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1.
PLoS One ; 19(5): e0303028, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38768186

RESUMEN

BACKGROUND: Understanding causes and contributors to maternal mortality is critical from a quality improvement perspective to inform decision making and monitor progress toward ending preventable maternal mortality. The indicator "maternal death review coverage" is defined as the percentage of maternal deaths occurring in a facility that are audited. Both the numerator and denominator of this indicator are subject to misclassification errors, underreporting, and bias. This study assessed the validity of the indicator by examining both its numerator-the number and quality of death reviews-and denominator-the number of facility-based maternal deaths and comparing estimates of the indicator obtained from facility- versus district-level data. METHODS AND FINDINGS: We collected data on the number of maternal deaths and content of death reviews from all health facilities serving as birthing sites in 12 districts in three countries: Argentina, Ghana, and India. Additional data were extracted from health management information systems on the number and dates of maternal deaths and maternal death reviews reported from health facilities to the district-level. We tabulated the percentage of facility deaths with evidence of a review, the percentage of reviews that met the World Health Organization defined standard for maternal and perinatal death surveillance and response. Results were stratified by sociodemographic characteristics of women and facility location and type. We compared these estimates to that obtained using district-level data. and looked at evidence of the review at the district/provincial level. Study teams reviewed facility records at 34 facilities in Argentina, 51 facilities in Ghana, and 282 facilities in India. In total, we found 17 deaths in Argentina, 14 deaths in Ghana, and 58 deaths in India evidenced at facilities. Overall, >80% of deaths had evidence of a review at facilities. In India, a much lower percentage of deaths occurring at secondary-level facilities (61.1%) had evidence of a review compared to deaths in tertiary-level facilities (92.1%). In all three countries, only about half of deaths in each country had complete reviews: 58.8% (n = 10) in Argentina, 57.2% (n = 8) in Ghana, and 41.1% (n = 24) in India. Dramatic reductions in indicator value were seen in several subnational geographic areas, including Gonda and Meerut in India and Sunyani in Ghana. For example, in Gonda only three of the 18 reviews conducted at facilities met the definitional standard (16.7%), which caused the value of the indicator to decrease from 81.8% to 13.6%. Stratification by women's sociodemographic factors suggested systematic differences in completeness of reviews by women's age, place of residence, and timing of death. CONCLUSIONS: Our study assessed the validity of an important indicator for ending preventable deaths: the coverage of reviews of maternal deaths occurring in facilities in three study settings. We found discrepancies in deaths recorded at facilities and those reported to districts from facilities. Further, few maternal death reviews met global quality standards for completeness. The value of the calculated indicator masked inaccuracies in counts of both deaths and reviews and gave no indication of completeness, thus undermining the ultimate utility of the measure in achieving an accurate measure of coverage.


Asunto(s)
Muerte Materna , Mortalidad Materna , Humanos , Femenino , Mortalidad Materna/tendencias , Estudios Retrospectivos , Muerte Materna/estadística & datos numéricos , Ghana/epidemiología , Embarazo , India/epidemiología , Argentina/epidemiología , Instituciones de Salud/estadística & datos numéricos , Registros Médicos/estadística & datos numéricos , Adulto
2.
PLoS One ; 19(5): e0299309, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38768249

RESUMEN

BACKGROUND: Nonpharmacological interventions, such as personal protective equipment for example, surgical masks and respirators, and maintenance of hand hygiene along with COVID-19 vaccines have been recommended to reduce viral transmission in the community and health care settings. There is evidence from the literature that surgical and N95 masks may reduce the initial degree of exposure to the virus. A limited research that has studied the cost-effective analysis of surgical masks and N95 masks among health care workers in the prevention of COVID-19 in India. The objective of this study was to estimate the cost-effectiveness of N95 and surgical mask compared to wearing no mask in public hospital settings for preventing COVID-19 infection among Health care workers (HCWs) from the health care provider's perspective. METHODS: A deterministic baseline model, without any mask use, based on Eikenberry et al was used to form the foundation for parameter estimation and to estimate transmission rates among HCWs. Information on mask efficacy, including the overall filtering efficiency of a mask and clinical efficiency, in terms of either inward efficiency(ei) or outward efficiency(e0), was obtained from published literature. Hospitalized HCWs were assumed to be in one of the disease states i.e., mild, moderate, severe, or critical. A total of 10,000 HCWs was considered as representative of the size of a tertiary care institution HCW population. The utility values for the mild, moderate and severe model health states were sourced from the primary data collection on quality-of-life of HCWs COVID-19 survivors. The utility scores for mild, moderate, and severe COVID-19 conditions were 0.88, 0.738 and 0.58, respectively. The cost of treatment for mild sickness (6,500 INR per day), moderate sickness (10,000 INR per day), severe (require ICU facility without ventilation, 15,000 INR per day), and critical (require ICU facility with ventilation per day, 18,000 INR) per day as per government and private COVID-19 treatment costs and capping were considered. One way sensitivity analyses were performed to identify the model inputs which had the largest impact on model results. RESULTS: The use of N95 masks compared to using no mask is cost-saving of $1,454,632 (INR 0.106 billion) per 10,000 HCWs in a year. The use of N95 masks compared to using surgical masks is cost-saving of $63,919 (INR 0.005 billion) per 10,000 HCWs in a year. the use of surgical masks compared to using no mask is cost-saving of $1,390,713 (INR 0.102 billion) per 10,000 HCWs in a year. The uncertainty analysis showed that considering fixed transmission rate (1.7), adoption of mask efficiency as 20%, 50% and 80% reduces the cumulative relative mortality to 41%, 79% and 94% respectively. On considering ei = e0 (99%) for N95 and surgical mask with ei = e0 (90%) the cumulative relative mortality was reduced by 97% and the use of N95 masks compared to using surgical masks is cost-saving of $24,361 (INR 0.002 billion) per 10,000 HCWs in a year. DISCUSSION: Both considered interventions were dominant compared to no mask based on the model estimates. N95 masks were also dominant compared to surgical masks.


