Out-of-pocket payment and financial risk protection for breast cancer treatment: a prospective study from India.

Background: Available data on cost of cancer treatment, out-of-pocket payment and reimbursement are limited in India. We estimated the treatment costs, out-of-pocket payment, and reimbursement in a cohort of breast cancer patients who sought treatment at a publicly funded tertiary cancer care hospital in India. Methods: A prospective longitudinal study was conducted from June 2019 to March 2022 at Tata Memorial Centre (TMC), Mumbai. Data on expenditure during each visit of treatment was collected by a team of trained medical social workers. The primary outcome variables were total cost (TC) of treatment, out-of-pocket payment (OOP), and reimbursement. TC included cost incurred by breast cancer patients during treatment at TMC. OOP was defined as the total cost incurred at TMC less of reimbursement. Reimbursement was any form of financial assistance (cashless or repayment), including social health insurance, private health insurance, employee health schemes, and assistance from charitable trusts, received by the patients for breast cancer treatment. Findings: Of the 500 patients included in the study, 45 discontinued treatment (due to financial or other reasons) and 26 died during treatment. The mean TC of breast cancer treatment was ₹258,095/US$3531 (95% CI: 238,225, 277,934). Direct medical cost (MC) accounted for 56.3% of the TC. Systemic therapy costs (₹50,869/US$696) were higher than radiotherapy (₹33,483/US$458) and surgery costs (₹25,075/US$343). About 74.4% patients availed some form of financial assistance at TMC; 8% patients received full reimbursement. The mean OOP for breast cancer treatment was ₹186,461/US$2551 (95% CI: 167,666, 205,257), accounting for 72.2% of the TC. Social health insurance (SHI) had a reasonable coverage (33.1%), followed by charitable trusts (29.6%), employee health insurance (5.1%), private health insurance (4.4%) and 25.6% had no reimbursement. But SHI covered only 40.1% of the TC of treatment compared to private health insurance that covered as much as 57.1% of it. Both TC and OOP were higher for patients who were younger, belonged to rural areas, had a comorbidity, were diagnosed at an advanced stage, and were from outside Maharashtra. Interpretation: In India, the cost and OOP for breast cancer treatment are high and reimbursement for the treatment flows from multiple sources. Though many of the patients receive some form of reimbursement, it is insufficient to prevent high OOP. Hence both wider insurance coverage as well as higher cap of the insurance packages in the health insurance schemes is suggested. Allowing for the automatic inclusion of cancer treatment in SHI can mitigate the financial burden of cancer patients in India. Funding: This work was funded by an extramural grant from the Women's Cancer Initiative and the Nag Foundation and an intramural grant from the International Institute of Population Sciences, Mumbai.

Performance of wood waste biochar and food waste compost in a pilot-scale sustainable drainage system for stormwater treatment.

Sustainable drainage system (SuDS) for stormwater reclamation has the potential to alleviate the water scarcity and environmental pollution issues. Laboratory studies have demonstrated that the capacity of SuDS to treat stormwater can be improved by integrating biochar and compost in the filter media, whereas their performance in scaled-up applications is less reported. This study examines the effectiveness of a pilot-scale SuDS, bioswale followed by bioretention, amended with wood waste biochar (1, 2, and 4 wt.%) and food waste compost (2 and 4 wt.%) to simultaneously remove multiple pollutants including nutrients, heavy metals, and trace organics from the simulated stormwater. Our results confirmed that SuDS modified with both biochar (2 wt.%) and compost (2 wt.%) displayed superior water quality improvement. The system exhibited high removal efficiency (> 70%) for total phosphorus and major metal species including Ni, Pb, Cd, Cr, Cu, and Zn. Total suspended solids concentration was approaching the detection limit in the effluent, thereby confirming its capability to reduce turbidity and particle-associated pollutants from stormwater. Co-application of biochar and compost also moderately immobilized trace organic contaminants such as 2,4-dichlorophenoxyacetic acid, diuron, and atrazine at field-relevant concentrations. Moreover, the soil amendments amplified the activities of enzymes including ß-D-cellobiosidase and urease, suggesting that the improved soil conditions and health of microbial communities could possibly increase phyto and bioremediation of contaminants accumulated in the filter media. Overall, our pilot-scale demonstration confirmed that the co-application of biochar and compost in SuDS can provide a variety of benefits for soil/plant health and water quality.

