BACKGROUND Globally,obesity and diabetes mellitus(DM)are emergent public health concerns in the adolescent population.India,home to the largest adolescent population and the second largest diabetes cohort is experienc...BACKGROUND Globally,obesity and diabetes mellitus(DM)are emergent public health concerns in the adolescent population.India,home to the largest adolescent population and the second largest diabetes cohort is experiencing rapid but unplanned urbanization,with accompanying unhealthy nutritional transition,and sedentary lifestyle.AIM To determine prevalence and determinants of obesity and hyperglycaemia and their association among community-dwelling older adolescents(15-19 years)in India.METHODS This cross-sectional analysis from the national family health survey-5 included data of 258028 adolescents aged 15-19 across India(2019-2021).The survey employed stratified two-stage sampling,with systematic random sampling in rural and urban areas.Statistical analysis included descriptive statistics,bivariate,and multivariable logistic regression,employing generalized linear models.RESULTS The weighted prevalence of DM was 1.09%including 0.77%[95%confidence interval(CI):0.72-0.83]previously diagnosed and 0.32%(95%CI:0.29-0.35)newly diagnosed cases detected on survey screening.On adjusted analysis,increasing age,higher education levels,higher wealth index,and overweight/obesity were the factors significantly associated with presence of DM.Only 61%of the adolescents with previously diagnosed DM were on anti-diabetes treatment.The weighted prevalence of overweight/obesity among older adolescents was 6.9%with significantly higher odds in the male sex,having higher educational levels,urban residence,and those with a higher wealth index.CONCLUSION Nearly one in hundred older adolescents in India have diabetes,with one in three undiagnosed.Strengthening DM screening and treatment access among adolescents through public health programs is urgently warranted.展开更多
<strong>Context:</strong> Health Care Workers (HCWs) involved in field-level activities are exposed to COVID-19 which puts them under physical and psychological stress. <strong>Aim:</strong> Th...<strong>Context:</strong> Health Care Workers (HCWs) involved in field-level activities are exposed to COVID-19 which puts them under physical and psychological stress. <strong>Aim:</strong> The objective of this study was to understand the perception of the health care workers regarding their occupational exposure to COVID-19, including the safety measures used during field surveillance activities. <strong>Settings and Design:</strong> This cross-sectional study was conducted from June 2020 to July 2020 among the health care workers involved in COVID-19 field containment activities in two south Indian states—Telangana and Tamil Nadu. <strong>Methods and Material:</strong> Respondents were purposively sampled based on their involvement in the COVID-19 field level activities. Sixteen In-Depth Interviewees (IDIs) were conducted telephonically with medical officers, district epidemiologists, community health workers, sanitary workers, emergency medical technicians, and ambulance coordinators.<strong> Statistical Analysis</strong> <strong>Used:</strong> IDIs were analyzed using manual thematic analysis. <strong>Results:</strong> Seven themes and sub-themes emerged: awareness and training, occupational exposure to COVID-19 and duration, safety measures, occupational burnout, social stigma, psychological violence, and facilitating factors. Respondents felt a high level of occupational exposure to COVID-19 in addition to increased workload and stress due to fear of infection, shortage of workforce, denial of week off, psychological violence, and social stigma which affected them deeply. Support from supervisors and family, and measures ensuring the safety of women were facilitating factors to cope with the situation. <strong>Conclusions:</strong> It is important to safeguard the general and mental health of field-level health workers involved in COVID-19 activities, to keep their morale high during the continuing pandemic.展开更多
AIM To perform a meta-analysis of the association of obesity with hypertension and type 2 diabetes mellitus(T2DM) in India among adults. METHODS To conduct meta-analysis, we performed comprehensive, electronic literat...AIM To perform a meta-analysis of the association of obesity with hypertension and type 2 diabetes mellitus(T2DM) in India among adults. METHODS To conduct meta-analysis, we performed comprehensive, electronic literature search in the PubM ed, CINAHL Plus, and Google Scholar. We restricted the analysis to studies with documentation of some measure of obesity namely; body mass index, waist-hip ratio, waist circumference and diagnosis of hypertension or diagnosis of T2DM. By obtaining summary estimates of all included studies, the meta-analysis was performed using both RevM an version 5 and "metan" command STATA version 11. Heterogeneity was measured by I^2 statistic. Funnel plot analysis has been done to assess the study publication bias.RESULTS Of the 956 studies screened, 18 met the eligibility criteria. The pooled odds ratio between obesity and hypertension was 3.82(95%CI: 3.39 to 4.25). The heterogeneity around this estimate(I^2 statistic) was 0%, indicating low variability. The pooled odds ratio from the included studies showed a statistically significant association between obesity and T2DM(OR = 1.14, 95%CI: 1.04 to 1.24) with a high degree of variability.CONCLUSION Despite methodological differences, obesity showed significant, potentially plausible association with hypertension and T2DM in studies conducted in India. Being a modifiable risk factor, our study informs setting policy priority and intervention efforts to prevent debilitating complications.展开更多