Asunto(s)
COVID-19 , Análisis Costo-Beneficio , Personal de Salud , Máscaras , Respiradores N95 , COVID-19/prevención & control , COVID-19/epidemiología , COVID-19/transmisión , Humanos , India/epidemiología , Máscaras/economía , Respiradores N95/economía , SARS-CoV-2 , Salud Pública , Análisis de Costo-Efectividad
3.
Codas ; 36(4): e20230233, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38775527

RESUMEN

PURPOSE: Prospective memory (PM) questionnaires are frequently used to evaluate perceptions of PM skills in daily life. This study aimed to systematically investigate communication-specific attributes using pre-existing PM self-rating questionnaires to inform clinicians and researchers about the role of PM in cognitive communicative evaluations. METHODS: PM-related items from three questionnaires (i.e., Prospective Memory Questionnaire, Comprehensive Assessment of Prospective Memory, and Prospective and Retrospective Memory Questionnaire) were compiled and embedded in Google Forms and distributed to 70 Speech-Language Pathologists (SLPs) with expertise in Cognitive Communicative Disorders across India. Participants first identified items related to communication, and were then contacted to rate the communication-related PM items using a Likert scale for their degree of appropriateness. Responses from 40 SLPs were obtained and subjected to item-content validity index (i-CVI) and exploratory factor analysis (EFA). RESULTS: Of the 114 PM items, 28 received ratings over 50% for their relevance to communication. Of the 28 items, 21 had an i-CVI score greater than 0.8. After the removal of overlapping content, 14 items were finalized and subjected to EFA, which resulted in four factors: PM failure due to loss of communicative content, PM failure due to loss of communicative intent, PM cost due to ongoing interference, and PM failure linked to the priority of communicative intent. CONCLUSION: This study highlights communication-related aspects of PM that can be used as a framework for SLPs to assess and research PM skills.


Asunto(s)
Comunicación , Memoria Episódica , Patología del Habla y Lenguaje , Humanos , Encuestas y Cuestionarios , Análisis Factorial , India , Femenino , Masculino , Reproducibilidad de los Resultados , Adulto , Psicometría , Trastornos de la Comunicación
4.
Environ Monit Assess ; 196(6): 568, 2024 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-38775887

RESUMEN

In the context of environmental and social applications, the analysis of land use and land cover (LULC) holds immense significance. The growing accessibility of remote sensing (RS) data has led to the development of LULC benchmark datasets, especially pivotal for intricate image classification tasks. This study addresses the scarcity of such benchmark datasets across diverse settings, with a particular focus on the distinctive landscape of India. The study entails the creation of patch-based datasets, consisting of 4000 labelled images spanning four distinct LULC classes derived from Sentinel-2 satellite imagery. For the subsequent classification task, three traditional machine learning (ML) models and three convolutional neural networks (CNNs) were employed. Despite facing several challenges throughout the process of dataset generation and subsequent classification, the CNN models consistently attained an overall accuracy of 90% or more. Notably, one of the ML models stood out with 96% accuracy, surpassing CNNs in this specific context. The study also conducts a comparative analysis of ML models on existing benchmark datasets, revealing higher prediction accuracy when dealing with fewer LULC classes. Thus, the selection of an appropriate model hinges on the given task, available resources, and the necessary trade-offs between performance and efficiency, particularly crucial in resource-constrained settings. The standardized benchmark dataset contributes valuable insights into the relative performance of deep CNN and ML models in LULC classification, providing a comprehensive understanding of their strengths and weaknesses.