Socioeconomic and geographic variations of disabilities in India: evidence from the National Family Health Survey, 2019-21.

BACKGROUND: Increasing disability is of global and national concern. Lack of evidence on disability across socioeconomic groups and geographic levels (especially small areas) impeded interventions for these disadvantaged subgroups. We aimed to examine the socioeconomic and geographic variations in disabilities, namely hearing, speech, visual, mental, and locomotor, in Indian participants using cross-sectional data from the National Family Health Survey 2019-2021. METHODS: Using data from 27,93,971 individuals, we estimated age-sex-adjusted disability rates at the national and sub-national levels. The extent of socioeconomic variations in disabilities was explored using the Erreygers Concentration Index and presented graphically through a concentration curve. We adopted a four-level random intercept logit model to compute the variance partitioning coefficient (VPC) to assess the significance of each geographical unit in total variability. We also calculated precision-weighted disability estimates of individuals across 707 districts and showed their correlation with within-district or between-cluster standard deviation. RESULTS: We estimated the prevalence of any disability of 10 per 1000 population. The locomotor disability was common, followed by mental, speech, hearing, and visual. The concentration index of each type of disability was highest in the poorest wealth quintile households and illiterate 18 + individuals, confirming higher socioeconomic variations in disability rates. Clusters share the largest source of geographic variation for any disability (6.5%), hearing (5.8%), visual (24.3%), and locomotor (17.4%). However, States/Union Territories (UTs) account for the highest variation in speech (3.7%) and mental (6.5%) disabilities, where the variation at the cluster level becomes negligible. Districts with the highest disability rates were clustered in Madhya Pradesh, Maharashtra, Karnataka, Tamil Nadu, Telangana, and Punjab. Further, we found positive correlations between the district rates and cluster standard deviations (SDs) for disabilities. CONCLUSIONS: Though the growing disability condition in India is itself a concerning issue, wide variations across socioeconomic groups and geographic locations indicate the implementation of several policy-relevant implications focusing on these vulnerable chunks of the population. Further, the critical importance of small-area variations within districts suggests the design of strategies targeting these high-burden areas of disabilities.

Socioeconomic variation in the prevalence of pain by anatomical sites among middle-aged and older adults in India: a cross-sectional study.

BACKGROUND: Pain is a significant global public health concern, particularly among individuals aged 45 and above. Its impact on the overall lifestyle of the individuals varies depending on the affected anatomical parts. Despite its widespread impact, there is limited awareness of the attributes of pain, making effective pain management challenging, particularly in India. This study aims to estimate the prevalence and variation in pain in different anatomical sites among middle-aged and older adults in India. METHODS: A cross-sectional design was employed, utilising data from the first wave of the Longitudinal Aging Study in India (LASI), 2017-2018. The age-sex adjusted prevalence of pain by anatomical sites (the back, joints, and ankles) was estimated using a multivariate logistic regression model. RESULTS: 47% of individuals aged 45 years and above reported joint pain, 31% reported back pain and 20% suffered from ankle or foot pain. The prevalence of pain at all the anatomical sites increased with age and was reported higher among females. Relative to respondents aged 45-59 years, those aged 75 years and older exhibited a 41% higher likelihood of experiencing back pain (AOR: 1.41, 95% CI: 1.19-1.67), a 67% higher likelihood of joint pain (AOR: 1.67, 95% CI: 1.49-1.89), and a 32% higher likelihood of ankle/foot pain (AOR: 1.32, 95% CI: 1.16-1.50). In comparison to males, females had a 56% higher likelihood of encountering back pain (AOR: 1.56, 95% CI: 1.40-1.74), a 38% higher likelihood of joint pain (AOR: 1.38, 95% CI: 1.27-1.50), and a 35% higher likelihood of ankle/foot pain (AOR: 1.35, 95% CI: 1.17-1.57). We also found significant regional variations in pain prevalence, with higher rates in the mountainous regions of India. CONCLUSION: This research highlights the high burden of pain in major anatomical sites among middle-aged and older adults in India and emphasises the need for increased awareness and effective pain management strategies.

