Bridging, Mapping, and Addressing Research Gaps in Health Sciences: The Naqvi-Gabr Research Gap Framework.

Innovations pertaining to the ever-evolving needs of the medical and healthcare sciences remain constant. This creates a gap between the rationalized needs of the study and the proposed research question. However, classifying, identifying, and addressing these research gaps require a systematic and precise structured map. Using the Medical Subject Heading (MeSH) terms "Research Gaps" AND "Healthcare" AND "Framework" in MEDLINE, Scopus, and CINAHL databases with the filters yielded no relevant literature. Therefore, this review aims to fill this practical and clinical knowledge gap by developing the Naqvi-Gabr Research Gap Framework through critical synthesis based on extensive research on medical and healthcare research gaps. Fourteen research gaps are distributed for allocation as per the healthcare delivery system approach: developing new treatments or prevention strategies, improving diagnostic tools and techniques, addressing health disparities, and improving access to healthcare services. This structured framework determines the strategic mapping of research gaps corresponding to the nature of the research. The identification and classification of the appropriate research gap led to precise and concise conclusions corresponding to the research process proposed in this study. Hence, the Naqvi-Gabr Research Gap Framework is a valuable tool for determining the potential application of gaps by researchers, policymakers, and other stakeholders with a productive address.

Determinants of Quit Attempts and Short-Term Abstinence among Smokeless Tobacco Users in India: Global Adult Tobacco Survey, 2016-17.

OBJECTIVE: Smokeless tobacco is the preponderant form of tobacco in India. The cessation indicators are weaker for smokeless tobacco users than smokers. There is a dearth of literature on the effectiveness of the interventions that motivate and assist smokeless tobacco users in quitting in program settings. METHODS: Data from Global Adult Tobacco Surveys (GATS), 2016-17, was analysed. Quit attempts in the previous 12 months among SLT users and duration of abstinence were the two outcome variables. The chief exposure variables were the receipts of various interventions that warned about the dangers of smokeless tobacco or encouraged quitting. Logistic regression analyses were employed to identify determinants of quit attempts. For the hazard of relapse to tobacco use, survival analysis was used. RESULTS: The odds of quit attempts among SLT users in the previous 12 months were more among those who received advice from healthcare providers (OR 2.09; 1.87-2.34), noticed messages from media that made them think about quitting (OR 1.67; 1.50-1.86) and noticed a warning label that made them think about quitting (OR 1.39; 1.25-1.55). Those who used counselling (HR 0.81; 0.70-0.93) or medication (HR 0.79; 0.66-0.95) sustained abstinence from smokeless tobacco for a longer duration compared to those who did not use any cessation method. CONCLUSION: Quit advice by healthcare providers is an influential determinant of a quit attempt, and this intervention needs to be scaled up. The media messages and warning labels were effective among those who considered quitting after noticing them. Cessation methods can help prolong the abstinence from smokeless tobacco, but the reach of cessation methods is limited.

Converging Epidemics: A Narrative Review of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) Coinfection.

Tuberculosis (TB), primarily caused by Mycobacterium tuberculosis (MTB), remains a leading cause of mortality in individuals living with human immunodeficiency virus (HIV) infection, posing a significant strain on healthcare systems. Coinfection of HIV and TB results in a mutually advantageous relationship that accelerates the progression of both diseases. TB is a major contributor to mortality in individuals with HIV. However, diagnosing coinfected individuals is challenging due to the prevalence of extrapulmonary TB and smear-negative disease. Over the past decade, significant progress has been made in the fight against TB, thanks to advances in molecular techniques. Yet, these molecular diagnostic assays remain inaccessible to many individuals coinfected with HIV and TB due to their high cost. To expedite treatment and reduce transmission, it is crucial to integrate HIV and TB control programs more closely, thereby minimizing diagnostic delays and enhancing early case detection. This review aims to provide a comprehensive overview of the current state of knowledge regarding the interplay between HIV and TB. It highlights recent developments in sensitive and rapid TB diagnostic tests, cutting-edge preventive strategies, and the screening of individuals coinfected with both HIV and TB. The objectives of this review are to shed light on the complex relationship between these two diseases and to emphasize the importance of integrated efforts in combating their impact on public health.

