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

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

Burden of oral cancer and associated risk factors at national and state levels: A systematic analysis from the global burden of disease in India, 1990-2021.

BACKGROUND: Oral cancer is the sixth most prevalent cancer globally, posing a significant health concern, especially in India, where it accounts for one-third of the global cases. Despite high incidence and mortality rates, comprehensive national and regional data on risk factors and trends are scarce. METHODS: This study analyzed data from the Global Burden of Disease (GBD) 2021 report, focusing on the age-standardized incidence rate (ASIR), mortality rate (ASMR), disability-adjusted life years (ASDR), and prevalence rate (ASPR) of oral cancer in India from 1990 to 2021. Joinpoint regression analysis was used to assess trends, and ARIMA models were applied to forecast future trends from 2022 to 2031. RESULTS: From 1990 to 2021, India experienced a moderate increase in oral cancer mortality, with ASMR rising from 5.32 to 5.92, reflecting an annual percentage change (APC) of 11.18 %. ASDR increased from 152.94 to 163.61 (APC of 6.98 %), and ASPR showed a marked rise from 15.71 to 25.46 (APC of 62.06 %). The burden varied significantly across states. Gender disparities were observed, with males consistently exhibiting higher incidence and mortality rates. ARIMA forecasts projected an upward trend in oral cancer metrics from 2022 to 2031, with ASIR expected to reach 10.15 per 100,000 and ASPR 29.38 per 100,000 by 2031. CONCLUSIONS: The study reveals a persistent and growing burden of oral cancer in India, highlighting the influence of lifestyle and socioeconomic factors. Targeted strategies to mitigate risk behaviors, improve early detection, and address disparities are urgently needed to reduce the disease's impact.

Trajectory of suicide among Indian children and adolescents: a pooled analysis of national data from 1995 to 2021.

BACKGROUND: Suicide is a major public health concern in India especially among children and adolescents. The yearly national statistics show a concerning trend of rising suicide deaths in these age groups. METHODS: The present study, taking 26 years of national data from the National Crime Record Bureau during 1995-2021, examined the trend, patterns, means, and modes of children/adolescent suicides in India. We also undertook a time series analysis by using ARIMA (0,2,1) model to forecast the expected suicide rate for the next one decade. RESULTS: A rising trend of suicide rate among children and adolescents was observed in India over the last 26 years. The forecast indicates a continuance of rising suicide cases for the upcoming decade in India. A substantially different trend of suicide rate was observed among early and late adolescents indicating significantly high vulnerability of late adolescents. Among children /adolescents, the most common causes of suicide were family problems, academic failure, illness, and unemployment. Illness has emerged as one of the leading causes of suicide, with a significant rise over time. Poverty and unemployment were also found as the important contributors with a steadily increasing trend of suicide among children and adolescents facing these problems in recent years. CONCLUSION: The study provides important analysis and information on suicide among children/adolescents in India, by providing useful insights for parents, teachers, policymakers, healthcare practitioners, and stakeholders aiming to prevent and control children and adolescent suicide and boost mental health. The study also provides important leads on risk factors with a forecast of suicide trends for the next 10 years.

mRNA expression of vitamin D receptor, calcium-sensing receptor, cyclin D1, and PTH in symptomatic and asymptomatic primary hyperparathyroidism.