Resilience of stormwater biofilters following the deposition of wildfire residues: Implication on downstream water quality management in wildfire-prone regions.

Stormwater treatment systems such as biofilters could intercept and remove pollutants from contaminated runoff in wildfire-affected areas, ensuring the protection of water quality downstream. However, the deposition of wildfire residues such as ash and black carbon onto biofilters could potentially impair their stormwater treatment functions. Yet, whether and how wildfire residue deposition could affect biofilter functions is unknown. This study examines the impact of wildfire residue deposition on biofilter infiltration and pollutant removal capacities. Exposure to wildfire residues decreased the infiltration capacity based on the amount of wildfire deposited. Wildfire residues accumulated at the top layer of the biofilter, forming a cake layer, but scraping this layer restored the infiltration capacity. While the deposition of wildfire residues slightly changed the pore water geochemistry, it did not significantly alter the removal of metals and E. coli. Although wildfire residues leached some metals into pore water within the simulated root zone, the leached metals were effectively removed by the compost present in the filter media. Collectively, these results indicate that biofilters downstream of wildfire-prone areas could remain resilient or functional and protect downstream water quality if deposited ash is periodically scraped to restore any loss of infiltration capacity following wildfire residue deposition.

PFAS release from the subsurface and capillary fringe during managed aquifer recharge.

Managed aquifer recharge (MAR) is a sustainable way of harvesting groundwater in water-stressed urbanized areas, where reclaimed wastewater or stormwater is applied on a large basin to infiltrate water into the groundwater aquifer naturally. This process could rapidly fluctuate the water table and move the capillary fringe boundary, and the change in flow dynamic and associated geochemical changes could trigger the release of sequestered pollutants, including per- and polyfluoroalkyl substances (PFAS), also known as 'forever chemicals', from the subsurface and capillary fringe. Yet, the potential of PFAS release from the subsurface and capillary zone during recharge events when the water table rapidly fluctuates has not been evaluated. This study uses laboratory column experiments to simulate PFAS release from pre-contaminated subsurface and capillary fringe during groundwater table fluctuation. The results reveal that the groundwater level fluctuations during MAR increased the release of perfluorobutanesulfonic acid (PFBS) and perfluorooctanesulfonic acid (PFOS) from the capillary fringe, but the fraction released depended on PFAS type and their association with soil colloids. A higher proportion of PFOS in column effluent was found to be associated with particles, while a greater portion of released PFBS was in a free or dissolved state. The direction of water table fluctuation did not affect the release of PFAS in this study. A lack of change in the concentration of bromide, a conservative tracer, during flow interruption, indicates that diffusion of PFAS through reconnected pores during water table rise had an insignificant effect on PFAS release. Overall, this study provides insights into how PFAS can be released from the subsurface and capillary fringe during managed aquifer recharge when the groundwater level is expected to fluctuate quickly.

Out of pocket expenditure and distress financing on cesarean delivery in India: evidence from NFHS-5.

BACKGROUND: Though over three-fourths of all births receive medical attention in India, the rate of cesarean delivery (22%) is twice higher than the WHO recommended level. Cesarean deliveries entail high costs and may lead to financial catastrophe for households. This paper examines the out-of-pocket expenditure (OOPE) and distress financing of cesarean deliveries in India. METHODS: We used data from the latest round of the National Family Health Survey conducted during 2019-21. The survey covered 636,699 households, and 724,115 women in the age group 15-49 years. We have used 159,643 births those delivered three years preceding the survey for whom the question on cost was canvassed. Descriptive analysis, bivariate analysis, concentration index (CI), and concentration curve (CC) were used in the analysis. RESULT: Cesarean deliveries in India was estimated at 14.08%, in private health centres and 9.96%  in public health centres. The prevalence of cesarean delivery increases with age, educational attainment, wealth quintile, BMI and high for those who had pregnancy complications, and previous birth as cesarean. The OOPE on cesarean births was US$133. It was US$498 in private health centres and US$99 in public health centres. The extent of distress financing of any cesarean delivery was 15.37%; 27% for those who delivered in private health centres compared to 16.61% for those who delivered in public health centres. The odds of financial distress arising due to OOPE on cesarean delivery increased with the increase of OOPE [AOR:10.00, 95% CI, 9.35-10.70]. Distress financing increased with birth order and was higher among those with low education and those who belonged to lower socioeconomic strata. CONCLUSION: High OOPE on a cesarean delivery leads to distress financing in India. Timely monitoring of pregnancy and providing comprehensive pregnancy care, improving the quality of primary health centres to conduct cesarean deliveries, and regulating private health centres may reduce the high OOPE and financial distress due to cesarean deliveries in India.