Determinants of Quit Attempts and Short-Term Abstinence among Smokers in India: Global Adult Tobacco Survey, 2016-17.

OBJECTIVE: The objective was to study the determinants of quit attempts and abstinence among smokers in India using nationally representative data from the Global Adult Tobacco Survey (GATS-2). METHODS: Data from GATS-India, (2016-17) was analysed. Key outcome variables included quitting attempts in the previous 12 months among smokers and duration of abstinence among those who attempted quitting. The receipt of messages through mass media, warning labels and quit advice by doctors or healthcare providers were key exposure variables for both outcomes. The use of cessation methods was an exposure variable for abstinence. Logistic regression analyses were employed to identify determinants of quit attempt and survival analysis for the duration of abstinence. RESULT: The adjusted analyses showed that those who received quit advice from doctors or healthcare providers had higher odds (2.11; CI 1.88-2.37) of quit attempts. Exposure to anti-smoking messages through media and warning labels was associated with higher quit attempt odds of 1.53 (1.33-1.77) and 1.63 (1.38-1.92), respectively, when the anti-smoking messages made the smokers think about quitting. The use of counselling as a cessation method had a lower risk (Hazard Ratio 0.80; 0.69-0.93) of relapse compared to the non-use of cessation aids. The use of counselling and modern pharmacotherapy also had a lower risk of relapse (Hazard Ratio 0.77; 0.59-0.99). However, only 6.0% had used counselling, and another 2.0% had used a combination of modern pharmacotherapy and counselling as cessation aids. Addiction to tobacco and higher consumption of smoked sticks were negatively associated with both outcomes. CONCLUSION: Quit advice by healthcare providers is associated with a higher likelihood of quit attempts. Counselling can help increase the period of abstinence in pragmatic settings, and there is a need to improve the access of smokers to counselling services.

Rapid-cycle evaluation and learning for the effective delivery of integrated interventions in early childhood in rural India.

Background: Effective and real-time data analytics plays an essential role in understanding gaps and improving the quality and coverage of complex public health interventions. Studies of public health information systems identify problems with data quality, such as incomplete records and untimely reporting. Effective data collection and real-time analysis systems for rapid-cycle learning are necessary to monitor public health programs and take timely evidence-based decisions. Early childhood development (ECD) programs are very diverse. Rapid-cycle evaluation and learning (REAL) guides the implementation process of such complex interventions in real time. Stepping stones was one such early childhood development program implemented in Central India. Objective: The objective was to improve the delivery of complex, integrated public health interventions for early childhood development in remote areas of rural India. Methodology: The program was developed according to the principles of inclusion and community-centeredness, which can be tested quickly and iteratively. To enhance the decision-making process and improve delivery and coverage, the core team implemented an information system for rapid-cycle learning. We developed performance indicators and a performance measurement matrix after defining the specific needs. Following that, we trained staff to collect complete data using electronic data collection tools and transfer it the same day to the server for quality review and further analysis. A variety of data/information was triangulated to address the gaps in intervention delivery, and those decisions were subsequently implemented. Results: We observed that the quality of data collection improved, and errors were reduced by 50% in the third quarter. The quality of the narrative was also enhanced; it became more elaborate and reflective. Sharing their field output in meetings and improving the quality of the narrative enhanced the self-reflection skills of field staff and consequently improved the quality of the intervention delivery. Refresher training and mentoring by supervisors helped to improve the data quality over time. Conclusion: Rapid-cycle evaluation and learning (REAL) can be implemented in resource-limited settings to improve the quality and coverage of integrated intervention in early childhood. It nurtures a reinforcing ecosystem that integrates providers, community, and family perspectives and guides interactions among stakeholders by integrating data from all available sources.

Interventions for promoting and optimizing breastfeeding practices: An overview of systematic review.