BACKGROUND AND OBJECTIVE: The exact underlying mechanism for the differential clinical profiles of symptomatic and asymptomatic primary hyperparathyroidism (PHPT) patients has not been fully elucidated, and efforts to define the molecular mechanisms underlying the phenotypic heterogeneity of PHPT have been limited. The aim of this study was to explore the underlying molecular mechanisms involved in the pathogenesis of symptomatic and asymptomatic sporadic PHPT in Asian Indians. METHODS: A prospective cohort study was conducted at a tertiary care hospital in North India. PHPT patients who underwent parathyroidectomy were included. The main outcome was the comparison of vitamin D receptor (VDR), calcium sensing receptor (CaSR), cyclin D 1 (CD1), and parathyroid hormone (PTH) mRNA levels between symptomatic and asymptomatic PHPT patients and controls determined via quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: Forty-two PHPT patients were studied. The mean (SD) age was 49.7 (12.8) years. Twenty patients were asymptomatic. The median PTH levels were significantly greater in the symptomatic group than in the asymptomatic group (878 vs 653 pg/ml). CaSR and VDR mRNAs were significantly lower in both symptomatic and asymptomatic patients than in controls. CD1 and PTH mRNAs were significantly increased in symptomatic patients but not in asymptomatic PHPT patients compared with controls. Symptomatic PHPT patients had significantly greater CD1 mRNA expression and reduced CaSR expression than asymptomatic patients. CONCLUSION: Symptomatic PHPT patients had significantly greater CD1 mRNA expression and lower CaSR expression than asymptomatic patients, underscoring the importance of the molecular mechanisms underlying the phenotypic heterogeneity of PHPT.

Canine parvovirus in North-East India: a phylogenetic and evolutionary analysis.

Canine parvovirus type 2 (CPV-2) infection in dogs is considered as one of the most common cause of morbidity and mortality in young dogs and continues to occur with high incidence worldwide. Despite a single-stranded DNA virus, CPV-2 possesses a high mutation rate which has led to the development of new variants from time to time. These variants are classically classified based on the amino acid markers present in the VP2 gene. In this study, we examined 20 different cases of CPV-2 infection from seven different states of the North East region (NER) of India. The near-complete genome sequences of all these isolates were subjected to phylodynamic and phylogeographic analysis to evaluate the genetic diversity and geographical spread of CPV-2 variants. Analysis of the deduced amino acid sequences revealed residues characteristic of the 'Asian CPV-2c lineage' in all the 20 sequences confirming it as the dominant strain circulating in NER, India. The phylogenetic analysis based on the whole genome showed that all 20 sequences formed a monophyletic clade together with other Asian CPV-2c sequences. Furthermore, phylogeographic analysis based on the VP2 gene showed the likely introduction of Asian CPV-2c strain to India from China. This study marks the first comprehensive report elucidating the molecular epidemiology of CPV-2 in India.

Navigating trust and health in India: the influence of social status and neighbourhood environment.

BACKGROUND: The research on the relationship between interpersonal trust and health has primarily focused on Western contexts, with scarce attention in developing contexts. Addressing this gap, the study examines the association between interpersonal trust (both generalised and particularised) and health outcomes (self-rated health /SRH, and depression) among Indian adults, considering the moderating roles of social statuses (gender and caste) and macro-level factors like district-level income inequality. METHODS: The study draws on data from the World Health Organization's (WHO) Study on global AGEing and adult health (SAGE) Wave-1, collected between 2007 and 2010. This dataset provides a comprehensive overview of health outcomes, including self-rated health (SRH) and depression, socio-cultural status of adults aged 18 and above in India. Additionally, district-level data on income inequality, quantified through the Gini index, were incorporated to examine the influence of contextual socioeconomic influence on the trust-health relationship. Multilevel regression analysis with interaction effects with social statuses and income inequality at district was employed in the analysis to investigate the intricate relationship between interpersonal trust (both generalised and particularised) and health outcomes. RESULTS: The study reveals that while generalised trust does not directly influence depression or SRH, particularised trust acts as a protective factor for both health outcomes. Gender-specific interaction effect shows that generalised trust reduces depression among males and improves SRH among females. Notably, caste does not significantly moderate the trust-health relationship. High district-level income inequality, however, modifies these associations: generalised trust is associated with improved SRH in areas of high inequality, whereas particularised trust correlates with increased depression in these districts. CONCLUSION: The findings highlight the complex dynamics between interpersonal trust, social status, and income inequality in shaping health outcomes in India. Generalised trust emerges as a potential buffer against the health-detrimental effects of income inequality, providing crucial insights for developing targeted health interventions. These results offer valuable guidance for global health policymakers and practitioners in effectively allocating development aid to enhance health outcomes, especially among the most marginalised groups.

