Minocycline in depression not responding to first-line therapy: A systematic review and meta-analysis.

BACKGROUND: Major depressive disorder is often resistant to first-line treatment, with around 30% failing to respond to traditional therapy. Treatment-resistant depression results in prolonged hospitalization and healthcare costs. Anti-inflammatory drugs have shown promising results in depression not responding to initial therapy. Minocycline has anti-inflammatory properties and crosses the blood-brain barrier. It has demonstrated varied results in several randomized controlled trials (RCTs). METHODS: We assessed the efficacy of minocycline compared to placebo in depression not responding to one first-line antidepressant via a systematic review and meta-analysis. We performed a comprehensive literature search across PubMed, Cochrane, and Scopus for RCTs. We visualized the results using forest plots and drapery plots. We assessed and explored heterogeneity using I2, prediction interval, and meta-regression. Then, we rated the certainty of the evidence. RESULTS: Four RCTs revealed a non-significant difference in depression severity [-3.93; 95% CI: -16.14 to 8.28], rate of response [1.15; 0.33-4.01], and rate of remission [0.94; 0.44-2.01]. However, the reduction in depression severity is significant at a trend of P < .1. The high between-study heterogeneity (I2 = 78%) for depression severity could be answered by meta-regression (P = .02) for the duration of therapy. CONCLUSION: There is no significant difference with minocycline compared to placebo for depression not responding to first-line antidepressant therapy. However, the treatment response varies with treatment duration and patients' neuroinflammatory state. Thus, larger and longer RCTs, especially in diverse disease subgroups, are needed for further insight. This is needed to allow greater precision medicine in depression and avoid elevated healthcare expenditure associated with hit-and-trial regimens. REGISTRATION: CRD42023398476 (PROSPERO).

Adolescent Friendly Health Clinics (AFHCS) in India and their compliance with government benchmarks: A scoping review.

Background: Adolescent Friendly Health Clinics (AFHCs) are one of the critical pillars of India's Adolescent Health Programme-Rashtriya Kishor Swasthya Karyakram that seeks to enable all adolescents to realize their full potential by making informed decisions concerning their health and by accessing the services. Thus, a review was conceptualised to assess the compliance of AFHCs with the benchmark proposed by the Government under Rashtriya Kishor Swasthya Karyakram. Methods: Three databases (PubMed, Scopus and Google Scholar) were searched for articles published between 2014 and December 2022. A snowball search strategy was also used to retrieve all published articles. Based on the search strategy eight studies were included. Results: AFHCs are not fully compliant with all the benchmarks proposed by the government of India. Evidence from the primary studies showed that the benchmarks need attention as privacy was lacking (six out of seven studies), unavailability of Information Education and Communication material (four out of five), signages (two out of four), referrals (one out of two), and judgemental attitude of health care providers (one out of 3). Conclusions: There is a pressing need to focus on the fulfilment of these gaps to make the clinics adolescent-friendly. This might increase the utilisation of available services in AFHCs by adolescents and will improve their health. The improved health will catalyse achieving the Sustainable Development Goals indicators that are associated with nutrition, reproductive health, sexual and intimate partner violence, child marriage, education, and employment.

Parents' expectation of antibiotic prescriptions for respiratory infections in children: a systematic review and meta-analysis.

Objectives: Despite most childhood infections being self-limiting, children are among the leading consumers of antibiotics. Little is known about parental expectations of antibiotics for childhood infections. A comprehensive systematic review and meta-analysis was conducted to explore the nature and extent of parental expectations of antibiotic prescriptions for children with respiratory infections. Design: Systematic review and meta-analysis. Methods: An extensive literature search using six major scientific databases was conducted for all published articles until 7 December 2022. Primary studies reporting parents' expectations of antibiotics for children with upper respiratory tract infections were included after assessment for quality. Heterogeneity between the studies was assessed using the I2 statistic and publication bias was analyzed using funnel plots and Egger regression tests. The primary outcome was a summary estimate of the percentage of parents who expect antibiotics from their physicians when their child presents with an upper respiratory tract infection. Results: From a total of 4510 studies found in the initial searches, a final pool of 19 eligible studies with 15,664 individuals was included in this meta-analysis. Nine of the 19 studies were from the United States or Saudi Arabia. The pooled prevalence of parental expectations of antibiotics in the population reviewed was 55.78% (95% CI = 44.60-66.41). There was significant heterogeneity between the studies, but funnel plot and meta-regression did not detect any publication bias. Conclusion: More than half of parents expect antibiotics for their children during consultation for upper respiratory tract infections. Such practices may cause undue side effects among children, contribute to the growing burden of antibiotic resistance, and lead to treatment failure for many common infections in the future. To optimize efforts to tackle antimicrobial resistance, shared decision-making and education emphasizing the proper and judicious use of antibiotics are much needed in pediatric healthcare settings. This can also help to manage parents' expectations when seeking antibiotics for their children. Despite pressure from parents, pediatric healthcare providers should continue to advocate for antibiotic use only when warranted and help improve knowledge and awareness amongst parents. Registration: The protocol has been registered with PROSPERO (CRD42022364198).