Background: Optimal breastfeeding (BF) practices are essential for child survival and proper growth and development. The purpose of this overview is to evaluate the effectiveness of different interventions for promoting and optimizing breastfeeding. Methods: We included systematic reviews (SRs) [including trials from Low-Income (LICs) and Low Middle-Income countries (LMICs)] that have evaluated the effect of various interventions for promoting and optimizing breastfeeding and excluded non-systematic reviews, and SRs based on observational studies. We searched various electronic databases. We followed the standard methodology as suggested by the Cochrane Handbook for Systematic Reviews of Interventions. Two sets of reviewers undertook screening followed by data extraction and assessment of the methodological quality of included SRs. Result: We identified and screened 1,002 Cochrane SRs and included six SRs in this overview. Included SRs reported only two of the primary outcomes, early initiation of breastfeeding (EIBF) and/or exclusive breastfeeding (EBF). None of the included SR reported continued BF up to 2 years of age. The results were evaluated using two major comparisons groups: BF intervention against routine care and one type of BF intervention vs. other types of BF intervention. Overall results from included SRs showed that there were improvements in the rates of EIBF and EBF among women who received BF intervention such as BF education sessions and support compared to those women who received only standard care. However, BF intervention via mobile devices showed no improvements. In Target Client Communication (TCC) via mobile devices intervention group, no significant improvements were reported in BF practices, and also the reported evidence was of very low certainty. Conclusion: Community Based Intervention Packages (CBIP) delivered to pregnant and reproductive-age women during their Antenatal care (ANC) and/or Postnatal care (PNC) periods by Ancillary Nurse-Midwives reported the highest improvement in EIBF compared to women who received standard care. However, insufficient evidence was reported to suggest that BF intervention showed improvements in EBF in both the comparison groups. This overview highlighted the gaps in primary research regarding the uncertainty about the settings such as LICs or LMICs, lack of evidence from LMICs, and also identified gaps in the availability of reliable up-to-date SRs on the effects of several BF interventions to promote and optimize practices. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020174998, PROSPERO [CRD42020174998].

Study of anaemia in pregnancy and low birth weight in fluoride endemic area of Western Rajasthan: a cohort study.

Background: Fluoride is a noxious element known to destroy gastrointestinal mucosa, leading to erythrocytes' destruction and causing anaemia. The birth weight of newborn babies is a significant indicator of a child's vulnerability to the risk of childhood diseases and chances of existence. Methods: This prospective cohort study was planned to find linkages between fluorosis and the low-birth weight of newborn babies with anaemic mothers. Antenatal mothers until the 20th week of gestation were followed up till delivery in the Antenatal Clinic of a District Hospital in one of the known fluoride-endemic districts (Nagaur) and the other not-so-endemic district (Jodhpur) of Western Rajasthan. Results: Around 19% of the newborn in Jodhpur and around 22% in Nagaur had low birth weight. Mean fluoride values in water samples were measured to be 0.57 (range from 0.0 to 2.7 PPM) in Jodhpur and 0.7 (range from 0.0 to 3.4 PPM) in Nagaur. Conclusions: Thus, in fluoride endemic areas, other factors should be included besides iron and folic acid supplementation for improving anaemia in pregnant women. This calls for assessing the effectiveness of de-fluoridation activities along with the area's most common indigenous food practices.

Digital Dilemmas: A Comprehensive Review of the Psychosocial and Sleep Effects of Web Streaming on the Indian Youth.

The rapid growth of web streaming platforms in India has ushered in a transformative era in entertainment consumption, particularly among the youth. This comprehensive review explores the psychosocial and sleep effects of web streaming on the younger generation. Examining the impact on social interactions, mental health, academic performance, cultural identity, and sleep patterns, the study delves into the intricate dynamics shaping the lives of Indian youth in the digital age. Key findings reveal the subtle yet significant changes in face-to-face interactions, the emergence of virtual relationships, and the potential influence on stress, anxiety, and depression due to addictive binge-watching behaviours. Moreover, the review highlights the challenges to academic performance through disruptions in study habits and increased screen time. Cultural and identity influences, both in terms of representation and misrepresentation, are explored, emphasizing the need to analyze the portrayal of Indian culture in web content critically. The sleep effects of web streaming, including sleep deprivation due to late-night binge-watching and the consequences of blue light exposure on melatonin production, add a crucial dimension to the discussion. Technological solutions such as screen time limitations, parental controls, and educational programs promoting media literacy and responsible digital consumption emerge as potential coping mechanisms. In conclusion, the study provides a nuanced understanding of the complexities surrounding web streaming and its impact on the youth in India. The implications for policy and practice underscore the importance of a balanced approach to digital consumption. At the same time, a call to action emphasizes the need for collaborative efforts in promoting responsible digital habits among the youth.