Hypertension in India: a gender-based study of prevalence and associated risk factors.

BACKGROUND: Hypertension, a major non-communicable disease, is responsible for a significant number of global deaths, including approximately 17.9 million yearly. The Global Burden of Disease 2019 (GBD 2019) estimates that 19% of global deaths are attributed to elevated blood pressure. India, with a population of over 1.4 billion, is facing a serious challenge in combating this silent killer. This study aims to analyze the gender-based prevalence of hypertension in India and explore its associated risk factors using data from the fifth National Family Health Survey (NFHS-5). METHODS: NFHS-5 collected data from 636,699 households across all states and union territories. The study includes standardized blood pressure measurements for 17,08,241 individuals aged 15 and above. The data were analyzed using Stata, employing descriptive statistics for the assessment of the prevalence and binary logistic regression to identify predictors of hypertension. RESULTS: The study found the overall prevalence of hypertension in India to be 22.6%, with men (24.1%) having a higher prevalence than women (21.2%). Prevalence increased with age, reaching 48.4% in individuals aged 60 and above. Urban residents had a slightly higher prevalence (25%) than rural residents (21.4%), indicating the rapid spread of hypertension across all populations. Regional variations were observed, with the highest prevalence in Sikkim (37.9%) and the lowest in Rajasthan (16.5%). Increasing age, urban residence, belonging to certain religions (Muslim and other than Hindu or Muslim), and being classified as Scheduled Tribes (ST) were associated with a higher likelihood of hypertension. Conversely, belonging to Scheduled Castes (SC) or Other Backward Classes (OBC), being currently unmarried, and having higher education were associated with a lower likelihood of hypertension. Wealth index analysis revealed that those in the richest quintile were more likely to have hypertension. Behavioural risk factors, such as alcohol consumption, overweight, obesity, increased waist circumference, and high blood glucose levels, are positively associated with hypertension. CONCLUSION: Hypertension is a significant health burden in India, affecting both men and women. Age is the strongest non-modifiable predictor for both men and women. However, ageing women have higher odds of hypertension than ageing men, and this distinction becomes much more evident in their older ages. Obese women, based on BMI, have higher odds of hypertension than men. However, hypertension prevalence is slightly higher among men who are overweight or obese compared to women. BMI, waist circumference, random glucose level, alcohol use, and education level emerged as major predictors. Health education and awareness campaigns are critical to control the growing burden of hypertension in India. Policymakers must focus on preventive measures, targeting lifestyle changes and improved healthcare access for both men and women. By addressing these risk factors, India can make significant progress in controlling hypertension and reducing its impact on public health.

Carotid Intima-Media Thickness in Indian Patients With Non-alcoholic Fatty Liver Disease: A Systematic Review and a Meta-Analysis.

There is a significant association of non-alcoholic fatty liver disease (NAFLD) with cardiovascular disease (CVD). Most CVDs begin with atherosclerosis in the arteries, which can be reliably measured as the carotid intima-media thickness (CIMT) by ultrasound. Given that ethnic and regional differences have an impact on NAFLD, we aimed to evaluate the association of NAFLD patients from India with subclinical atherosclerosis, measured as CIMT. A thorough literature search was performed on four electronic databases using combinations of several keywords. The relevant data were pooled in a random or fixed-effect model, based on heterogeneity, to calculate the pooled standardised mean difference (SMD), or odds ratio (OR) with 95% confidence interval (CI). The final analysis included a total of 15 studies with 1196 NAFLD and 1482 control subjects. NAFLD patients had a 21.3% higher mean CIMT than the controls. The pooled SMD was 1.001 (95% CI: 0.627-1.375, p < 0.001). Three studies that balanced cardiometabolic risk factors found a similar association (p = 0.037). Furthermore, NAFLD was significantly associated with the presence of high (>0.8 mm) CIMT (pooled OR = 5.4, 95% CI: 2.0-14 .9) and carotid plaques (pooled OR = 10.24, 95% CI: 5.74-18.26). The mean CIMT was also higher in diabetic NAFLD than in the diabetic control (pooled SMD = 1.07, 95% CI = 0.818-1.324, p < 0.001). There is a significant positive association between the marker of subclinical atherosclerosis and NAFLD in India. This might give more light on screening and follow-up plans for such patients.