<strong>Objectives:</strong> The objective of this study was to examine the impact of large scale non-pharmaceutical interventions on COVID-19 pandemic. <strong>Methods:</strong> We used interr...<strong>Objectives:</strong> The objective of this study was to examine the impact of large scale non-pharmaceutical interventions on COVID-19 pandemic. <strong>Methods:</strong> We used interrupted time series analysis (ITS), a quasi-experimental model to evaluate the effect of interventions in four states of India by comparing the COVID-19 positivity before lockdown, during lockdown and opening-up period. <strong>Results:</strong> The positivity in all the four states declined during lockdown and the trends reversed soon after the lockdown measures were relaxed as the states opened-up. The rate of reduction of positivity was significantly different between states. Between the lockdown and opening-up period, an increase in positivity was recorded in all the states with significant variation between states. <strong>Conclusion:</strong> The analysis provides conclusive evidence that the lockdown measures had a positive effect in reducing the burden of COVID-19 and establishes a causal relationship.展开更多
Objectives: Understanding the role of Self-Help Group (SHG) in light of the evolving dynamics of sex work needs to be delved into to strategize HIV interventions among FSWs in India. This paper aims to study the HIV p...Objectives: Understanding the role of Self-Help Group (SHG) in light of the evolving dynamics of sex work needs to be delved into to strategize HIV interventions among FSWs in India. This paper aims to study the HIV program outcome among the FSWs associated with SHGs and FSWs not associated with SHGs in Thane, Maharashtra. Study Design: This cross-sectional study was undertaken from the Behavioral Tracking Survey (BTS) conducted among 503 FSWs in Thane in 2015. Two-stage probability based conventional sampling was done for selection of brothel and bar based FSWs, while Time Location Cluster (TLC) sampling was done for home, lodge and street based sex workers. Methods: Bivariate and multivariate logistic regression were performed to compare and contrast between FSWs associated with SHG and those not associated with SHG with respect to the utilization of HIV related services by them. “Condom use”, “consistent condom use”, “contact with peer-educators”, “counseling sessions” and “HIV testing” were chosen as indicators on HIV service utilization. Results: 8% (38) of FSWs are registered with SHG;92% aged ≥25 years, 47% illiterate, and 71% are currently married. The likelihood of utilizing HIV services including, knowledge on HIV/AIDS and its mode of transmission (OR: 5.54;CI: 1.87 - 16.60;p Conclusions: Considering the improved HIV program outcomes among FSWs associated with SHG, HIV interventions among FSWs could consider facilitating the formation of SHGs with FSWs as one of the key strategies to empower the community for ensuring better program outcomes.展开更多
Background:Health financing is a major challenge in low-and middle-income counties(LMICs)for achieving Universal Health Coverage(UHC).Past studies have argued that the budgetary allocation on health financing depends ...Background:Health financing is a major challenge in low-and middle-income counties(LMICs)for achieving Universal Health Coverage(UHC).Past studies have argued that the budgetary allocation on health financing depends on macrofiscal policies of an economy such as sustained economic growth and higher revenue mobilization.While the global financial crisis of late 2008 observed a shortage of financial resources in richer countries and adversely affected the health sector.Therefore,this study has examined the impact of macro-fiscal policies on health financing by adopting socioeconomic factors in 85 LMICs for the period 2000 to 2013.Methods:The study has employed the panel System Generalized Method of Moment model that captures the endogeneity problem in the regression estimation by adopting appropriate instrumental variables.Results:The elasticity of public health expenditure(PHE)with respect to macro-fiscal factors varies across LMICs.Tax revenue shows a positive and statistically significant relationship with PHE in full sample,pre-global financial crisis,middle-income,and coefficient value varies from 0.040 to 0.141%.Fiscal deficit and debt services payment shows a negative effect on PHE in full sample,as well as sub-samples and coefficient value,varies from 0.001 to 0.032%.Aging and per capita income show an expected positive relationship with PHE in LIMI countries.Conclusions:Favorable macro-fiscal policies would necessarily raise finance for the health sector development but the prioritization of health budget allocation during the crisis period depends on the nature of tax revenue mobilization and demand for health services.Therefore,the generation of health-specific revenues and effective usage of health budget would probably accelerate the progress towards the achievement of UHC.展开更多