Do drinking water treatment residuals underperform in the presence of compost in stormwater media filters?

Drinking water treatment residuals (WTR), a waste-derived product, are often recommended to use as an amendment in stormwater biofilters to enhance their capacity to remove phosphate and microbial pollutants. However, their efficacy has been assumed to remain high in the presence of compost, one of the most common amendments used in biofilters. This study tests the validity of that assumption by comparing the removal capacities of WTR-amended biofilters with and without the presence of compost. Our results show that amending sand with WTR increased E. coli removal by at least 1-log, but the addition of compost in the sand-WTR media lowered the removal capacity by 13 %. Similarly, the addition of WTR to sand improved phosphate removal to nearly 1177 %, but the removal decreased slightly by 8 % when adding compost to the media. The results confirmed that dissolved organic carbon (DOC) leached from the compost could compete for adsorption sites for bacteria and phosphate, thereby lowering WTR's adsorption capacity based on the amount of DOC adsorbed on WTR. Collectively, these results indicate that the stormwater treatment industry should avoid mixing compost with WTR to get the maximum benefits of WTR for bacterial removal and improve the performance lifetime of WTR-amended biofilters.

Public health insurance coverage in India before and after PM-JAY: repeated cross-sectional analysis of nationally representative survey data.

INTRODUCTION: The provision of non-contributory public health insurance (NPHI) to marginalised populations is a critical step along the path to universal health coverage. We aimed to assess the extent to which Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY)-potentially, the world's largest NPHI programme-has succeeded in raising health insurance coverage of the poorest two-fifths of the population of India. METHODS: We used nationally representative data from the National Family Health Survey on 633 699 and 601 509 households in 2015-2016 (pre-PM-JAY) and 2019-2021 (mostly, post PM-JAY), respectively. We stratified by urban/rural and estimated NPHI coverage nationally, and by state, district and socioeconomic categories. We decomposed coverage variance between states, districts, and households and measured socioeconomic inequality in coverage. For Uttar Pradesh, we tested whether coverage increased most in districts where PM-JAY had been implemented before the second survey and whether coverage increased most for targeted poorer households in these districts. RESULTS: We estimated that NPHI coverage increased by 11.7 percentage points (pp) (95% CI 11.0% to 12.4%) and 8.0 pp (95% CI 7.3% to 8.7%) in rural and urban India, respectively. In rural areas, coverage increased most for targeted households and pro-rich inequality decreased. Geographical inequalities in coverage narrowed. Coverage did not increase more in states that implemented PM-JAY. In Uttar Pradesh, the coverage increase was larger by 3.4 pp (95% CI 0.9% to 6.0%) and 4.2 pp (95% CI 1.2% to 7.1%) in rural and urban areas, respectively, in districts exposed to PM-JAY and the increase was 3.5 pp (95% CI 0.9% to 6.1%) larger for targeted households in these districts. CONCLUSION: The introduction of PM-JAY coincided with increased public health insurance coverage and decreased inequality in coverage. But the gains cannot all be plausibly attributed to PM-JAY, and they are insufficient to reach the goal of universal coverage of the poor.

Electron donation of Fe-Mn biochar for chromium(VI) immobilization: Key roles of embedded zero-valent iron clusters within iron-manganese oxide.