Asunto(s)
Aprendizaje Profundo , Monitoreo del Ambiente , Aprendizaje Automático , India , Monitoreo del Ambiente/métodos , Conservación de los Recursos Naturales/métodos , Imágenes Satelitales , Redes Neurales de la Computación , Tecnología de Sensores Remotos
5.
Environ Monit Assess ; 196(6): 567, 2024 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-38775991

RESUMEN

The study attempted to evaluate the agricultural soil quality using the Soil Quality Index (SQI) model in two Community Development Blocks, Ausgram-II and Memari-II of Purba Bardhaman District. Total 104 soil samples were collected (0-20 cm depth) from each Block to analyse 13 parameters (bulk density, soil porosity, soil aggregate stability, water holding capacity, infiltration rate, available nitrogen, available phosphorous, available potassium, soil pH, soil organic carbon, electrical conductivity, soil respiration and microbial biomass carbon) in this study. The Integrated Quality Index (IQI) was applied using the weighted additive approach and non-linear scoring technique to retain the Minimum Data Set (MDS). Principal Component Analysis (PCA) identified that SAS, BD, available K, pH, available N, and available P were the key contributing parameters to SQI in Ausgram-II. In contrast, WHC, SR, available N, pH, and SAS contributed the most to SQI in Memari-II. Results revealed that Ausgram-II (0.97) is notably higher SQI than Memari-II (0.69). In Ausgram-II, 99.72% of agricultural lands showed very high SQI (Grade I), whereas, in Memari-II, 49.95% of lands exhibited a moderate SQI (Grade III) and 49.90% showed a high SQI (Grade II). Sustainable Yield Index (SYI), Sensitivity Index (SI) and Efficiency Ratio (ER) were used to validate the SQIs. A positive correlation was observed between SQI and paddy ( R2 = 0.82 & 0.72) and potato yield (R2 = 0.71 & 0.78) in Ausgram-II and Memari-II Block, respectively. This study could evaluate the agricultural soil quality and provide insights for decision-making in fertiliser management practices to promote agricultural sustainability.


Asunto(s)
Agricultura , Monitoreo del Ambiente , Oryza , Suelo , India , Suelo/química , Monitoreo del Ambiente/métodos , Oryza/crecimiento & desarrollo , Nitrógeno/análisis , Contaminantes del Suelo/análisis , Fósforo/análisis
6.
PLoS One ; 19(5): e0298340, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38718057

RESUMEN

BACKGROUND: Noncommunicable diseases (NCDs) account for nearly 75% of all deaths in Tamil Nadu. The government of Tamil Nadu has initiated several strategies to control NCDs under the Tamil Nadu Health Systems Reform Program (TNHSRP). We aimed to estimate the prevalence of NCD risk factors and determine the predictors of diabetes and hypertension, which will be helpful for planning and serve as a baseline for evaluating the impact of interventions. METHODS: A state-wide representative cross-sectional study was conducted among 18-69-year-old adults in Tamil Nadu in 2020. The study used a multi-stage sampling method to select the calculated sample size of 5780. We adapted the study tools based on WHO's STEPS surveillance methodology. We collected information about sociodemographic factors, NCD risk factors and measured blood pressure and fasting capillary blood glucose. The predictors of diabetes and hypertension were calculated using generalised linear models with 95% confidence intervals (95% CI). RESULTS: Due to the COVID-19 pandemic lockdown, we could cover 68% (n = 3800) of the intended sample size. Among the eligible individuals surveyed (n = 4128), we had a response rate of 92%. The mean age of the study participants was 42.8 years, and 51% were women. Current tobacco use was prevalent in 40% (95% CI: 33.7-40.0) of men and 7.9% (95% CI: 6.4-9.8) of women. Current consumption of alcohol was prevalent among 39.1% (95% CI: 36.4-42.0) of men. Nearly 28.5% (95% CI: 26.7-30.4) of the study participants were overweight, and 11.4% (95% CI: 10.1-12.7) were obese. The prevalence of hypertension was 33.9% (95% CI: 32.0-35.8), and that of diabetes was 17.6% (95% CI: 16.1-19.2). Older age, men, and obesity were independently associated with diabetes and hypertension. CONCLUSION: The burden of NCD risk factors like tobacco use, and alcohol use were high among men in the state of Tamil Nadu. The prevalence of other risk factors like physical inactivity, raised blood pressure and raised blood glucose were also high in the state. The state should further emphasise measures that reduce the burden of NCD risk factors. Policy-based and health system-based interventions to control NCDs must be a high priority for the state.


