farm scale in Western-Central India.

The enormous progress in weather and extended range predictions for the Indian monsoon over the last decade has not been translated to operationalized irrigation water management tools despite many agricultural advisories from operational agencies. The limited implementation is mainly due to the resolution mismatches of forecasts and decision-needs and a lack of soil moisture monitoring networks. Sustained soil moisture monitoring suffers from the high cost to farmers in installing distributed sensors. Here we develop an irrigation water management tool for the farmers at farm scale, which starts with utilizing and merging a few available soil moisture sensors and L-band satellite observations of surface soil moisture using machine learning. Such derived soil moisture field is used as the initial condition with the multi-ensemble future rainfall for the following few weeks given the weather/extended range forecasts in a farm-scale ecohydrological model. This ecohydrological model is integrated with Monte-Carlo simulations within a stochastic optimization framework to minimize water use while not allowing the soil moisture to drop below a threshold level with a certain probability. The optimization results in water arrangement decisions 2 weeks in advance and water application decisions 1-7 days in advance. We also estimate the water storage capacity needed at farm scale for effective water utilization. We find that 20-45 % and 17-35 % water savings were achievable for Kharif and Rabi seasons, respectively, without losing any yield when applied to grape farms of Nashik, Maharashtra, India. The proposed framework is co-developed with the farmers and can be used in any region for any crops, since it is generalized and easy to transfer. This is an extension of our earlier work to an end-to-end system using satellite data for soil moisture.

Warming inhibits increases in vegetation net primary productivity despite greening in India.

India is the second-highest contributor to the post-2000 global greening. However, with satellite data, here we show that this 18.51% increase in Leaf Area Index (LAI) during 2001-2019 fails to translate into increased carbon uptake due to warming constraints. Our analysis further shows 6.19% decrease in Net Primary Productivity (NPP) during 2001-2019 over the temporally consistent forests in India despite 6.75% increase in LAI. We identify hotspots of statistically significant decreasing trends in NPP over the key forested regions of Northeast India, Peninsular India, and the Western Ghats. Together, these areas contribute to more than 31% of the NPP of India (1274.8 TgC.year-1). These three regions are also the warming hotspots in India. Granger Causality analysis confirms that temperature causes the changes in net-photosynthesis of vegetation. Decreasing photosynthesis and stable respiration, above a threshold temperature, over these regions, as seen in observations, are the key reasons behind the declining NPP. Our analysis shows that warming has already started affecting carbon uptake in Indian forests and calls for improved climate resilient forest management practices in a warming world.

Mental health implications of COVID-19 pandemic and its response in India.

INTRODUCTION: Mental health concerns and treatment usually take a backseat when the limited resources are geared for pandemic containment. In this global humanitarian crisis of the COVID-19 pandemic, mental health issues have been reported from all over the world. OBJECTIVES: In this study, we attempt to review the prevailing mental health issues during the COVID-19 pandemic through global experiences, and reactive strategies established in mental health care with special reference to the Indian context. By performing a rapid synthesis of available evidence, we aim to propose a conceptual and recommendation framework for mental health issues during the COVID-19 pandemic. METHODS: A search of the PubMed electronic database and google scholar were undertaken using the search terms 'novel coronavirus', 'COVID-19', 'nCoV', SARS-CoV-2, 'mental health', 'psychiatry', 'psychology', 'anxiety', 'depression' and 'stress' in various permutations and combinations. Published journals, magazines and newspaper articles, official webpages and independent websites of various institutions and non-government organizations, verified social media portals were compiled. RESULTS: The major mental health issues reported were stress, anxiety, depression, insomnia, denial, anger and fear. Children and older people, frontline workers, people with existing mental health illnesses were among the vulnerable in this context. COVID-19 related suicides have also been increasingly common. Globally, measures have been taken to address mental health issues through the use of guidelines and intervention strategies. The role of social media has also been immense in this context. State-specific intervention strategies, telepsychiatry consultations, toll free number specific for psychological and behavioral issues have been issued by the Government of India. CONCLUSION: Keeping a positive approach, developing vulnerable-group-specific need-based interventions with proper risk communication strategies and keeping at par with the evolving epidemiology of COVID-19 would be instrumental in guiding the planning and prioritization of mental health care resources to serve the most vulnerable.