The dense surface passivation layer on zero-valent iron (ZVI) restricts its efficiency for water decontamination, causing a poor economy and waste of resources. Herein, we found that the ZVI on Fe-Mn biochar could afford a high electron-donating efficiency for the Cr(VI) reduction and immobilization. Over 78.0% of Fe in the Fe-Mn biochar was used for the Cr(VI) reduction and immobilization, i.e., 56.2 - 161.7 times higher than the commercial ZVI (0.5%) and modified ZVI (0.9 -1.3%), indicating that the unique ZVI species in Fe-Mn biochar offered an outstanding Fe utilization efficiency. We proposed that oxygen atoms in the FeO in the FeMnO2 precursor were removed during pyrolysis with biochar while the MnO skeleton was preserved, forming the embedded ZVI clusters within Fe-Mn oxide. The unique structure inhibited the formation of the Fe-Cr complex on Fe(0), which would facilitate the electron transfer between core Fe(0) and Cr(VI). Moreover, the surface FeMnO2 inhibited the diffusion of Fe and facilitated its affinity with pollutants, thus supporting higher efficiency for pollutant immobilization. The preserved performance of Fe-Mn biochar was proved in industrial wastewater and after long-term oxidation process, and the economic benefit was evaluated. This work provides a new approach for developing active ZVI-based materials with high Fe utilization efficiency and economics for water pollution control.

Health-Related Quality of Life (HRQoL) Using EQ-5D-5L: Value Set Derived for Indian Breast Cancer Cohort.

OBJECTIVE: The purpose of this study was to report quality of life of newly diagnosed breast cancer patients from India in a large cohort using the EQ-5D-5L instrument. METHODS: The study used longitudinal data of 500 breast cancer and 200 non-cancer subjects registered at our centre, during June 2019 and March 2022. The EQ-5D-5L and EQ-VAS instruments were used to measure and compare utility scores among cancer and non-cancer subjects. Descriptive statistics were analyzed and Tobit regression model were used to confirm the predictors of the utility score. RESULTS: The cancer subjects had a mean EQ-ED-5L utility score of 0.8703 (SD=0.121), 0.8745 (SD=0.094) and 0.8902 (SD=0.107) at the time of baseline, completion and follow up surveys respectively.  EQ-5D-5L values had significantly worsened after diagnosis of cancer as compared to the non-cancer cohort (0.87 vs. 0.93, p value 0.000). EQ-5D-5L utility scores as per stage for the cancer cohort were 0.88, 0.86 and 0.83 respectively for stage I-II, III and IV. Similarly, the EQ-VAS scores for stage I-II, III and IV were 74.9, 72.6 and 73.2 respectively. Multivariate analysis confirmed strong association of age, religion and income with the utility-values. CONCLUSION: This is the first longitudinal study reporting the utility scores derived from a large cohort of breast cancer patients demonstrating lower utility scores compared to non-cancer cohort. The utility scores also improve post treatment completion for cancer patients and decrease with higher stage at diagnosis. This information will be useful for future health economic research in India pertaining to breast cancer.

Examining chronic disease onset across varying age groups of Indian adults using competing risk analysis.

In low-and-middle-income countries, people develop chronic diseases at a younger age, leading to health-and-economic loss. Estimates of the age of onset of chronic disease provide evidence for policy intervention, but in the Indian context, evidence is limited. The present study aims to explore the onset of seven chronic diseases across adults and the elderly, along with the prognostic factors of chronic disease onset. Using Wave 1 data of the Longitudinal Ageing Study in India (LASI), we estimated the statistical distributions, the median age at onset, and Loglogistic and Weibull accelerated failure time model to understand the onset of seven medically diagnosed self-reported chronic diseases across age groups. We also obtained the sub-distribution hazard ratio (SHR) from the Fine-Gray model to determine the risk of contracting selected chronic diseases in a competing risk setup. The seven chronic diseases- hypertension, diabetes, lung disease, heart disease/stroke, arthritis, neurological disease, and cancer- were developing early, especially in individuals aged 45-54 and 55-64. Arthritis risk was higher in rural areas, and physically active adults and elderly were 1.32 times (95% CI 1.12-1.56) more likely to develop heart disease/stroke. The emerging evidence of the early onset of neurological diseases in middle-aged adults (i.e., among the 45-54 age group) reminds us of the need to reinforce a balance between the physical and mental life of individuals. The early onset of chronic diseases in the independent and working-age category (45-54 years) can have many social and economic implications. For instance, it can create a greater healthcare burden when these individuals grow older with these diseases. Further, disease-specific interventions would be helpful in reducing future chronic disease burden.