Cognitive Benefits of Hearing Aids in Elderly Indian Population: A Longitudinal Study.

Age-related hearing loss is common among older individuals and is linked to cognitive impairment and a decrease in overall quality of life. Although hearing aids enhance auditory capabilities, their influence on cognitive performance in the Indian context has not been thoroughly investigated. This study investigates the cognitive benefits of hearing aids in elderly Indian patients with age-related hearing loss. A prospective cohort study was conducted at a tertiary care centre between January 2021 and December 2022. The study included 200 elderly patients who were fitted with behind-the-ear (BTE) or receiver-in-canal (RIC) hearing aids. The assessment of cognitive function was conducted using two standardised tests: the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The assessment of quality of life was conducted using the WHOQOL-OLD questionnaire, while hearing acuity was examined by pure-tone audiometry and speech perception tests. Data were collected at baseline, 6 months, and 18 months. Multiple linear regression analysis identified predictors of cognitive outcomes. There were significant enhancements in MMSE, MoCA, HHIE, and WHOQOL-OLD scores across the 18-month duration (p < 0.001). The pure-tone audiometry thresholds and speech perception scores demonstrated significant improvement (p < 0.001). Regression analysis indicated that baseline cognitive function, hearing ability, and quality of life were significant predictors of cognitive outcomes at 18 months. No severe cognitive impairment or other confounding severe medical conditions were reported. This study revealed that the use of hearing aids has a substantial positive impact on cognitive function, quality of life, and hearing ability in the older Indian population suffering from age-related hearing loss. Timely intervention and the availability of hearing aids are essential for improving cognitive health and overall well-being in this demographic. Future study should look into the consequences and influence of various hearing aid models. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04939-7.

India's Potential as a Leader in Cancer Care Progress in the Future: A Synthetic Interdisciplinary Perspective.

This paper comprehensively analyzes India's potential to become a leader in cancer care in the Global South, particularly in precision population cancer medicine (PPCM). Through an interdisciplinary lens, it examines the current landscape of cancer care in India, highlighting its strengths, weaknesses, opportunities, and threats in this domain. This review explores the concept of knowledge translation and its importance in bridging the gap between knowledge generation and implementation in medical sciences and applies this to the Indian healthcare scenario. The review then delves into India's technological prowess, exemplified by its digital health initiatives such as the CoWIN (winning over COVID-19) app and the Ayushman Bharat Digital Mission, which provide a strong foundation for leveraging advanced technologies in healthcare. The authors discuss India's pharmaceutical industry, often referred to as the "pharmacy of the world," emphasizing its crucial role in global drug manufacturing and distribution. It also examines the country's emerging genomic research landscape, including initiatives such as GenomeIndia and the Indian Cancer Genome Atlas Foundation, which are pivotal for advancing personalized medicine. A significant portion of the review is dedicated to analyzing India's clinical trial ecosystem. It traces the evolution of regulatory frameworks governing clinical research in the country and highlights recent reforms that have made India an increasingly attractive destination for global studies, the potential adoption of innovative trial designs and artificial intelligence (AI)-driven analyses. Crucially, the authors confront the formidable obstacles inherent in India's complex healthcare landscape, illuminating the unique challenges that must be overcome. The review acknowledges India's underrepresentation in global clinical trials despite its large population and significant cancer burden. The issue of financial toxicity in cancer care is discussed, underscoring the need for affordable treatment options. The study also points out the nascent state of India's genomic databases, which account for only a small percentage of global genetic data. Despite these challenges, the authors posit that by effectively leveraging its information technology (IT) infrastructure, robust pharmaceutical sector, and large, diverse population, India has the potential to develop unique, country-specific solutions for cancer care. The study suggests that by fostering genomic research, strategically reforming its clinical trial ecosystem, and harnessing its digital capabilities, India could transform its cancer care landscape and emerge as a model for other developing nations in the Global South. In essence, this paper provides a roadmap for India's journey towards becoming a leader in PPCM, offering valuable insights for policymakers, healthcare professionals, and researchers in the field of oncology and precision medicine. Indeed, by using PPCM as a "pilot project," India can learn to use its new strategies to improve non-cancer care disease prevention, early detection, and improved and more cost-effective management. This approach could revolutionize cancer care in India and serve as a model for other developing nations in the Global South. By leveraging the strategies and technologies developed for PPCM, India could significantly enhance its healthcare system, highlighting the importance and urgency of improving cancer care in the region.