Dietary Determinants of Renal Calculi: A Case-Control Study From a Tertiary Care Hospital of Western Rajasthan.

Introduction Nephrolithiasis affects all countries of the world with an approximate global lifetime prevalence of 15-20%. In India, 12% of the total population is anticipated to have renal stone disease. This study was aimed at providing a relationship between various dietary factors in the formation of renal stones. Methods A case-control study was conducted among 207 patients (106 cases and 101 controls) attending the outpatient and inpatient departments of a tertiary care hospital in Jodhpur, Rajasthan. All the participants with confirmed renal stones by means of ultrasound and radiographic evaluation, aged 15-65 years were included as cases and were matched on age and gender with controls. Pearson chi-square test followed by binary logistic regression was used to assess significant associations. Results Out of all participants, 71.0% were males and 65.7% were from the age group 41-65 years. The study showed a statistically significant association between renal stones and high salt intake, reduced water intake, less consumption of milk and milk products, daily intake of tea, consumption of oxalate-rich foods and consumption of junk foods. Conclusion Dietary factors play an important role in the risk of the development of renal stones. Simple dietary modifications may significantly reduce the chances of the development of nephrolithiasis, especially in the vulnerable population.

Competence-Based Assessment of Biomedical Equipment Management and Maintenance System (e-Upkaran) Using Benefit Evaluation Framework.

Introduction To establish a centralized inventory management system for the efficient functioning of all healthcare facilities, e-Upkaran (equipment management and maintenance system) was launched in 2015 in the state of Rajasthan. This study is conducted to assess the functioning of e-Upkaran in Rajasthan. Methods The assessment of the e-Upkaran system for primary and secondary healthcare centers was carried out using a systematic review of the literature and a multi-indicator stakeholder questionnaire. The benefits evaluation framework focused on the system quality, information and service quality, use and user satisfaction, and net benefits utilized for the assessment. A review of the literature was done to highlight the importance of computerized medical equipment management and maintenance systems and appraise the challenges and benefits associated with such systems as compared to the traditional pen-paper register. Information was gathered based on available documents, field observation, and data obtained from specific hospital staff, including the bioengineers and other users of e-Upkaran. Results The finding of this study suggests that e-Upkaran efficiently improves documentation, reporting, maintenance, and management of medical equipment. It is more efficient than the traditional paper-pen system. It is designed to minimize downtime and maintain equipment in good operating condition and has potential benefits in terms of improving information quality, use, and net benefit. The cost of service ratio is within the benchmark value. This system has also considerably reduced out-of-pocket expenditure. Computer proficiency and the workload of other e-health programs pose a challenge in the implementation of this program. Conclusion The e-Upkaran system is competent in terms of improving information quality, use, and net benefit. Other Indian states could also adopt this system to improve their biomedical equipment management and maintenance system.

Role of Art Therapy in the Promotion of Mental Health: A Critical Review.

Art therapy is used most commonly to treat mental illnesses and can aid in controlling manifestations correlated with psychosocially challenging behaviours, slowing cognitive decline, and enhancing the quality of life. Art therapy can help people express themselves more freely, improve their mental health, and improve interpersonal relationships. The basis of art therapy is established on the idea that people can recover and feel better via artistic expression. This review examines the current research on how active participation in the arts might improve mental health. A detailed literature search was carried out utilizing essential databases such as PubMed, the WHO's mental health database, and Google and Google Scholar. This review study looks into research done on art therapy and its potential advantages for adult mental health rehabilitation. It focuses on visual art therapy since it's a key to reducing variation within the "creative arts" and defines the peculiar elements and effectiveness of art therapy used by mental health services. It was found that the use of art therapy as an adjunct treatment showed improved mental health in patients.