Asunto(s)
Diabetes Mellitus , Hipertensión , Enfermedades no Transmisibles , Humanos , Masculino , Persona de Mediana Edad , Adulto , Femenino , Enfermedades no Transmisibles/epidemiología , Factores de Riesgo , Prevalencia , Estudios Transversales , Anciano , Hipertensión/epidemiología , India/epidemiología , Adolescente , Adulto Joven , Diabetes Mellitus/epidemiología , COVID-19/epidemiología
7.
Environ Monit Assess ; 196(6): 526, 2024 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-38722374

RESUMEN

Flood disasters are frequent natural disasters that occur annually during the monsoon season and significantly impact urban areas. This area is characterized by impermeable concrete surfaces, which increase runoff and are particularly susceptible to flooding. Therefore, this study aims to adopt Bi-variate statistical methods such as frequency ratio (FR) and weight of evidence (WOE) to map flood susceptibility in an urbanized watershed. The study area encompasses an urbanized watershed surrounding the Chennai Metropolitan area in southern India. The essential parameters considered for flood susceptibility zonation include geomorphology, soil, land use/land cover (LU/LC), rainfall, drainage, slope, aspect, Topographic Wetness Index (TWI), and Normalized Difference Vegetation Index (NDVI). The flood susceptibility map was derived using 70% of randomly selected flood areas from the flood inventory database, and the other 30% was used for validation using the area under curve (AUC) method. The AUC method produced a frequency ratio of 0.806 and a weight of evidence value of 0.865 contributing to the zonation of the three classes. The study further investigates the impact of urbanization on flood susceptibility and is further classified into high, moderate, and low flood risk zones. With the abrupt change in climatic scenarios, there is an increase in the risk of flash floods. The results of this study can be used by policymakers and planners in developing a preparedness system to mitigate economic, human, and property losses due to floods in any urbanized watershed.


Asunto(s)
Monitoreo del Ambiente , Inundaciones , Inundaciones/estadística & datos numéricos , India , Monitoreo del Ambiente/métodos , Urbanización , Ciudades , Medición de Riesgo
8.
Environ Monit Assess ; 196(6): 527, 2024 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-38722419

RESUMEN

Understanding the connections between human activities and the natural environment depends heavily on information about land use and land cover (LULC) in the form of accurate LULC maps. Environmental monitoring using deep learning (DL) is rapidly growing to preserve a sustainable environment in the long term. For establishing effective policies, regulations, and implementation, DL can be a valuable tool for assessing environmental conditions and natural resources that will positively impact the ecosystem. This paper presents the assessment of land use and land cover change detection (LULCCD) and prediction using DL techniques for the southwestern coastal region, Goa, also known as the tourist destination of India. It consists of three components: (i) change detection (CD), (ii) quantification of LULC changes, and (iii) prediction. A new CD assessment framework, Spatio-Temporal Encoder-Decoder Self Attention Network (STEDSAN), is proposed for the LULCCD process. A dual branch encoder-decoder network is constructed using strided convolution with downsampling for the encoder and transpose convolution with upsampling for the decoder to assess the bitemporal images spatially. The self-attention (SA) mechanism captures the complex global spatial-temporal (ST) interactions between individual pixels over space-time to produce more distinct features. Each branch accepts the LULC map of 2 years as one of its inputs to determine binary and multiclass changes among the bitemporal images. The STEDSAN model determines the patterns, trends, and conversion from one LULC type to another for the assessment period from 2005 to 2018. The binary change maps were also compared with the existing state of the art (SOTA) CD methods, with STEDSAN having an overall accuracy of 94.93%. The prediction was made using an recurrent neural network (RNN) known as long short term memory network (LSTM) for the year 2025. Experiments were conducted to determine area-wise changes in several LULC classes, such as built-up (BU), crops (kharif crop (KC), rabi crop (RC), zaid crop (ZC), double/triple (D/T C)), current fallow (CF), plantation (PL), forests (evergreen forest (EF), deciduous forest (DF), degraded/scurb forest (D/SF) ), littoral swamp (LS), grassland (GL), wasteland (WL), waterbodies max (Wmx), and waterbodies min (Wmn). As per the analysis, over the period of 13 years, there has been a net increase in the amount of BU (1.25%), RC (1.17%), and D/TC( 2.42%) and a net decrease in DF (3.29%) and WL(1.44%) being the most dominant classes being changed. These findings will offer a thorough description of identifying trends in coastal areas that may incorporate methodological hints for future studies. This study will also promote handling the spatial and temporal complexity of remotely sensed data employed in categorizing the coastal LULC of a heterogeneous landscape.


Asunto(s)
Conservación de los Recursos Naturales , Aprendizaje Profundo , Monitoreo del Ambiente , India , Monitoreo del Ambiente/métodos , Conservación de los Recursos Naturales/métodos , Ecosistema , Agricultura/métodos
9.
Leadersh Health Serv (Bradf Engl) ; ahead-of-print(ahead-of-print)2024 May 13.
Artículo en Inglés | MEDLINE | ID: mdl-38722792