Role of Immunotherapy in the Management of Advanced Hepatocellular Carcinoma: A Systematic Review.

INTRODUCTION: The most prevalent histologic subtype of primary liver cancer, hepato-cellular carcinoma, is also the third most lethal malignancy worldwide and a significant cause of cancer death. When diagnosed, it is frequently too late for curative therapies. To add to the difficulty, it is resistant to conventional systemic therapies like chemotherapy. METHOD: Re-cently, more attention has been given to the use of immunotherapy for this condition. Immuno-therapy has had a major impact on the outcome of several malignancies; several studies have revealed the potential role of immunotherapy in advanced hepatocellular carcinoma. To provide an overview of the current literature, justification, and clinical evidence for the use of immuno-therapy in advanced hepatocellular carcinoma, we employed a systematic literature review (SLR) approach in this work. Additionally, we explored the benefits and rationales of various treatment combinations and described the molecular mechanisms behind resistance to a number of immunotherapy drugs. RESULTS: A total of 188 articles from credible journals published be-tween 2013 and August 7, 2023, were screened. Eight of those articles were chosen for in-depth study. This systematic review concluded that the current immunotherapeutic approaches have the potential to improve outcomes for aHCC patients; however, several clinical and biological hurdles have to be overcome, and predictive markers are still eagerly needed. CONCLUSION: To fully realize the potential of immunotherapy agents and their combination therapies to enhance health outcomes for patients with aHCC, additional investigation and research are required.

Predicting the Transition From Depression to Suicidal Ideation Using Facebook Data Among Indian-Bangladeshi Individuals: Protocol for a Cohort Study.

BACKGROUND: Suicide stands as a global public health concern with a pronounced impact, especially in low- and middle-income countries, where it remains largely unnoticed as a significant health concern, leading to delays in diagnosis and intervention. South Asia, in particular, has seen limited development in this area of research, and applying existing models from other regions is challenging due to cost constraints and the region's distinct linguistics and behavior. Social media analysis, notably on platforms such as Facebook (Meta Platforms Inc), offers the potential for detecting major depressive disorder and aiding individuals at risk of suicidal ideation. OBJECTIVE: This study primarily focuses on India and Bangladesh, both South Asian countries. It aims to construct a predictive model for suicidal ideation by incorporating unique, unexplored features along with masked content from both public and private Facebook profiles. Moreover, the research aims to fill the existing research gap by addressing the distinct challenges posed by South Asia's unique behavioral patterns, socioeconomic conditions, and linguistic nuances. Ultimately, this research strives to enhance suicide prevention efforts in the region by offering a cost-effective solution. METHODS: This quantitative research study will gather data through a web-based platform. Initially, participants will be asked a few demographic questions and to complete the 9-item Patient Health Questionnaire assessment. Eligible participants who provide consent will receive an email requesting them to upload a ZIP file of their Facebook data. The study will begin by determining whether Facebook is the primary application for the participants based on their active hours and Facebook use duration. Subsequently, the predictive model will incorporate a wide range of previously unexplored variables, including anonymous postings, and textual analysis features, such as captions, biographic information, group membership, preferred pages, interactions with advertisement content, and search history. The model will also analyze the use of emojis and the types of games participants engage with on Facebook. RESULTS: The study obtained approval from the scientific review committee on October 2, 2023, and subsequently received institutional review committee ethical clearance on December 8, 2023. Our system is anticipated to automatically detect posts related to depression by analyzing the text and use pattern of the individual with the best accuracy possible. Ultimately, our research aims to have practical utility in identifying individuals who may be at risk of depression or in need of mental health support. CONCLUSIONS: This initiative aims to enhance engagement in suicidal ideation medical care in South Asia to improve health outcomes. It is set to be the first study to consider predicting participants' primary social application use before analyzing their content to forecast behavior and mental states. The study holds the potential to revolutionize strategies and offer insights for scalable, accessible interventions while maintaining quality through comprehensive Facebook feature analysis. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55511.