Genome-wide association studies(GWAS)have identified several genetic variants associated with coronary heart disease(CHD),and variations in plasma lipoproteins and blood pressure(BP).Loci corresponding to CDKN2A/CDKN2...Genome-wide association studies(GWAS)have identified several genetic variants associated with coronary heart disease(CHD),and variations in plasma lipoproteins and blood pressure(BP).Loci corresponding to CDKN2A/CDKN2B/ANRIL,MTHFD1L,CELSR2,PSRC1 and SORT1 genes have been associated with CHD,and TMEM57,DOCK7,CELSR2,APOB,ABCG5,HMGCR,TRIB1,FADS2/S3,LDLR,NCAN and TOMM40-APOE with total cholesterol.Similarly,CELSR2-PSRC1-SORT1,PCSK9,APOB,HMGCR,NCAN-CILP2-PBX4,LDLR,TOMM40-APOE,and APOC1-APOE are associated with variations in low-density lipoprotein cholesterol levels.Altogether,forty,forty three and twenty loci have been associated with high-density lipoprotein cholesterol,triglycerides and BP phenotypes,respectively.Some of these identified loci are common for all the traits,some do not map to functional genes,and some are located in genes that encode for proteins not previously known to be involved in the biological pathway of the trait.GWAS have been successful at identifying new and unexpected genetic loci common to diseases and traits,thus rapidly providing key novel insights into disease biology.Since genotype information is fixed,with minimum biological variability,it is useful in early life risk prediction.However,these variants explain only a small proportion of the observed variance of these traits.Therefore,the utility of genetic determinants in assessing risk at later stages of life has limited immediate clinical impact.The future application of genetic screening will be in identifying risk groups early in life to direct targeted preventive measures.展开更多
High omega-6/omega-3 ratio intake promotes development of many chronic diseases. Secondary prevention studies though have demonstrated a decline in progression of many such diseases after reducing the intake, specific...High omega-6/omega-3 ratio intake promotes development of many chronic diseases. Secondary prevention studies though have demonstrated a decline in progression of many such diseases after reducing the intake, specific biochemical indices of cardiovascular disease risk markers have not been evaluated. We have evaluated the circulating levels of omega-6/omega-3 ratio and its effect on cardiovascular risk markers in India. Present study was conducted in industrial setting where employees were randomly selected. Data on their demographic characteristics were collected using pre-tested questionnaire. Fasting blood samples were collected from all the participants. Serum was separated and stored at-80℃ till the time of analysis. Lipids were estimated using standard kits. Fatty acids in serum were estimated by Gas chromatography. The identified Omega-3 fatty acid included were 18:3 (Alpha-linolenic acid), 20:5 (Eicosapentenoic acid) & 22:6 (Docosahexenoic acid). Among omega-6 included were 18:2 (linoleic acid), 18:3 (gamma-linolenic acid) & 20:4 (Arachidonic acid). Complete data was available for 176 participants (89% males and 11% females) with mean age of 47.23 ± 6.00 years. The bmi of the participants was 24.88 ±3.43 Kg/m2 and waist circumference was 91.50 ±9.56 cm. The median of omega-6/omega-3 ratio in the study population was 36.69 (range: 6.21 -?183.69). The levels of total cholesterol, triglycerides, ldl-cholesterol and cholesterol/hdl ratio and apo B correlated significantly with omega-6/3 ratio. There was no correlation observed with hsCRP and LDL-particle size. A direct relationship of omega-6/ omega-3 ratio with dyslipidemia was observed in our study.展开更多
Background:Economic dimensions of implementing quality improvement for diabetes care are understudied worldwide.We describe the economic evaluation protocol within a randomised controlled trial that tested a multicomp...Background:Economic dimensions of implementing quality improvement for diabetes care are understudied worldwide.We describe the economic evaluation protocol within a randomised controlled trial that tested a multicomponent quality improvement(QI)strategy for individuals with poorly-controlled type 2 diabetes in South Asia.Methods/design:This economic evaluation of the Centre for Cardiometabolic Risk Reduction in South Asia(CARRS)randomised trial involved 1146 people with poorly-controlled type 2 diabetes receiving care at 10 diverse diabetes clinics across India and Pakistan.The economic evaluation comprises both a within-trial cost-effectiveness analysis(mean 2.5 years follow up)and a microsimulation model-based cost-utility analysis(life-time horizon).Effectiveness measures include multiple risk factor control(achieving HbA1c<7%and blood pressure<130/80 mmHg and/or LDL-cholesterol<100 mg/dl),and patient reported outcomes including quality adjusted life years(QALYs)measured by EQ-5D-3 L,hospitalizations,and diabetes related complications at the trial end.Cost measures include direct medical and non-medical costs relevant to outpatient care(consultation fee,medicines,laboratory tests,supplies,food,and escort/accompanying person costs,transport)and inpatient care(hospitalization,transport,and accompanying person costs)of the intervention compared to usual diabetes care.Patient,healthcare system,and societal perspectives will be applied for costing.Both cost and health effects will be discounted at 3%per year for within trial cost-effectiveness analysis over 2.5 years and decision modelling analysis over a lifetime horizon.Outcomes will be reported as the incremental cost-effectiveness ratios(ICER)to achieve multiple risk factor control,avoid diabetes-related complications,or QALYs gained against varying levels of willingness to pay threshold values.Sensitivity analyses will be performed to assess uncertainties around ICER estimates by varying costs(95%CIs)across public vs.private settings and using conservative estimates of effect size(95%CIs)for multiple risk factor control.Costs will be reported in US$2018.Discussion:We hypothesize that the additional upfront costs of delivering the intervention will be counterbalanced by improvements in clinical outcomes and patient-reported outcomes,thereby rendering this multi-component QI intervention cost-effective in resource constrained South Asian settings.Trial registration:ClinicalTrials.gov:NCT01212328.展开更多