RESUMEN

PURPOSE: The purpose of this study is to investigate the relationship between inclusive leadership (IL), psychological safety (PS), affective commitment (AC) and organizational citizenship behavior (OCB) at the workplace. By understanding the sequential linkages, the research aims to provide insights for fostering a positive organizational culture that promotes employee commitment and employees' willingness to go the extra mile for the organization. DESIGN/METHODOLOGY/APPROACH: The authors study how IL and OCB are related through PS and AC. For this purpose, cross-sectional data from 384 nursing professionals in India was collected and structural equation modeling was conducted on the same using IBM AMOS. FINDINGS: The study found that IL has a major impact on OCB. The study further found that perceived IL leads to PS which is associated with OCB through AC. RESEARCH LIMITATIONS/IMPLICATIONS: The study has many theoretical and practical implications. This study uses a framework that is based on Affective events theory. In a health-care environment, IL can foster AC by promoting a culture of respect, collaboration and value for diverse perspectives, which enhances health-care professionals' emotional attachment to their work and the organization. Additionally, by encouraging open communication and a sense of belonging, IL contributes to OCB, as health-care staff are more likely to engage in discretionary behaviors that support the overall effectiveness and positive functioning of the health-care team if PS is improved, ultimately improving patient care outcomes. ORIGINALITY/VALUE: To the best of the authors' knowledge, this is one of the primary studies that looks into the sequential mechanism through which IL impacts OCB.


Asunto(s)
Liderazgo , Cultura Organizacional , Humanos , Estudios Transversales , India , Adulto , Femenino , Masculino , Lugar de Trabajo/psicología , Personal de Salud/psicología , Encuestas y Cuestionarios , Lealtad del Personal
10.
JCO Glob Oncol ; 10: e2300308, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38723218

RESUMEN

PURPOSE: Desmoid fibromatosis (DF) is a locally aggressive tumor with low mortality but significant morbidity. There is a lack of standard of care, and existing therapies are associated with significant barriers including access, cost, and toxicities. This study aimed to explore the efficacy and safety of the metronomic therapy (MT) in DF in a large, homogenous cohort from India. PATIENTS AND METHODS: This study involved histologically confirmed DF cases treated with MT comprising vinblastine (6 mg) and methotrexate (15 mg) both once a week, and tamoxifen (40 mg/m2) in two divided doses once daily between 2002 and 2018. RESULTS: There were 315 patients with a median age of 27 years; the commonest site was extremity (142 of 315; 45.0%). There were 159 (50.1%) male patients. Of the 123 (39.0%) prior treated patients, 119 had surgery. Of 315 patients, 263 (83.5%) received treatment at our institute (MT-151, 77-local treatment, 9-tyrosine kinase inhibitor, and 26 were observed). Among the MT cohort (n = 163, 61.2%), at a median follow-up of 36 (0.5-186) months, the 3-year progression-free and overall survival were 81.1% (95% CI, 74.3 to 88.4) and 99.2% (95% CI, 97.6 to 100), respectively. There were 35% partial responses. Ninety-two patients (56.4%) completed 1-year therapy, which was an independent prognosticator (P < .0001; hazard ratio, 0.177 [95% CI, 0.083 to 0.377]). MT was well tolerated. Predominant grade ≥3 toxicities were febrile neutropenia, 12 (7.4%) without any chemotoxicity-related death. The annual cost of MT was $130 US dollars. CONCLUSION: The novel, low-cost MT qualifies as one of the effective, less toxic, sustainable, standard-of-care options for the treatment of DF with global reach and merits wide recognition.


Asunto(s)
Administración Metronómica , Fibromatosis Agresiva , Metotrexato , Centros de Atención Terciaria , Humanos , Masculino , Femenino , Adulto , Fibromatosis Agresiva/tratamiento farmacológico , Fibromatosis Agresiva/mortalidad , Fibromatosis Agresiva/economía , India , Centros de Atención Terciaria/estadística & datos numéricos , Adulto Joven , Persona de Mediana Edad , Adolescente , Metotrexato/administración & dosificación , Metotrexato/uso terapéutico , Metotrexato/economía , Nivel de Atención , Niño , Vinblastina/administración & dosificación , Vinblastina/uso terapéutico , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/economía , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Tamoxifeno/administración & dosificación , Tamoxifeno/economía , Tamoxifeno/uso terapéutico , Estudios Retrospectivos
11.
Environ Monit Assess ; 196(6): 528, 2024 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-38724799