Access to dental care among individuals with intellectual and developmental disabilities in India: A scoping review.

INTRODUCTION: Individuals with intellectual and developmental disabilities (IDDs) face numerous challenges in accessing dental care. Despite difficulties, more evidence exploring difficulties among this cohort in India is needed. This study aims to conduct a scoping review of articles published in India exploring access to dental care among individuals with IDD. METHOD: We followed the Arksey O'Malley framework for scoping reviews and the PRISMA guidelines for reporting studies. Findings were analyzed based on Levesque's framework for access. RESULTS: Seventeen articles were collated from five databases. The perceived need for dental care was low, and dental visits were mainly need-based and infrequent. Knowledge regarding dental care did not translate to dental visits. Patient-related barriers were cost, transportation difficulties, fear, lack of dentist skills, patient behavior, and cooperation. From the providers' perspective, most dentists were willing to treat but noted infrastructural and knowledge-based limitations. CONCLUSION: Access to dental care was limited due to infrastructure constraints and a lack of dentist training. Caregivers and individuals with IDD did not prioritize dental health, faced communication barriers, and were afraid of dental procedures. It is important to improve preventive dental care and raise awareness among caregivers of individuals with IDD in India. Training dentists and incorporating special care dentistry into the standard dental curriculum will improve access.

Caste-based Diminished Returns of Educational Attainment on Wealth Accumulation in India.

Background: Education is widely recognized as a key driver of wealth generation, providing individuals with the opportunity to enhance their socioeconomic status. However, the effectiveness of education in generating wealth varies significantly across different social groups. In the United States, research has shown that Black individuals experience weaker economic returns on education compared to their White counterparts, a phenomenon explained by the theory of Minorities' Diminished Returns (MDRs). Although MDRs have been documented in various countries, their relevance to caste-based disparities in India remains unexplored. Objective: This study aims to investigate the caste-based diminished returns of education on wealth in India. We hypothesize that the returns on educational attainment, in terms of wealth generation, will be weaker for individuals from Scheduled Castes (SCs) compared to those from higher castes, using data from the India Demographic and Health Surveys (DHS). Methods: This study was a cross-sectional analysis of DHS -2019/2021 data from India, examining the relationship between educational attainment and wealth across different caste groups (scheduled castes and non-scheduled castes). Multivariate regression models will be employed to assess the interaction between caste and education in predicting wealth outcomes, controlling for relevant covariates such as age, gender, and region. Results: The study is expected to find that the returns on education, in terms of wealth, are significantly weaker for individuals from Scheduled Castes compared to those from higher castes. This would indicate that caste-based discrimination continues to hinder the economic progress of Scheduled Castes, even when they achieve similar levels of education as their upper-caste counterparts. Conclusion: The findings of this study will extend the MDR framework to the Indian context, demonstrating that caste-based disparities result in diminished returns on education for wealth generation. This study underscores the need for targeted policies that address the specific barriers faced by Scheduled Castes in translating educational attainment into economic success and highlights the ongoing impact of caste-based discrimination in India.

Barriers and Facilitators Towards Deceased Organ Donation: A Qualitative Study Among Three Major Religious Groups in Chandigarh, and Chennai, India.