'Digital Wellbeing': The Need of the Hour in Today's Digitalized and Technology Driven World!

The constant contact and usage of technology in today's world have brought about the dire consequences of digital addiction and its effects. This has led to a serious dilemma of management of screentime by an individual. Studies have shown a negative impact of excessive gadget use leading to a decline in performance rates, effect on sleep patterns, and reduction in workplace achievements thereby causing hindrance in unlocking the maximum potential of an individual. This has paved the way for the introduction of a novel concept known as 'Digital well-being' for tackling this underlying issue to bring about screen time reduction as well as to establish an ideal work-life balance. Digital well-being enhances the usage of technology itself to combat increased screen time by using restraints and promotes wellness by enabling productive and healthy lifestyles. In a new era where smartphones and technology have begun to dictate our lives, it is necessary to apply restraints and ensure there is a balance of wellness as well as productivity outflow. Digital well-being can be achieved by interventions that should be administered with the use of apps and healthy practices. The use of new-age apps acts as positive reinforcement and helps in providing a restrictive environment as well as maintains the time invested for useful and productive engagements. There is a lot of research yet to be done regarding this topic empirically regarding its success and this review article aims to approach the effectiveness of digital wellbeing and its applications in combating stress and increasing work performance and preventing digital addiction.

Ghrelin for the management of cachexia associated with cancer.

BACKGROUND: Cancer sufferers are amongst the most malnourished of all the patient groups. Studies have shown that ghrelin, a gut hormone can be a potential therapeutic agent for cachexia (wasting syndrome) associated with cancer. A variety of mechanisms of action of ghrelin in people with cancer cachexia have been proposed. However, safety and efficacy of ghrelin for cancer-associated cachexia have not been systematically reviewed. The aim of this review was to assess whether ghrelin is associated with better food intake, body composition and survival than other options for adults with cancer cachexia. OBJECTIVES: To assess the efficacy and safety of ghrelin in improving food intake, body composition and survival in people with cachexia associated with cancer. SEARCH METHODS: We searched CENTRAL, MEDLINE and Embase without language restrictions up to July 2017. We also searched for ongoing studies in trials registers, performed handsearching, checked bibliographic references of relevant articles and contacted authors and experts in the field to seek potentially relevant research. We applied no restrictions on language, date, or publication status. SELECTION CRITERIA: We included randomised controlled (parallel-group or cross-over) trials comparing ghrelin (any formulation or route of administration) with placebo or an active comparator in adults (aged 18 years and over) who met any of the international criteria for cancer cachexia. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for eligibility. Two review authors then extracted data and assessed the risk of bias for individual studies using standard Cochrane methodology. For dichotomous variables, we planned to calculate risk ratio with 95% confidence intervals (CI) and for continuous data, we planned to calculate mean differences (MD) with 95% CI. We assessed the evidence using GRADE and created 'Summary of findings' tables. MAIN RESULTS: We screened 926 individual references and identified three studies that satisfied the inclusion criteria. Fifty-nine participants (37 men and 22 women) aged between 54 and 78 years were randomised initially, 47 participants completed the treatment. One study had a parallel design and two had a cross-over design. The studies included people with a variety of cancers and also differed in the dosage, route of administration, frequency and duration of treatment.One trial, which compared ghrelin with placebo, found that ghrelin improved food intake (very low-quality evidence) and had no adverse events (very low-quality evidence). Due to unavailability of data we were unable to report on comparisons for ghrelin versus no treatment or alternative experimental treatment modalities, or ghrelin in combination with other treatments or ghrelin analogues/ghrelin mimetics/ghrelin potentiators. Two studies compared a higher dose of ghrelin with a lower dose of ghrelin, however due to differences in study designs and great diversity in the treatment provided we did not pool the results. In both trials, food intake did not differ between participants on higher-dose and lower-dose ghrelin. None of the included studies assessed data on body weight. One study reported higher adverse events with a higher dose as compared to a lower dose of ghrelin.All studies were at high risk of attrition bias and bias for size of the study. Risk of bias in other domains was unclear or low.We rated the overall quality of the evidence for primary outcomes (food intake, body weight, adverse events) as very low. We downgraded the quality of the evidence due to lack of data, high or unclear risk of bias of the studies and small study size. AUTHORS' CONCLUSIONS: There is insufficient evidence to be able to support or refute the use of ghrelin in people with cancer cachexia. Adequately powered randomised controlled trials focusing on evaluation of safety and efficacy of ghrelin in people with cancer cachexia is warranted.