Masks in COVID-19 pandemic: Are we doing it right?

The coronavirus (COVID-19) pandemic has caused the world to undergo an unprecedented change in a short period. Personal protective equipment such as the face mask or face cover has become a daily necessity. Moreover, since some states and countries have made the use of face covers or face masks compulsory, one cannot ignore or afford to have a wrong or incomplete awareness about face masks. Current information suggests that the two main routes of transmission of the COVID-19 virus are respiratory droplets and contact. This article aims to review the existing information and highlight the need for the use of face masks or face covers to combat the COVID-19 pandemic and promote and provide necessary recommendations. Many countries have implemented or recommended mask wearing in the community, but recommendation for rational use of masks is being issued, as the crisis and shortage for masks are universally existing. The use of different types of masks has been assigned according to the risk of exposure and should be therefore judiciously used. As this is a novel disease, the guidelines are changing every day and one needs to be updated with correct information so that one can protect themselves and their families from this extreme level of the crisis faced by the world now. The use of face covers or masks should not be discouraged as there has been substantial evidence that its use can help reduce the spread of infection. "Mass masking" along with hand hygiene and social distancing are the only effective recommended measures to prevent the spread of the disease.

Impaired Quality of Life and Its Determinants among Postmenopausal Women of Slum Communities in Bhubaneswar, India.

BACKGROUND: The severity of menopausal symptoms negatively impacts a woman's quality of life (QoL). OBJECTIVE: The aim of the study was to assess the prevalence of menopause-related impaired QoL and determine its associated factors among postmenopausal women living in slum areas of Bhubaneswar, India. MATERIALS AND METHODS: This cross-sectional study was conducted among 198 postmenopausal women aged 45-65 years during the year 2016-2017. The Menopause Rating Scale (MRS) was used to assess the prevalence and severity of menopausal symptoms. RESULTS: Joint and muscular discomfort was the most prevalent moderate-to-severe symptom (90.4%), followed by hot flushes (72.8%), irritability (67.2%), and physical and mental exhaustion (64.2%). More than two-third (133, 67.2%) of women had impaired QoL (severe total MRS score ≥17). Multivariate logistic regression analysis revealed that impaired QoL was associated younger age (adjusted odds ratio [AOR]: 4.6, 95% confidence interval [CI]: 2.12-9.98), tobacco consumption (AOR: 2.0, 95% CI: 1.05-3.82), not being satisfied in relation with husband (AOR: 3.33, 95% CI: 1.84-6.06), not having autonomy in health-care decision-making in the family (AOR: 2.30, 95% CI: 1.12-4.73), history of reproductive tract infection (AOR: 4.57, 95% CI: 1.71-12.19), and earlier onset of menopause (AOR: 3.26, 95% CI: 1.18-8.96). CONCLUSION: The point prevalence of menopause-related impaired QOL in postmenopausal women living in slums of Bhubaneswar was high. Incorporating these determinants in the existing strategies can be useful to improve the QoL of these women.

Impact of COVID-19 epidemic curtailment strategies in selected Indian states: An analysis by reproduction number and doubling time with incidence modelling.