Background:Globally,the threat of infectious diseases,particularly emerging infectious diseases,originating at the human-animal-environment interface,has caught health systems off guard.With forecasts that future path...Background:Globally,the threat of infectious diseases,particularly emerging infectious diseases,originating at the human-animal-environment interface,has caught health systems off guard.With forecasts that future pathogen emergence will be centred in hotspots in Asia,Africa,and Latin America,the need to prepare policy frameworks that can combat this threat is urgent.Discussion:Emergence of diseases such as avian influenza and Ebola virus disease,which threatened social disruption,have established the need for intersectoral coordination/collaboration.These events led to the initiation of establishing institutionalised collaborative frameworks in India to adopt a One Health approach to disease prevention and control.However,the gains made in influenza control could not be adapted to other infectious diseases.Intersectoral coordination was briefly carried out,more as a reactive response to threats.The systemic failure to sustain such efforts have therefore,only undermined a coordinated response.The recent draft National Health Policy,2015,has also failed to establish the need for intersectoral coordination in disease control approaches.Neglecting the need to endorse linkages between human health,animal health and husbandry,agriculture,and environmental sectors,has led to duplicative and weak response systems.The absence of health impact assessment with respect to the development agenda in policies,has cast negative effects on the health and wellbeing of man,animal,and the environment.Lack of attention to building core capacity in these critical sectors has further raised challenges in designing and deploying mitigation strategies.With developing countries like India being home to a major portion of the world’s poorest livestock farmers,the absence of a policy discourse that endorses the One Health approach in development and health policies is a major hurdle in eliminating poverty and poverty-related diseases.Conclusions:The adoption of One Health approaches in health and related sectoral policies is a critical policy requirement for India and other developing countries.The goal should be to not just establish preparedness plans,but also to encourage a policy environment where assessment and mitigation of downstream impacts of different agenda are incorporated.展开更多
Background:Lymphatic filariasis is targeted for elimination in India through mass drug administration(MDA)with diethylcarbamazine(DEC)combined with albendazole(ABZ).For the strategy to be effective,>65%of those liv...Background:Lymphatic filariasis is targeted for elimination in India through mass drug administration(MDA)with diethylcarbamazine(DEC)combined with albendazole(ABZ).For the strategy to be effective,>65%of those living in endemic areas must be covered by and compliant to MDA.Post the MDA 2011 campaign in the endemic district of Odisha,we conducted a survey to assess:(i)the filariasis knowledge in the community,(ii)the coverage and compliance of MDA from the community perspective,and(iii)factors affecting compliance,as well as the operational issues involved in carrying out MDA activities from the drug distributor’s perspective.Methods:A sample of 691 participants-both male and female,aged two years or above-were selected through multistage stratified sampling and interviewed using a semi-structured questionnaire.Additionally,drug distributors and the medical officers in charge of the MDA were also interviewed to understand some of the operational issues encountered during MDA.Results:Ninety-nine percent of the study participants received DEC and ABZ tablets during MDA,of which only just above a quarter actually consumed the drugs.The cause of non-compliance was mostly due to fear of side effects,lack of awareness of the benefits of MDA,and non-attendance of health staff in the villages.Lack of adequate training of drug distributors and poor health communication activities before the MDA campaign commenced and the absence of follow-up by health workers following MDA were a few of the operational difficulties encountered during the MDA campaign.Conclusion:Currently MDA is restricted to the distribution of drugs only and the key issues of implementation in compliance,health education,managing side effects,and logistics are not given enough attention.It is therefore essential to address the issues linked to low compliance to make the program more efficient and achieve the goal of filariasis elimination.展开更多
This study is aimed to estimate the epidemiological burden of dengue in Odisha,India using the disability adjusted life year(DALY)methods and to explore the associated factors in the year 2010-2016.During the period o...This study is aimed to estimate the epidemiological burden of dengue in Odisha,India using the disability adjusted life year(DALY)methods and to explore the associated factors in the year 2010-2016.During the period of 2010-2016,27772 cases(68.4%male)were reported in the state.Mean age(years)of male and female was 31.63 and 33.82,respectively.Mean district wise disability adjusted life years(DALY)per 100000 people was higher in the year 2016(0.45)and mean DALY lost per person was highest in the year 2015(34.90 years).Adjusted regression model indicates,every unit increase in humidity and population density increases DALY by 1.05 and 1.02 units respectively.Whereas,unit change in sex ratio(females per 1000 males)and forest coverage increases the DALY by 0.98 units.Our results indicate geographical variation of DALY in Odisha,which is associated with population density,humidity and forest cover.Discrepancies identified between standard incidence and DALY maps suggests,latter can be used to present disease burden more effectively.More prevalence among young males suggests the need of strengthening the targeted prevention and control measures.展开更多