This study aimed to examine the barriers and facilitators of the public toward deceased organ donation in Chandigarh, and Chennai, India, from three major religious groups, Hinduism, Islamism, and Christianity. Twenty-five focus groups were conducted (n = 87) stratified by study region, religion, sex, and age. Data were analysed using framework analysis. The results revealed that individuals were primarily willing to donate their organs. However, their religious views regarding death, after-life beliefs, funeral ritual practices, and lack of knowledge regarding their religion's position toward deceased organ donation created tension and ambiguity in the decision-making. However, younger age groups (18-30 years) appeared more open and positive toward deceased organ donation. The conclusion demands a clear need for religious leaders and stakeholders to address their religion's stance, which creates tension and ambiguity in any uncertainties surrounding cultural and religious-based views among the Indian population.

The association between BMI and cognition in India: data from the Longitudinal Aging Study in India (LASI).

BACKGROUND: High body-mass index (BMI) is an established risk factor for late-life cognitive impairment and dementia, but most evidence comes from high-income contexts. Existing evidence from cross-sectional data in low- and middle-income settings is inconsistent, and many studies do not adequately address potential sources of bias. METHODS: We used data from Wave 1 of the Longitudinal Aging Study in India (LASI) (analytic N = 56,753) to estimate the association between BMI categories and cognitive functioning among older adults aged 45 + years using survey-weighted linear regression models stratified by gender and controlling for potential confounders including demographic factors, socio-economic status (SES) characteristics, and health-related behaviors. To probe potential sources of bias, including residual confounding and reverse causation, we used weighting and trimming methods, sample restriction, and explored effect modification. RESULTS: In fully adjusted models, relative to normal BMI underweight BMI was associated with lower cognitive scores (Men: -0.16 SD difference, 95% CI -0.18, -0.13; Women: -0.12 SD, -0.15, -0.10). Overweight and obesity were associated with higher cognitive scores in both men (overweight: 0.09; 0.07, 0.12, obese: 0.10; 0.05, 0.15) and women (overweight: 0.09; 0.07-0.12, obese: 0.12; 0.08-0.15). Estimates were similar after weighting and trimming but were attenuated after excluding those with low cognition (≥1 SD below the mean relative to those with similar demographic characteristics). Positive associations between overweight and obese BMI and cognition were attenuated or null in those living in urban settings and those with higher levels of educational attainment. CONCLUSIONS: Underweight BMI is a risk factor for poor cognitive outcomes in adults 45 years and older and may be indicative of poor nutritional status and life-course disadvantage in India. In tandem with existing literature, supplemental analyses and effect modification results indicate that unmeasured confounding and reverse causation may explain the observed positive associations between overweight and obese BMI and cognitive functioning from cross-sectional studies in low- and middle-income settings. Future data with longitudinal follow-up will be helpful to further disentangle biases.

Dengue in Pune city, India (2017-2019): a comprehensive analysis.

Objectives: To understand the dynamics of dengue disease with special reference to (1) age (2) primary/secondary infections (3) serostatus and (4) serotypes examined during three consecutive years. Methods: During 3 dengue seasons (2017-19), NS1/IgM ELISAs were used for dengue diagnosis in one of the 15 administrative wards of Pune City, India. Predefined symptoms were recorded at the time of diagnosis/hospitalization. IgG-capture ELISA (Panbio) was used to differentiate primary/secondary infections. DENV serotypes were determined for 260 viral RNA-positive patients. Results: During the 3 years, 3,014/6,786 (44.4%, 41.4-49.9%) suspected cases were diagnosed as dengue. Use of either NS1 or IgM would have missed 25.5% or 43% of the confirmed dengue cases, respectively. Notably, a higher proportion of secondary dengue cases remained mild while a substantial proportion of primary infections developed warning signs. The symptoms among Dengue/non-dengue patients and primary/secondary infections varied and influenced by age and serostatus. The number and proportion of dengue serotypes varied yearly. A remarkable decline in dengue cases was observed during the COVID-19 pandemic years. Conclusion: A substantial proportion of primary and secondary dengue patients progress to warning signs/severity or mild infection respectively, underscoring the possible role of non-ADE mechanisms in causing severe dengue that requires hospitalization. Both NS1 and IgM should be used for efficient diagnosis.

Is India on a path to reduce the tobacco industry's influence in tobacco control? Insights from the Global Tobacco Industry Interference Index (2019-2023).