RESUMEN

Indian agriculture transitioned from a food deficit sector to a food surplus following the Green Revolution. However, the continued progress of Indian agriculture has been hampered by climate change. This research explores the district-wise vulnerability in Madhya Pradesh, India, to climate change by assessing the composite vulnerability index using the agricultural vulnerability index (AVI) and socio-economic vulnerability index (SEVI). The study seeks to understand how agricultural and socio-economic factors lead to variations in vulnerability across districts and influence targeted adaptation and mitigation strategies. The trend analysis results present declining rainfall and inclining temperature from 1951 to 2021 in Madhya Pradesh, directly affecting the agricultural sector and human livelihood. The composite vulnerability index (CVI) results revealed that districts with low values (< 0.394), such as Burhanpur and Balaghat, demonstrate reduced susceptibility due to limited cultivation, low reliance on rainfall, lower drought susceptibility, and decreased population density. Districts such as Panna and Bhopal show moderate vulnerability (0.394-0.423), with lower fallow land, reduced rainfed agriculture, and socio-economic vulnerability. Extensive agriculture and marginalised workers' presence influence high vulnerability (0.423 to 0.456) in districts such as Tikamgarh and Indore. Districts like Barwani and Jhabua have the highest CVI values (> 0.456), indicating substantial susceptibility to climate impacts. The cluster analysis validates the results of the vulnerability index. The findings highlight the urgent need for tailored adaptation strategies to address the diverse agricultural and socio-economic indicators creating vulnerability in Madhya Pradesh. The study helps understand regional vulnerability patterns and provides evidence-based policy approaches for resilience to climate change effects.


Asunto(s)
Agricultura , Cambio Climático , Factores Socioeconómicos , India , Humanos , Monitoreo del Ambiente
12.
J Biosci ; 492024.
Artículo en Inglés | MEDLINE | ID: mdl-38726821

RESUMEN

Disease cross-transmission between wild and domestic ungulates can negatively impact livelihoods and wildlife conservation. In Pin valley, migratory sheep and goats share pastures seasonally with the resident Asiatic ibex (Capra sibirica), leading to potential disease cross-transmission. Focussing on gastro-intestinal nematodes (GINs) as determinants of health in ungulates, we hypothesized that infection on pastures would increase over summer from contamination by migrating livestock. Consequently, interventions in livestock that are well-timed should reduce infection pressure for ibex. Using a parasite life-cycle model, that predicts infective larval availability, we investigated GIN transmission dynamics and evaluated potential interventions. Migratory livestock were predicted to contribute most infective larvae onto shared pastures due to higher density and parasite levels, driving infections in both livestock and ibex. The model predicted a c.30-day antiparasitic intervention towards the end of the livestock's time in Pin would be most effective at reducing GINs in both hosts. Albeit with the caveats of not being able to provide evidence of interspecific parasite transmission due to the inability to identify parasite species, this case demonstrates the usefulness of our predictive model for investigating parasite transmission in landscapes where domestic and wild ungulates share pastures. Additionally, it suggests management options for further investigation.


Asunto(s)
Cabras , Ganado , Animales , India/epidemiología , Cabras/parasitología , Ganado/parasitología , Ovinos/parasitología , Migración Animal , Enfermedades de las Cabras/parasitología , Enfermedades de las Cabras/transmisión , Animales Salvajes/parasitología , Enfermedades de las Ovejas/parasitología , Enfermedades de las Ovejas/transmisión , Enfermedades de las Ovejas/prevención & control , Infecciones por Nematodos/transmisión , Infecciones por Nematodos/veterinaria , Infecciones por Nematodos/prevención & control , Infecciones por Nematodos/parasitología , Infecciones por Nematodos/epidemiología , Estaciones del Año , Larva/parasitología , Nematodos/patogenicidad
13.
J Biosci ; 492024.
Artículo en Inglés | MEDLINE | ID: mdl-38726822

RESUMEN

Fish of the genus Hypselobarbus (Bleeker 1860) are widely dispersed in the rivers of the Western Ghats in India and endemic to southern Indian peninsular freshwaters. These are small- to medium-sized fishes of the family Cyprinidae. Although fish with deformed bodies or body parts are rare in natural waters, this article deals with four abnormal specimens of Hypselobarbus curmuca (Hamilton 1807) collected from the rivers Tunga, Bhadra, and Kali during 2022. The abnormalities observed in four different individuals are pughead deformity, pelvic fin deformity, pectoral fin deformity, and enlarged scales. The morphological comparison of normal individuals of Hypselobarbus curmuca (Hamilton 1807) with abnormal specimens revealed variation. Using the MT-COI gene, species identity was confirmed and the mean genetic divergence between the normal and abnormal specimens was estimated to be less than 1%.


Asunto(s)
Cyprinidae , Ríos , Animales , India/epidemiología , Cyprinidae/genética , Filogenia , Complejo IV de Transporte de Electrones/genética , Variación Genética , Aletas de Animales/anatomía & histología , Aletas de Animales/anomalías , Proteínas de Peces/genética
14.
Environ Monit Assess ; 196(6): 533, 2024 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-38727749