Objective:Eclampsia is a potentially fatal disorder in pregnant women and remains an im-portant cause of maternal and perinatal child morbidity and death worldwide.We aimed to assess the prevalence of and risk factors...Objective:Eclampsia is a potentially fatal disorder in pregnant women and remains an im-portant cause of maternal and perinatal child morbidity and death worldwide.We aimed to assess the prevalence of and risk factors for convulsions(not occurring from fever)during pregnancy in Indian women.Convulsion is a key symptom suggestive of eclampsia.Methods:Cross-sectional data from India’s third National Family Health Survey,conducted during 2005-2006 were used.Self-reported information on convulsions during pregnancy was obtained from 39,657 women aged 15-49 years who had a live birth in the 5 years preceding the survey.Multiple logistic regression analysis was used to explore risk factors for convulsion in pregnancy.Results:Overall,1 in 10 women reported having convulsions in their most recent pregnancy.The prevalence was significantly higher in women living in rural areas compared with those liv-ing in urban areas(11.3% vs.7.4%;P<0.0001),with marked state and geographic variation.The odds of convulsions were significantly higher in women with a twin pregnancy[odds ratio(OR)2.12;95% confidence interval(CI)1.45-3.11],a previously terminated pregnancy(OR 1.32;95% CI 1.20-1.45),diabetes(OR 1.37;95% CI 0.99-1.89),or asthma(OR 1.85;95% CI 1.35-2.54),in women who were alerted to pregnancy complications(OR 2.78;95% CI 2.50-3.08),in Sikh wom-en(OR 1.73;95% CI 1.28-2.33),in women in a low social group(OR 1.40;95% CI 1.25-1.58),and in women residing in central India(OR 1.51;95% CI 1.31-1.74)or eastern India(OR 1.33;95% CI 1.14-1.54)with reference to their counterparts.Conclusion:Our findings from a large population-based nationally representative sample of Indian women indicate a high prevalence of convulsions,a symptom suggestive of eclampsia,and its association with several maternal,lifestyle risk factors and sociodemographic characteristics.展开更多
Background: Life-threatening bleeding is a major cause of trauma-related deaths. Stop the Bleed—Active bleeding control (ABC) program in Hyderabad recently showed that lay first responders can be effectively trained....Background: Life-threatening bleeding is a major cause of trauma-related deaths. Stop the Bleed—Active bleeding control (ABC) program in Hyderabad recently showed that lay first responders can be effectively trained. However, the willingness of high school students to train in bleeding control is unknown. We report Stop the Bleed training needs assessment from high schools in India and estimate the potential multiplier effect. Methods: A cross-sectional survey was conducted from 12 randomly selected schools in Hyderabad. The study was to understand current knowledge, skills and willingness to get trained and respond to life-threatening bleeding from injuries. 107 Participants (35 Teachers and 72 students) were purposively selected for telephonic interviews with a structured questionnaire. Results: Response rate was 93% overall. 80% of participants have never been trained in bleeding control. 84% reported willingness to be trained, train others and help bleeding victims. All the teachers reported that stop the bleed training would be useful in high schools. 70.6% of teachers recommended that training could start from middle school (10 to 15 years), 47% preferred the online training mode. Only 20% of participants had prior training in lifesaving first aid and 32% did not know the number of emergency medical services (EMS). Each trained participant has the potential to train 3 to 4 people at the household level and perhaps more at the community level. Conclusion: The surveyed schools in Hyderabad do not have the knowledge, skills, or training curriculum in Stop the Bleed. Students and teachers are willing to be trained and train others, with great potential for a “multiplier-effect” in the community.展开更多
Asia and its Hindu Kush Himalayan(HKH)region is particularly vulnerable to environmental change,especially climate and land use changes further influenced by rapid population growth,high level of poverty and unsustain...Asia and its Hindu Kush Himalayan(HKH)region is particularly vulnerable to environmental change,especially climate and land use changes further influenced by rapid population growth,high level of poverty and unsustainable development.Asia has been a hotspot of dengue fever and chikungunya mainly due to its dense human population,unplanned urbanization and poverty.In an urban cycle,dengue virus(DENV)and chikungunya virus(CHIKV)are transmitted by Aedes aegypti and Ae.albopictus mosquitoes which are also competent vectors of Zika virus(ZIKV).Over the last decade,DENV and CHIKV transmissions by Ae.aegypti have extended to the Himalayan countries of Bhutan and Nepal and ZIKV could follow in the footsteps of these viruses in the HKH region.The already established distribution of human-biting Aedes mosquito vectors and a naïve population with lack of immunity against ZIKV places the HKH region at a higher risk of ZIKV.Some of the countries in the HKH region have already reported ZIKV cases.We have documented an increasing threat of ZIKV in Asia and its HKH region because of the high abundance and wide distribution of human-biting mosquito vectors,climate change,poverty,report of indigenous cases in the region,increasing numbers of imported cases and a naïve population with lack of immunity against ZIKV.An outbreak anywhere is potentially a threat everywhere.Therefore,in order to ensure international health security,all efforts to prevent,detect,and respond to ZIKV ought to be intensified now in Asia and its HKH region.To prepare for possible ZIKV outbreaks,Asia and the HKH region can also learn from the success stories and strategies adopted by other regions and countries in preventing ZIKV and associated complications.The future control strategies for DENV,CHIKV and ZIKV should be considered in tandem with the threat to human well-being that is posed by other emerging and re-emerging vector-borne and zoonotic diseases,and by the continuing urgent need to strengthen public primary healthcare systems in the region.展开更多