Introduction: The tobacco industry (TI), driven by profit motives, consistently conceals health risks through deceptive strategies, notably in countries like India. These tactics create vulnerabilities that hinder effective tobacco control measures and enable the TI to exploit legal gaps. Understanding these TI strategies is essential for policymakers to take appropriate preventive and corrective measures in order to limit tobacco industry interference (TII) in policy-making. The study aims at understanding the trend of TII in India between 2019 and 2023. Methodology: The secondary data from the Global Tobacco Industry Interference report, consisting of seven major domains of the TII index, viz. policy participation, corporate social responsibility (CSR) activities, industry benefits, unnecessary interaction, transparency, conflict of interest, and preventive measures, were retrieved. A composite score was obtained after adding scores of different domains, for each year. Results: The findings of the study demonstrated an initial improvement in India's implementation of WHO FCTC Article 5.3, as evidenced by a decreasing score between 2019 and 2021. However, this trend halted in 2023, with data showing a slight increase in the score. When compared with other Asian countries, India shows marginal improvement in score than Cambodia, China, Indonesia, Lao PDR, Malaysia, Myanmar, Nepal, Philippines, Thailand, and South Korea. Some of the countries in the region, including India, Pakistan, Bangladesh, Sri Lanka, Myanmar, Brunei, China, and Vietnam experienced a decline in TII. Discussion: There has been a rise in CSR activities, forms of unnecessary interactions of TII with policymakers, and participation in policy development; however, improvements are observed in providing benefits to the TI, conflict of interest, and preventive measures. In order to fortify the regulatory framework, it is imperative to create awareness among stakeholders on conflict of interest, denormalize corporate social responsibility (CSR) initiatives by the TI, provision of a watchdog for TII in the country and "whole of government" approach in implementation of FCTC Article 5.3.

Battling Alone on Multiple Fronts - How Gender Norms Affect the Soldiers' Wife as Caregiver in India.

Objectives: Women form the backbone of caregiving in palliative home care throughout the world. They put in more intense care for longer hours, perform more intimate tasks, and face more physical and mental strain, comorbidities, anxiety, and depression. However, gender norms that perceive caregiving as a natural part of femininity dismiss this as part of their duty toward their family, thus making their care work invisible, taken for granted, and devalued. This results in women bearing more burden with less support and no appreciation and suffering more negative mental and physical health outcomes than men. Globally, women perform 76.2% of unpaid care work. India ranks a dismal - 135 out of 146 countries in the 2022 Gender Gap report. Less than 10% of Indian men participate in household work. Women in rural India continue to be less educated; the majority are not allowed to travel alone and are culturally not involved in decision-making, which is done by the males. Wives of armed forces personnel are forced to live without their husbands for long periods. This leads to even more challenges when they also need to take care of patients with life-limiting illnesses. No study has been done on this population till now. This study aimed to explore the experiences of the women in armed forces families, caring at home for patients with palliative needs. Materials and Methods: This was a qualitative study based on a thematic analysis of semi-structured interviews with adult caregivers - either serving personnel or their dependent family members. Results: Female relatives were the main caregivers in 13 cases; the majority belonged to rural areas, were between 22 and 47 years of age, most were married, had young children, and reported health issues of their own. Major themes that emerged include lack of information, the expectation of being a caregiver irrespective of ability/needs, physical and psychological burden, neglected emotional needs, difficulty in traveling alone, social isolation, loss of employment with the financial burden, stigmatisation and ill-treatment of widows by in-laws. Conclusion: 'Soldier's wives, who must stay alone, face increased burdens as they face not only the physical and emotional burden of caregiving but also the additional challenges of living alone, mostly in rural Indian society, where gender norms are still deeply ingrained. Creating awareness about this vulnerable community among palliative care providers is required to improve services for them. There is also an urgent need for identifying, challenging, and addressing stereotyped roles and disparities in healthcare systems, practices, care goals, and policies by sensitising staff, educating families, developing gender-sensitive resources and support systems, initiating care discussions, and undertaking more gender-related research.