Policy content and stakeholder network analysis for infant and young child feeding in India.

BACKGROUND: Over the last decade, infant and young child feeding (IYCF) indicators in India have improved. However, poor IYCF practices are still apparent, associated with pervasive high rates of child under-nutrition. Interventions to improve IYCF need augmentation by appropriate policy support to consolidate gains. The aim of this study was to identify opportunities to strengthen and support IYCF policies through a policy content and stakeholder network analysis. METHODS: IYCF policies and guidelines were systematically mapped and coded using predetermined themes. Six 'net-map' group interviews were conducted for stakeholder analysis with data analyzed using ORA (organizational risk analyzer, copyright Carley, Carnegie Mellon University) software. The study was carried out at a national level and in the states of Maharashtra and unified Andhra Pradesh. RESULTS: Thirty relevant policy documents were identified. Support for IYCF was clearly apparent and was actioned within sectoral policies and strategic plans. We identified support for provision of information to mothers and caregivers in both sectoral and high-level/strategic policy documents. At a sectoral level, there was support for training health care workers and for enabling mothers to access IYCF. Opportunities to strengthen policy included expanding coverage and translating policy goals into implementation level documents. At the national level, Ministry of Women and Child Development [MoWCD], Ministry of Health and Family Welfare [MoHFW] and the Prime Minister's Nutrition Council [PMNC] were the most influential actors in providing technical support while MoHFW, MoWCD, and Bill Melinda Gates Foundation were the most influential actors in providing funding and were therefore influential stakeholders in shaping IYCF policies and programs. CONCLUSION: We identified a wide range of strengths in the IYCF policy environment in India and also opportunities for improvement. One key strength is the integration of IYCF policies into a range of agendas and guidelines related to health and child development service delivery at the national and state level. However, the lack of a specific national policy on IYCF means that there is no formal mechanism for review and monitoring implementation across sectors and jurisdictions. Another opportunity identified is the development of IYCF policy guidelines in emergencies and for tribal populations.

Resource utilization in the management of traumatic brain injury patients in a critical care unit: An audit from rural setup of a developing country.

INTRODUCTION: Traumatic brain injuries (TBI) are steadily increasing and are a major cause of mortality and morbidity, particularly in the young population, leading to the loss of life and productivity in the developing countries. Providing critical care to these patients with TBI is a challenge even in well-advanced centers in major cities of India. In the present study, we describe our experience of resource utilization in the management of TBI in a critical care unit (CCU) from a rural setup. MATERIALS AND METHODS: All consecutive patients who were admitted from January 2007 to December 2009 in the CCU for the management of traumatic brain injury were included in the study. The case records of the patients were reviewed retrospectively, and data were collected on age, gender, severity of head injury, associated injuries, total CCU stay, total hospital stay, and outcome. RESULTS: The total duration (days) of hospital stay was 8.96±6.16 days and a median of 8 days, and CCU stay was 3.77±6.34 days with a median of 2 days. No deaths occurred with mild head injury. A total of 73 (19.16%) deaths occurred in 381 admitted subjects in CCU. The risk of death among both the sexes is not significantly different, that is, odds ratio (OR) 1.032 [95% confidence interval (CI) 0.351-3.03], so also the risk of death among the different age groups is also not significant having OR, 0.978 (95% CI, 0.954-1.00). The severity of head injury (mild, moderate, and severe) and CCU stay parameters had significant difference with risk of death [OR, 3.22 (95% CI, 2.49-4.16) and OR, 2.50 (95% CI, 1.9-3.2)]. CONCLUSIONS: Apparently it seems possible to use the existing health care structures in rural areas to improve trauma care. It becomes particularly relevant in poor resource, developing countries, where health care facilities and access to specialized care units are still far below the acceptable standard, there is a need to compare with the reference group to further support the evidence.