Objective:There has been a steady increase in the demand for cancer follow-up care in India.Compared with Western countries,there is little evidence on the capacity of the Indian primary care workforce to accommodate ...Objective:There has been a steady increase in the demand for cancer follow-up care in India.Compared with Western countries,there is little evidence on the capacity of the Indian primary care workforce to accommodate such tasks.We explored the perceptions of oncologists,general practitioners,and patients with regard to the involvement of primary care in cancer follow-up care.Methods:We undertook semistructured focus-group discussions with eight oncologists,nine general practitioners,and 17 cancer patients to gain an understanding of their perceived roles and responsibilities with regard to primary care in delivering follow-up care and the potential concerns.Data from the focus groups were transcribed verbatim,translated,and analyzed with use of a the-matic approach.Results:Most general practitioners felt that their job is to see‘normal’patients,and cancer patients were exceptions to routine care.Oncologists were apprehensive with regard to the com-petence of general practitioners and patient trust.Patients consult oncologists for cancer follow-up care as they perceive it to be very specialized.Patients expressed difficulty in accessing follow-up care and want specialized oncological care by trained personnel in their vicinity.Conclusion:Despite the growing number of cancer survivors,we found a disconnect between primary care and cancer follow-up care.展开更多
文摘BACKGROUND Globally,obesity and diabetes mellitus(DM)are emergent public health concerns in the adolescent population.India,home to the largest adolescent population and the second largest diabetes cohort is experiencing rapid but unplanned urbanization,with accompanying unhealthy nutritional transition,and sedentary lifestyle.AIM To determine prevalence and determinants of obesity and hyperglycaemia and their association among community-dwelling older adolescents(15-19 years)in India.METHODS This cross-sectional analysis from the national family health survey-5 included data of 258028 adolescents aged 15-19 across India(2019-2021).The survey employed stratified two-stage sampling,with systematic random sampling in rural and urban areas.Statistical analysis included descriptive statistics,bivariate,and multivariable logistic regression,employing generalized linear models.RESULTS The weighted prevalence of DM was 1.09%including 0.77%[95%confidence interval(CI):0.72-0.83]previously diagnosed and 0.32%(95%CI:0.29-0.35)newly diagnosed cases detected on survey screening.On adjusted analysis,increasing age,higher education levels,higher wealth index,and overweight/obesity were the factors significantly associated with presence of DM.Only 61%of the adolescents with previously diagnosed DM were on anti-diabetes treatment.The weighted prevalence of overweight/obesity among older adolescents was 6.9%with significantly higher odds in the male sex,having higher educational levels,urban residence,and those with a higher wealth index.CONCLUSION Nearly one in hundred older adolescents in India have diabetes,with one in three undiagnosed.Strengthening DM screening and treatment access among adolescents through public health programs is urgently warranted.
文摘<strong>Context:</strong> Health Care Workers (HCWs) involved in field-level activities are exposed to COVID-19 which puts them under physical and psychological stress. <strong>Aim:</strong> The objective of this study was to understand the perception of the health care workers regarding their occupational exposure to COVID-19, including the safety measures used during field surveillance activities. <strong>Settings and Design:</strong> This cross-sectional study was conducted from June 2020 to July 2020 among the health care workers involved in COVID-19 field containment activities in two south Indian states—Telangana and Tamil Nadu. <strong>Methods and Material:</strong> Respondents were purposively sampled based on their involvement in the COVID-19 field level activities. Sixteen In-Depth Interviewees (IDIs) were conducted telephonically with medical officers, district epidemiologists, community health workers, sanitary workers, emergency medical technicians, and ambulance coordinators.<strong> Statistical Analysis</strong> <strong>Used:</strong> IDIs were analyzed using manual thematic analysis. <strong>Results:</strong> Seven themes and sub-themes emerged: awareness and training, occupational exposure to COVID-19 and duration, safety measures, occupational burnout, social stigma, psychological violence, and facilitating factors. Respondents felt a high level of occupational exposure to COVID-19 in addition to increased workload and stress due to fear of infection, shortage of workforce, denial of week off, psychological violence, and social stigma which affected them deeply. Support from supervisors and family, and measures ensuring the safety of women were facilitating factors to cope with the situation. <strong>Conclusions:</strong> It is important to safeguard the general and mental health of field-level health workers involved in COVID-19 activities, to keep their morale high during the continuing pandemic.