Sociodemographic and geographic inequalities in diagnosis and treatment of older adults' chronic conditions in India: a nationally representative population-based study.

CONTEXT: Expeditious diagnosis and treatment of chronic conditions are critical to control the burden of non-communicable disease in low- and middle-income countries. We aimed to estimate sociodemographic and geographic inequalities in diagnosis and treatment of chronic conditions among adults aged 45 + in India. METHODS: We used 2017-18 nationally representative data to estimate prevalence of chronic conditions (hypertension, diabetes, lung disease, heart disease, stroke, arthritis, cholesterol, and neurological) reported as diagnosed and percentages of diagnosed conditions that were untreated by sociodemographic characteristics and state. We used concentration indices to measure socioeconomic inequalities in diagnosis and lack of treatment. Fully adjusted inequalities were estimated with multivariable probit and fractional regression models. FINDINGS: About 46.1% (95% CI: 44.9 to 47.3) of adults aged 45 + reported a diagnosis of at least one chronic condition and 27.5% (95% CI: 26.2 to 28.7) of the reported conditions were untreated. The percentage untreated was highest for neurological conditions (53.2%; 95% CI: 50.1 to 59.6) and lowest for diabetes (10.1%; 95% CI: 8.4 to 11.5). Age- and sex-adjusted prevalence of any diagnosed condition was highest in the richest quartile (55.3%; 95% CI: 53.3 to 57.3) and lowest in the poorest (37.7%: 95% CI: 36.1 to 39.3). Conditional on reported diagnosis, the percentage of conditions untreated was highest in the poorest quartile (34.4%: 95% CI: 32.3 to 36.5) and lowest in the richest (21.1%: 95% CI: 19.2 to 23.1). Concentration indices confirmed these patterns. Multivariable models showed that the percentage of untreated conditions was 6.0 points higher (95% CI: 3.3 to 8.6) in the poorest quartile than in the richest. Between state variations in the prevalence of diagnosed conditions and their treatment were large. CONCLUSIONS: Ensuring more equitable treatment of chronic conditions in India requires improved access for poorer, less educated, and rural older people who often remain untreated even once diagnosed.

Socio-economic variations of breast cancer treatment and discontinuation: a study from a public tertiary cancer hospital in Mumbai, India.

BACKGROUND: The study examined the socio-economic variation of breast cancer treatment and treatment discontinuation due to deaths and financial crisis. METHODS: We used primary data of 500 patients with breast cancer sought treatment at India's one of the largest cancer hospital in Mumbai, between June 2019 and March 2022. This study is registered on the Clinical Trial Registry of India (CTRI/2019/07/020142). Kaplan-Meier method and Cox-hazard regression model were used to calculate the probability of treatment discontinuation. RESULTS: Of the 500 patients, three-fifths were under 50 years, with the median age being 46 years. More than half of the patients were from outside of the state and had travelled an average distance of 1,044 kms to get treatment. The majority of the patients were poor with an average household income of INR15,551. A total of 71 (14%) patients out of 500 had discontinued their treatment. About 5.2% of the patients died and 4.8% of them discontinued treatment due to financial crisis. Over one-fourth of all deaths were reported among stage IV patients (25%). Patients who did not have any health insurance, never attended school, cancer stage IV had a higher percentage of treatment discontinuation due to financial crisis. Hazard of discontinuation was lower for patients with secondary (HR:0.48; 95% CI: 0.27-0.84) and higher secondary education (HR: 0.42; 95% CI: 0.19-0.92), patients from rural area (HR: 0.79; 95% CI: 0.42-1.50), treated under general or non-chargeable category (HR: 0.60; 95% CI:0.22-1.60) while it was higher for the stage IV patients (HR: 3.61; 95% CI: 1.58-8.29). CONCLUSION: Integrating breast cancer screening in maternal and child health programme can reduce delay in diagnosis and premature mortality. Provisioning of free treatment for poor patients may reduce discontinuation of treatment.