The Government of India in-network with the state governments has implemented the epidemic curtailment strategies inclusive of case-isolation, quarantine and lockdown in response to ongoing novel coronavirus (COVID-19) outbreak. In this manuscript, we attempt to estimate the impact of these steps across ten selected Indian states using crowd-sourced data. The trajectory of the outbreak was parameterized by the reproduction number (R0), doubling time, and growth rate. These parameters were estimated at two time-periods after the enforcement of the lockdown on 24th March 2020, i.e. 15 days into lockdown and 30 days into lockdown. The authors used a crowd sourced database which is available in the public domain. After preparing the data for analysis, R0 was estimated using maximum likelihood (ML) method which is based on the expectation minimum algorithm where the distribution probability of secondary cases is maximized using the serial interval discretization. The doubling time and growth rate were estimated by the natural log transformation of the exponential growth equation. The overall analysis shows decreasing trends in time-varying reproduction numbers (R(t)) and growth rate (with a few exceptions) and increasing trends in doubling time. The curtailment strategies employed by the Indian government seem to be effective in reducing the transmission parameters of the COVID-19 epidemic. The estimated R(t) are still above the threshold of 1, and the resultant absolute case numbers show an increase with time. Future curtailment and mitigation strategies thus may take into account these findings while formulating further course of action.

Assessment of Poor Functional Status and its Predictors among the Elderly in a Rural Area of West Bengal.

CONTEXT: Functional ability considered a proxy for healthy aging, not only related to mental and physical health but it also determines social well-being. Eliciting the determinants of functionality components among the elderly will assist in evolving with appropriate plans at both domiciliary and facility level to eliminate their sufferings and disabilities. AIM: The aim of this study is to find out the magnitude of poor functional status among the elderly and its predictors. MATERIALS AND METHODS: This is a community-based cross-sectional study conducted among 246 geriatric people in a rural area of West Bengal from August 2017 to December 2017; data were analyzed using the SPSS software (version 16.0. Chicago, SPSS Inc.). Logistic regression analysis was performed to find out the factors associated with poor functional status (activities of daily living [ADL] and instrumental ADL [IADL]). RESULTS: The study concluded that 32.4% and 59.3% were dependent for basic ADL and IADL, respectively. Binary logistics showed people aged >70 years, female gender, less than primary level education, widowed/separated, who lived in the joint family, poorest percentile of economic status, who were depressed and who suffered from multimorbidity had increased odds of dependency for ADL and IADL. In multivariate logit regression, age >70 years and depression remained significant for ADL; in addition, marital status, education, and family type remained significant for IADL. CONCLUSION: There should be a provision for community-based comprehensive geriatric health and disability assessment, as it enables older people to avert the illness at the early stage, to delay the onset of disabling diseases. This will ensure their participation in the upliftment of the society, and they thus will be less dependent on their progeny.

Breastfeeding awareness and perception among antenatal mothers: A cross-sectional study in urban slum population of Bhubaneswar, Odisha.

INTRODUCTION: Breast milk provides nutritional, immunological, behavioral, and economic benefits and helps to build mother-infant bonding. Antenatal mothers need to be sufficiently aware about the benefits of breastfeeding. OBJECTIVES: The aim of this study is to assess the awareness and perception of breastfeeding among antenatal mothers and to find out any association between sociodemographic factors and breastfeeding awareness. METHODOLOGY: A cross-sectional study was conducted among 250 antenatal women residing in the urban slums of field-practice area of urban health and training center; using a predesigned, pretested, semi-structured interview schedule. Antenatal checkup followed by one to one counseling for the women regarding breastfeeding was provided. Data were represented by frequencies, proportions, and associations using Chi-square, and the P < 0.05 was considered statistically significant. RESULTS: Most (55.6%) of the women were in the age group of 18-24 years. The mean age at marriage was 19.2 ± 2.5 years. 81.2% of them were Hindus, 13.2% had adequate, 49.6% had moderately adequate, whereas 37.2% women had inadequate awareness about breastfeeding. About 100% intended to breastfeed their children, but only 64% said that they intended to exclusively breastfeed. 66.4% knew about the importance of colostrum. Age-group, religion, literacy, occupation, type of family, gravida, and number of antenatal visits showed highly significant (P < 0.001) association with awareness of breastfeeding. CONCLUSION: Nearly one-third of the antenatal mothers lacked awareness on breastfeeding practices. Although all intended to breastfeed, still only 64% knew about exclusive breastfeeding. These gaps need to be addressed by awareness generation activities during antenatal counseling.