基金Supported by Wellcome Trust DBT India Alliance Intermediate Fellowship(Clinical and Public Health)to Giridhara R Babu
文摘AIM To perform a meta-analysis of the association of obesity with hypertension and type 2 diabetes mellitus(T2DM) in India among adults. METHODS To conduct meta-analysis, we performed comprehensive, electronic literature search in the PubM ed, CINAHL Plus, and Google Scholar. We restricted the analysis to studies with documentation of some measure of obesity namely; body mass index, waist-hip ratio, waist circumference and diagnosis of hypertension or diagnosis of T2DM. By obtaining summary estimates of all included studies, the meta-analysis was performed using both RevM an version 5 and "metan" command STATA version 11. Heterogeneity was measured by I^2 statistic. Funnel plot analysis has been done to assess the study publication bias.RESULTS Of the 956 studies screened, 18 met the eligibility criteria. The pooled odds ratio between obesity and hypertension was 3.82(95%CI: 3.39 to 4.25). The heterogeneity around this estimate(I^2 statistic) was 0%, indicating low variability. The pooled odds ratio from the included studies showed a statistically significant association between obesity and T2DM(OR = 1.14, 95%CI: 1.04 to 1.24) with a high degree of variability.CONCLUSION Despite methodological differences, obesity showed significant, potentially plausible association with hypertension and T2DM in studies conducted in India. Being a modifiable risk factor, our study informs setting policy priority and intervention efforts to prevent debilitating complications.
文摘<strong>Objectives:</strong> The objective of this study was to examine the impact of large scale non-pharmaceutical interventions on COVID-19 pandemic. <strong>Methods:</strong> We used interrupted time series analysis (ITS), a quasi-experimental model to evaluate the effect of interventions in four states of India by comparing the COVID-19 positivity before lockdown, during lockdown and opening-up period. <strong>Results:</strong> The positivity in all the four states declined during lockdown and the trends reversed soon after the lockdown measures were relaxed as the states opened-up. The rate of reduction of positivity was significantly different between states. Between the lockdown and opening-up period, an increase in positivity was recorded in all the states with significant variation between states. <strong>Conclusion:</strong> The analysis provides conclusive evidence that the lockdown measures had a positive effect in reducing the burden of COVID-19 and establishes a causal relationship.
文摘Objectives: Understanding the role of Self-Help Group (SHG) in light of the evolving dynamics of sex work needs to be delved into to strategize HIV interventions among FSWs in India. This paper aims to study the HIV program outcome among the FSWs associated with SHGs and FSWs not associated with SHGs in Thane, Maharashtra. Study Design: This cross-sectional study was undertaken from the Behavioral Tracking Survey (BTS) conducted among 503 FSWs in Thane in 2015. Two-stage probability based conventional sampling was done for selection of brothel and bar based FSWs, while Time Location Cluster (TLC) sampling was done for home, lodge and street based sex workers. Methods: Bivariate and multivariate logistic regression were performed to compare and contrast between FSWs associated with SHG and those not associated with SHG with respect to the utilization of HIV related services by them. “Condom use”, “consistent condom use”, “contact with peer-educators”, “counseling sessions” and “HIV testing” were chosen as indicators on HIV service utilization. Results: 8% (38) of FSWs are registered with SHG;92% aged ≥25 years, 47% illiterate, and 71% are currently married. The likelihood of utilizing HIV services including, knowledge on HIV/AIDS and its mode of transmission (OR: 5.54;CI: 1.87 - 16.60;p Conclusions: Considering the improved HIV program outcomes among FSWs associated with SHG, HIV interventions among FSWs could consider facilitating the formation of SHGs with FSWs as one of the key strategies to empower the community for ensuring better program outcomes.