RESUMEN

The Indo-Gangetic Plains (IGP) of the Indian subcontinent during winters experience widespread fog episodes. The low visibility is not only attributed to meteorological conditions but also to the increased pollution levels in the region. The study was carried out for Tier 1 and Tier II cities of the IGP of India, including Kolkata, Amritsar, Patiala, Hisar, Delhi, Patna, and Lucknow. This work analyzes data from 1990 to 2023 (33 years) employing the Mann-Kendall-Theil-Sen slope to determine the trends in fog occurrences and the relation between fog and meteorological parameters using multiple linear regressions. Furthermore, identifying the most relevant fog (visibility)-impacting factors from a set of both meteorological factors and air pollutants using step-wise regression. All cities indicated trend in the number of foggy days except for Kolkata. The multiple regression analysis reveals relatively low associations between fog occurrences and meteorological factors (30 to 59%), although the association was stronger when air pollution levels were considered (60 to 91%). Relative humidity, PM2.5, and PM10 have the most influence on fog formation. The study provides comprehensive insights into fog trends by incorporating meteorological data and air pollution analysis. The findings highlight the significance of acknowledging meteorological and pollution factors to understand and mitigate the impacts of reduced visibility. Hence, this information can guide policymakers, urban planners, and environmental management agencies in developing effective strategies to manage fog-related risks and improve air quality.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Ciudades , Monitoreo del Ambiente , Tiempo (Meteorología) , Contaminantes Atmosféricos/análisis , India , Contaminación del Aire/estadística & datos numéricos , Esmog , Conceptos Meteorológicos , Material Particulado/análisis
15.
Med Anthropol ; 43(4): 338-352, 2024 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-38753501

RESUMEN

We explore the temporalities that shape and alleviate serious health-related suffering among those with chronic and terminal conditions in Kerala, India. Drawing on ethnographic fieldwork between 2009 and 2019, we examine the entanglements between waiting for care within dominant institutions and the community organizing that palliates this waiting. Specifically, people navigate multiple medical institutions, experience loneliness and abandonment, loss of autonomy, and delays and denials of recognition as they wait for care. Community palliative care organizations offering free, routine, home-based care provide samadhanam (peace of mind) and swatantrayam (self-determination) in lifeworlds mired with chronic waiting. We document how community care sustains an alternative politics of shared time, untethered from marketized notions of efficiency and productivity toward profits. In so doing, we cast in high relief community healthcare imaginaries that alleviate serious health-related suffering and reconfigure Global North-centric perspectives.


Asunto(s)
Antropología Médica , Humanos , India/etnología , Femenino , Masculino , Cuidados Paliativos , Servicios de Salud Comunitaria , Persona de Mediana Edad , Adulto , Enfermedad Crónica/terapia , Enfermedad Crónica/etnología
16.
JCO Glob Oncol ; 10: e2300225, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38754051

RESUMEN

PURPOSE: Colorectal cancer (CRC) in young adults is a rising concern in developing countries such as India. This study investigates clinicopathologic profiles, treatment patterns, and outcomes of CRC in young adults, focusing on adolescent and young adult (AYA) CRC in a low- and middle-income country (LMIC). METHODS: A retrospective registry study from January 2018 to December 2020 involved 126 young adults (age 40 years and younger) with CRC. Patient demographics, clinical features, tumor characteristics, treatment modalities, and survival outcomes were analyzed after obtaining institutional ethics committees' approval. RESULTS: Among 126 AYA patients, 62.70% had colon cancer and 37.30% had rectal cancer. Most patients (67%) were age 30-39 years, with no significant gender predisposition. Females had higher metastatic burden. Abdominal pain with obstruction features was common. Adenocarcinoma (65%) with signet ring differentiation (26%) suggested aggressive behavior. Limited access to molecular testing hindered mutation identification. Capecitabine-based chemotherapy was favored because of logistical constraints. Adjuvant therapy showed comparable recurrence-free survival in young adults and older patients. For localized colon cancer, the 2-year median progression-free survival was 74%, and for localized rectal cancer, it was 18 months. Palliative therapy resulted in a median overall survival of 33 months (95% CI, 18 to 47). Limited access to targeted agents affected treatment options, with only 27.5% of patients with metastatic disease receiving them. Chemotherapy was generally well tolerated, with hematologic side effect being most common. CONCLUSION: This collaborative study in an LMIC offers crucial insights into CRC in AYA patients in India. Differences in disease characteristics, treatment patterns, and limited access to targeted agents highlight the need for further research and resource allocation to improve outcomes in this population.


Asunto(s)
Neoplasias Colorrectales , Humanos , Femenino , Masculino , India/epidemiología , Adulto , Estudios Retrospectivos , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/terapia , Neoplasias Colorrectales/mortalidad , Adulto Joven , Resultado del Tratamiento , Adolescente
17.
Indian J Med Ethics ; IX(2): 121-126, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38755761