It Cost Us All of Our Savings to Deliver Our Baby: A Qualitative Study to Explore Barriers and Facilitators of Maternal and Child Health Service Access and Utilization in a Remote Rural Region in India During the COVID-19 Pandemic.

INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic, rural and geographically isolated regions in lower-middle-income countries (LMICs) encountered major deficits in maternal and child health (MCH) care that were accentuated by pre-existing weak public health infrastructure and diversion of existing health resources for pandemic management purposes. This explorative qualitative study was conducted to assess the barriers, challenges, and facilitators in the access and utilization of essential MCH services among pregnant women during the COVID-19 pandemic in a geographically remote and rural area in India, having nearly 70% rural population. METHOD: The study was conducted using an ethnographic approach. Three villages were selected purposively from the Purba Medinipur district of the Eastern state of West Bengal, geographically isolated by a local river. Information on challenges of utilization was collected by in-depth interviews (IDI) with a universal sample of 25 mothers who underwent pregnancy after March 2020 and focus group discussions (FGD) with their husbands and mothers-in-laws. Thematic analysis was used to analyze the qualitative data. RESULTS: The median (IQR) age of the mothers that delivered during pregnancy were 23 (18, 28) years and ranging from 18 to 28 years (N=25). All the mothers were married, housewives, literate, and Hindu by religion, while in the accompanying husband cohort, a majority (56 %) had completed high school. Half (52%) were primigravida with at least one living child (60 %). All the mothers had a successful birth outcome and only one had current evidence of mild depression. Low utilization of MCH services during the pandemic in the study area was recognized as an outcome of individual-level, interpersonal-level, and community-level barriers. Diversion of routine health staff for COVID-19 related services occasionally compelled pregnant women and children to seek care from unlicensed healthcare providers who remained accessible even during periods of stringent lockdown. Furthermore, the irregular functioning of the local primary health care system translated into missed home visits and disruption of nutritional assistance services. A dual burden of economic loss was reported in most households from loss of livelihood and wages and additional expenditure incurred in underdoing deliveries at private health facilities, thereby potentially translating into catastrophic out-of-pocket costs. The designation of a separate government health facility for delivery due to the unavailability of the local hospital did not mitigate the circumstances due to its lack of utilization by the villagers who encountered difficult access and a lack of trust in an unfamiliar environment. The functioning of a popular conditional cash transfer scheme for promoting safe motherhood was also possibly compromised during the pandemic. CONCLUSIONS: Accessibility to MCH services was severely affected during the COVID-19 pandemic, especially during the stringent lockdown periods in remote and rural areas in India. Future pandemic preparedness must have enhanced health policy and administrative focus on preventing significant disruption of MCH services by maintaining improved accessibility to alternative health facilities, monitoring regular home visits by frontline health workers, rendering effective distribution of benefits from existing social protection schemes, and universal promotion of respectful maternity care.

Potentially Asymptomatic Infection of Monkeypox Virus: A Systematic Review and Meta-Analysis.

Background: Monkeypox is a global public health concern, given the recent outbreaks in non-endemic countries where little scientific evidence exists on the disease. Specifically, there is a lack of data on asymptomatic monkeypox virus infection. This study aims to evaluate the overall prevalence of asymptomatic monkeypox virus infection. Methods: In this systematic review and meta-analysis, we performed an extensive literature search in PubMed, Scopus, Web of Science, ProQuest, EMBASE, EBSCOHost, Cochrane, and preprint servers (medRxiv, arXiv, bioRxiv, BioRN, ChiRxiv, ChiRN, and SSRN) and assessed all published articles till September 2022. Primary studies reporting monkeypox infections among asymptomatic participants were included after quality assessment. The characteristics of the study and information on the number of cases and symptomatic status were extracted from the included studies. The heterogeneity between studies was assessed using the I2 statistic. Publication bias was analyzed using funnel plots and Egger regression tests. The primary outcome was the pooled prevalence of asymptomatic infections within the examined population. Results: A total of 16 studies were included for qualitative synthesis, while five studies, including 645 individuals, were included for quantitative synthesis. There was substantial heterogeneity between studies (I2 = 94.86%; p < 0.01), with a pooled percentage of asymptomatic infections in the studied population of 10.2% (95%CI, 2.5−17.9%). Conclusion: This meta-analysis suggests that many people infected with the monkeypox virus are asymptomatic and difficult to detect. Therefore, prompt detection of these cases of monkeypox virus and appropriate subsequent management is of utmost importance to global public health.