Socioeconomic inequality in awareness, treatment and control of diabetes among adults in India: Evidence from National Family Health Survey of India (NFHS), 2019-2021.

Diabetes is a growing epidemic and a major threat to most of the households in India. Yet, there is little evidence on the extent of awareness, treatment, and control (ATC) among adults in the country. In this study, we estimate the prevalence and ATC of diabetes among adults across various sociodemographic groups and states of India. We used data on 2,078,315 individuals aged 15 years and over from the recent fifth round, the most recent one, of the National Family Health Survey (NFHS-5), 2019-2021, that was carried out across all the states of India. Diabetic individuals were identified as those who had random blood glucose above 140 mg/dL or were taking diabetes medication or has doctor-diagnosed diabetes. Diabetic individuals who reported diagnosis were labelled as aware, those who reported taking medication for controlling blood glucose levels were labelled as treated and those whose blood glucose levels were < 140 mg/dL were labelled as controlled. The estimates of prevalence of diabetes, and ATC were age-sex adjusted and disaggregated by household wealth quintile, education, age, sex, urban-rural residence, caste, religion, marital status, household size, and state. Concentration index was used to quantify socioeconomic inequalities and multivariable logistic regression was used to estimate the adjusted differences in those outcomes. We estimated diabetes prevalence to be 16.1% (15.9-16.1%). Among those with diabetes, 27.5% (27.1-27.9%) were aware, 21.5% (21.1-21.7%) were taking treatment and 7% (6.8-7.1%) had their diabetes under control. Across the states of India, the adjusted rates of awareness varied from 14.4% (12.1-16.8%) to 54.4% (40.3-68.4%), of treatment from 9.3% (7.5-11.1%) to 41.2% (39.9-42.6%), and of control from 2.7% (1.6-3.7%) to 11.9% (9.7-14.0%). The age-sex adjusted rates were lower (p < 0.001) among the poorer and less educated individuals as well as among males, residents of rural areas, and those from the socially backward groups Among individuals with diabetes, the richest fifth were respectively 12.4 percentage points (pp) (11.3-13.4; p < 0.001), 10.5 pp (9.7-11.4; p < 0.001), and 2.3 pp (1.6-3.0; p < 0.001) more likely to be aware, getting treated, and having diabetes under control, than the poorest fifth. The concentration indices of ATC were 0.089 (0.085-0.092), 0.083 (0.079-0.085) and 0.017 (0.015-0.018) respectively. Overall, the ATC of diabetes is low in India. It is especially low the poorer and the less educated individuals. Targeted interventions and management can reduce the diabetes burden in India.

Prevalence of pain and its treatment among older adults in India: a nationally representative population-based study.

ABSTRACT: There were no estimates of the prevalence of pain and its treatment in the older population of India obtained from face-to-face interviews with a nationally representative sample. We addressed this evidence gap by using data on 63,931 individuals aged 45 years and older from the 2017/2018 Longitudinal Ageing Study in India. We identified pain from an affirmative response to the question: Are you often troubled by pain? We also identified those who reported pain that limited usual activities and who received treatment for pain. We estimated age- and sex-adjusted prevalence of pain, pain limiting usual activity and treatment, and compared these estimates across states and sociodemographic groups. We used a multivariable probit model to estimate full adjusted differences in the probability of each outcome across states and sociodemographic groups. We estimated that 36.6% (95% confidence interval [CI]: 35.3-37.8) of older adults in India were often troubled by pain and 25.2% (95% CI: 24.2-26.1) experienced pain limiting usual activity. We estimated that 73.3% (95% CI: 71.9-74.6) of those often troubled by pain and 76.4% (95% CI: 74.9-78.0) of those with pain that limited usual activity received treatment. There was large variation in each outcome across states. Fully adjusted prevalence of pain and pain limiting usual activity were higher among individuals who were female, older, less educated, rural residents, and poorer. Prevalence of treatment among those troubled by pain was lower among socially disadvantaged groups.