RESUMEN

BACKGROUND: Given the imperative for dental practitioners to be familiar with the existing ethical principles and laws governing their practice, this study aimed to evaluate awareness and practice of the dentists (code of ethics) regulations 2014 and consumer protection act 2019 among dental practitioners in Andhra Pradesh state, India. METHODS: A cross sectional study was conducted among 384 dental practitioners in Andhra Pradesh state, India. A questionnaire consisting of 25 items was used to assess awareness and practice of the dentists (code of ethics) regulations and consumer protection act. The data collected were analysed using IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. RESULTS: Only 53(13.8%) dental practitioners in the study were aware that the dentists (code of ethics) regulations had been revised in 2014. About 190 (49.5%) practitioners were aware of the precise period for mandatory preservation of patient records. Most dental practitioners (278, 72.4%) accepted commissions in the form of gifts or cash from laboratories, radiologists, or pharmacists and 306 (79.7%) dental practitioners used unregistered dental lab technicians as employees in their practice. Furthermore, 297 (77.3%) practitioners were found to provide or sell drugs to patients in their clinic/office. The new regulations under consumer protection act 2019 were unknown to 194 (50.5%) dental practitioners. CONCLUSIONS: The present study indicates that the awareness of dental practitioners towards the dentists (code of ethics) regulations 2014 and consumer protection act 2019 is inadequate. It highlights the need for training programmes and curriculum changes with a focus on ethical and legal issues in clinical dental practice.


Asunto(s)
Códigos de Ética , Odontólogos , Ética Odontológica , Humanos , India , Estudios Transversales , Odontólogos/ética , Odontólogos/legislación & jurisprudencia , Encuestas y Cuestionarios , Masculino , Femenino , Adulto , Pautas de la Práctica en Odontología/ética , Pautas de la Práctica en Odontología/estadística & datos numéricos , Pautas de la Práctica en Odontología/normas , Pautas de la Práctica en Odontología/legislación & jurisprudencia , Concienciación
18.
Indian J Med Ethics ; IX(2): 114-120, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38755762

RESUMEN

BACKGROUND: Care provision received renewed attention during the Covid-19 pandemic as several healthcare providers vied for the coveted title of "frontline warrior" while they struggled to provide care efficiently under varying health system constraints. While several studies on the health workforce during the pandemic highlighted their difficulties, there is little reflection on what "care" or "caring" itself meant specifically for community health workers (CHWs) as they navigated different community and health systems settings. The aim of the study was to examine CHWs' care-giving experiences during the pandemic. METHODS: Twenty narrative interviews with CHWs including ASHAs (Accredited Social Health Activists) and ANMs (Auxiliary Nurse Midwives) were conducted in different states between July and December 2020. RESULTS: Our findings highlight the moral, affectual, and relational dimensions of care in the CHWs' engagement with their routine and Covid-19 related services, as well as the "technical" aspects of it. In this article, we argue that these two aspects are, in fact, enmeshed in complex ways. CHWs extend this moral understanding not just to their work, but also to their relationship with the health system and the government, as they express a deep sense of neglect and the lack of "being cared for" by the health system. CONCLUSION: CHWs' experiences demand a more nuanced understanding of the ethics of care or caring that challenges the binaries between the "technical" and moral aspects of care.


Asunto(s)
COVID-19 , Agentes Comunitarios de Salud , SARS-CoV-2 , Humanos , Agentes Comunitarios de Salud/psicología , Femenino , India , Pandemias , Masculino , Adulto , Actitud del Personal de Salud , Investigación Cualitativa , Atención a la Salud/ética , Entrevistas como Asunto , Persona de Mediana Edad
19.
Indian J Med Ethics ; IX(2): 169-170, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38755764

RESUMEN

As the world grapples with the constant threat of new pathogens, the role of government oversight in research and response efforts has become a topic of considerable debate in the academic community. In the recently released "SOP [standard operating procedure] for Nipah virus research in Kerala for studies involving human participants / human samples" by the Government of Kerala, the SOP, apart from administrative permission, requires the proposal to be cleared by the Institutional Research Committee at a Government Medical College, and the inclusion of an investigator from a government institution [1]. In these challenging times, it is crucial to weigh the pros and cons of stringent administrative controls to ensure an effective and ethical approach to tackling emerging infectious diseases.


Asunto(s)
Enfermedades Transmisibles Emergentes , Humanos , Enfermedades Transmisibles Emergentes/prevención & control , India , Investigación Biomédica/ética , Regulación Gubernamental , Virus Nipah , Infecciones por Henipavirus/prevención & control , Comités de Ética en Investigación/normas
20.
Indian J Med Ethics ; IX(2): 168, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38755767

RESUMEN

Saviour babies or saviour siblings are conceived specifically to be sources of biological materials - ranging from cord blood, stem cells or even organs - to save another child, usually an older sibling, who is suffering from a disease like thalassemia that can be cured with this biological material. In 2020, the media reported about the birth of India's first saviour baby, in the state of Gujarat [1]. In January 2023, there was a report of the birth of another saviour baby, in the state of Maharashtra [2]. Ethical concerns relating to saviour siblings find a place in the western bioethics discourse. However, it is little discussed in the Indian context.


Asunto(s)
Hermanos , Humanos , India , Femenino , Talasemia
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