The Burden of Non-Communicable Diseases (NCDs) among Prisoners in India: A Systematic Review and Meta-Analysis.

BACKGROUND: The increasing prevalence and subsequent mortality due to non-communicable diseases (NCDs) among Indian prisoners are often ignored by policymakers. This systematic review and meta-analysis aim to analyze the rising burden of Noncommunicable Diseases in Indian prisons and estimate the pooled prevalence of depression among Indian prisoners. METHODS: A total 9 studies were chosen in accordance with PRISMA guidelines that investigated the burden of NCDs in Indian prisons and were published between January 2010 and August 2022. Statistical analysis was performed in STATA Version 16 software, and the funnel plot was used to identify publication bias. RESULTS: A total of 167 articles were identified, and 9 were included in this analysis. The pooled prevalence of depression among prisoners was 48.78% (95% CI, 27.24-70.55%). According to the review, prisoners showed a significant prevalence of moderate to severe depression, dental caries, poor periodontal condition, and suicide ideation. This study is the first to analyze NCDs prevalence among Indian prisoners. Poor mental and dental health standards and the virtual absence of healthcare facilities necessitate governmental actions to boost inmates' health. It is essential to develop preventative interventions for this extremely isolated and vulnerable group in addition to diagnosing and treating noncommunicable diseases. CONCLUSIONS: Our study findings will enable decision-makers to structure and develop appropriate preventative and curative programs for inmates' general wellbeing.

Health-Seeking Behaviour for Childhood Ailments in Caregivers of Under-Five Children in an Urban Resettlement Colony in Delhi, India.

This explorative qualitative study assesses the health-seeking behaviour for childhood ailments in caregivers of under-five children in a low-income neighbourhood in Delhi, India during July-September 2021. A total of 17 caregivers (mothers) of eight male and nine female under-five children were enrolled, with the mother being the caregiver in most (94%) cases. Caregivers consulted on common childhood ailments from multiple sources, including family, neighbours, healthcare providers (both licensed and unlicensed), frontline workers, and local pharmacists. The internet was often used as a source of child health information due to its ease of access but often "confused" caregivers due to the presence of too much information. Health-seeking behaviour of caregivers for childhood ailments could range from self-medication, local pharmacist dispensing, and private and public healthcare providers. Factors that influenced preference for the healthcare facility or provider were accessibility issues (waiting time, queuing), perceived physician competence, and associated out-of-pocket expenses. Caregivers reported dissatisfaction with government health facilities because of shorter operational hours, overcrowding, suboptimal sanitation, queuing with limited seating arrangements, and occasionally discourteous health staff. Self-medication and over-the-counter use of antibiotics was high due to a lack of awareness of the challenges of antibiotic resistance or any perceived side effects. Preference for unlicensed practitioners for medical treatment was low and based on long-term familial beliefs and acceptance. However, traditional practitioners enjoyed a high level of trust in the community from shared cultural values, enjoining attenuation of the perceived non-biological agents of childhood illnesses through non-medical supernatural interventions.

Perceptions of Good Health and Impact of COVID-19 Among Adolescents in a Low-Income Urban Agglomerate in Delhi, India: A Qualitative Study.

Adolescents constitute 16% of the global population and are susceptible to adverse health and illness from substance abuse, unhealthy diet, physical inactivity, and high-risk sexual behaviors. We conducted this study to assess the perceptions of good health, health-seeking behavior, and health service utilization among adolescents living in a low-income urban neighborhood after the second wave of the COVID-19 pandemic. A total of 23 adolescents, including 12 males and 11 females, were interviewed. Adolescents' perceived body image and size considerations apart from functioning at an optimum physical capacity as the principal attributes of good health, which was possible through the intake of a healthy diet and exercise. Adolescents were likely to be aware of the addiction potential and risk of cancer from using tobacco and alcohol, but attitudes towards eschewing their use were ambivalent. Adolescents perceived themselves as lacking access to reliable, adequate, and validated sources of sexual and reproductive health information. Knowledge and utilization of adolescent health services in this area were negligible, suggestive of the need to strengthen these services and improve the program outreach.