A review of compaction effect on subsurface processes in soil: Implications on stormwater treatment in roadside compacted soil.

Sustainable cities require spacious infrastructures such as roadways to serve multiple functions, including transportation and water treatment. This can be achieved by installing stormwater control measures (SCM) such as biofilters and swales on the roadside compacted soil, but compacted soil limits infiltration and other functions of SCM. Understanding the effect of compaction on subsurface processes could help design SCM that could alleviate the negative impacts of compaction. Therefore, we synthesize reported data on compaction effects on subsurface processes, including infiltration rate, plant health, root microbiome, and biochemical processes. The results show that compaction could reduce runoff infiltration rate, but adding sand to roadside soil could alleviate the negative impact of compaction. Compaction could decrease the oxygen diffusion rate in the root zone, thereby affecting plant root activities, vegetation establishment, and microbial functions in SCM. The impacts of compaction on carbon mineralization rate and root biomass vary widely based on soil type, aeration status, plant species, and inherent soil compaction level. As these processes are critical in maintaining the long-term functions of SCM, the analysis would help develop strategies to alleviate the negative impacts of compaction and turn road infrastructure into a water solution in sustainable cities.

Wildfire impacts on surface water quality parameters: Cause of data variability and reporting needs.

Surface runoff mobilizes the burned residues and ashes produced during wildfires and deposits them in surface waters, thereby deteriorating water quality. A lack of a consistent reporting protocol precludes a quantitative understanding of how and to what extent wildfire may affect the water quality of surface waters. This study aims to analyze reported pre- and post-fire water quality data to inform the data reporting and highlight research opportunities. A comparison of the pre-and post-fire water quality data from 44 studies reveals that wildfire could increase the concentration of many pollutants by two orders of magnitude. However, the concentration increase is sensitive to when the sample was taken after the wildfire, the wildfire burned area, discharge rate in the surface water bodies where samples were collected, and pollutant type. Increases in burned areas disproportionally increased total suspended solids (TSS) concentration, indicating TSS concentration is dependent on the source area. Increases in surface water flow up to 10 m3 s-1 increased TSS concentration but any further increase in flow rate decreased TSS concentration, potentially due to dilution. Nutrients and suspended solids concentrations increase within a year after the wildfire, whereas peaks for heavy metals occur after 1-2 years of wildfire, indicating a delay in the leaching of heavy metals compared to nutrients from wildfire-affected areas. The concentration of polycyclic aromatic hydrocarbons (PAHs) was greatest within a year post-fire but did not exceed the surface water quality limits. The analysis also revealed inconsistency in the existing sampling protocols and provides a guideline for a modified protocol along with highlighting new research opportunities. Overall, this study underlines the need for consistent reporting of post-fire water quality data along with environmental factors that could affect the data so that the post-fire water quality can be assessed or compared between studies.

Children's playgrounds contain more microplastics than other areas in urban parks.

Children spend many hours in urban parks and playgrounds, where the tree canopy could filter microplastics released from the surrounding urban hotspots. However, the majority of children's playgrounds also contain plastic structures that could potentially release microplastics. To assess if the children's playgrounds pose a higher exposure risk than other places inside the park, we evaluate the extent of microplastic contamination in the sand, soil, and leaf samples from 19 playgrounds inside urban parks in Los Angeles, CA, USA. The average microplastic concentration in sand samples collected inside the playground was 72 p g-1, and >50 % of identified plastics were either polyethylene or polypropylene. Microplastic concentrations inside the playgrounds were on average >5 times greater than concentrations outside the playgrounds in the park, indicating that children playing within the playground may be exposed to more microplastics than children playing outside the playground in the same park. By comparing the microplastic composition found inside and outside the playgrounds with the plastic composition of the plastic structures in the playground, we show that plastic structures and other products used inside the playgrounds could contribute to elevated microplastic concentration. The population density was slightly correlated with a microplastic concentration in the park soil but did not correlate with microplastic concentration inside the playgrounds. Therefore, playgrounds in urban parks may have microplastic exposure risks via inhalation or ingestion via hand-to-mouth transfer.