文摘Background:Health financing is a major challenge in low-and middle-income counties(LMICs)for achieving Universal Health Coverage(UHC).Past studies have argued that the budgetary allocation on health financing depends on macrofiscal policies of an economy such as sustained economic growth and higher revenue mobilization.While the global financial crisis of late 2008 observed a shortage of financial resources in richer countries and adversely affected the health sector.Therefore,this study has examined the impact of macro-fiscal policies on health financing by adopting socioeconomic factors in 85 LMICs for the period 2000 to 2013.Methods:The study has employed the panel System Generalized Method of Moment model that captures the endogeneity problem in the regression estimation by adopting appropriate instrumental variables.Results:The elasticity of public health expenditure(PHE)with respect to macro-fiscal factors varies across LMICs.Tax revenue shows a positive and statistically significant relationship with PHE in full sample,pre-global financial crisis,middle-income,and coefficient value varies from 0.040 to 0.141%.Fiscal deficit and debt services payment shows a negative effect on PHE in full sample,as well as sub-samples and coefficient value,varies from 0.001 to 0.032%.Aging and per capita income show an expected positive relationship with PHE in LIMI countries.Conclusions:Favorable macro-fiscal policies would necessarily raise finance for the health sector development but the prioritization of health budget allocation during the crisis period depends on the nature of tax revenue mobilization and demand for health services.Therefore,the generation of health-specific revenues and effective usage of health budget would probably accelerate the progress towards the achievement of UHC.
基金Supported by A Wellcome Trust Capacity Strengthening Strategic Award to the Public Health Foundation of India and a consortium of UK universities(to Jeemon P)Research grants from National Heart Lung and Blood Institute,United States of America (HHSN286200900026C)National Institute of Health,United States of America(1D43HD065249)(to Prabhakaran D)
文摘Genome-wide association studies(GWAS)have identified several genetic variants associated with coronary heart disease(CHD),and variations in plasma lipoproteins and blood pressure(BP).Loci corresponding to CDKN2A/CDKN2B/ANRIL,MTHFD1L,CELSR2,PSRC1 and SORT1 genes have been associated with CHD,and TMEM57,DOCK7,CELSR2,APOB,ABCG5,HMGCR,TRIB1,FADS2/S3,LDLR,NCAN and TOMM40-APOE with total cholesterol.Similarly,CELSR2-PSRC1-SORT1,PCSK9,APOB,HMGCR,NCAN-CILP2-PBX4,LDLR,TOMM40-APOE,and APOC1-APOE are associated with variations in low-density lipoprotein cholesterol levels.Altogether,forty,forty three and twenty loci have been associated with high-density lipoprotein cholesterol,triglycerides and BP phenotypes,respectively.Some of these identified loci are common for all the traits,some do not map to functional genes,and some are located in genes that encode for proteins not previously known to be involved in the biological pathway of the trait.GWAS have been successful at identifying new and unexpected genetic loci common to diseases and traits,thus rapidly providing key novel insights into disease biology.Since genotype information is fixed,with minimum biological variability,it is useful in early life risk prediction.However,these variants explain only a small proportion of the observed variance of these traits.Therefore,the utility of genetic determinants in assessing risk at later stages of life has limited immediate clinical impact.The future application of genetic screening will be in identifying risk groups early in life to direct targeted preventive measures.
文摘High omega-6/omega-3 ratio intake promotes development of many chronic diseases. Secondary prevention studies though have demonstrated a decline in progression of many such diseases after reducing the intake, specific biochemical indices of cardiovascular disease risk markers have not been evaluated. We have evaluated the circulating levels of omega-6/omega-3 ratio and its effect on cardiovascular risk markers in India. Present study was conducted in industrial setting where employees were randomly selected. Data on their demographic characteristics were collected using pre-tested questionnaire. Fasting blood samples were collected from all the participants. Serum was separated and stored at-80℃ till the time of analysis. Lipids were estimated using standard kits. Fatty acids in serum were estimated by Gas chromatography. The identified Omega-3 fatty acid included were 18:3 (Alpha-linolenic acid), 20:5 (Eicosapentenoic acid) & 22:6 (Docosahexenoic acid). Among omega-6 included were 18:2 (linoleic acid), 18:3 (gamma-linolenic acid) & 20:4 (Arachidonic acid). Complete data was available for 176 participants (89% males and 11% females) with mean age of 47.23 ± 6.00 years. The bmi of the participants was 24.88 ±3.43 Kg/m2 and waist circumference was 91.50 ±9.56 cm. The median of omega-6/omega-3 ratio in the study population was 36.69 (range: 6.21 -?183.69). The levels of total cholesterol, triglycerides, ldl-cholesterol and cholesterol/hdl ratio and apo B correlated significantly with omega-6/3 ratio. There was no correlation observed with hsCRP and LDL-particle size. A direct relationship of omega-6/ omega-3 ratio with dyslipidemia was observed in our study.
基金funded in part by the National Heart,Lung,and Blood Institute,National Institutes of Health,U.SDepartment of Health and Human Services,under contract number HHSN268200900026C+3 种基金by UnitedHealth Group,Minneapolis,Minnesota.Several members of the research team at the Public Health Foundation of India and Emory University were supported by the Fogarty International Clinical Research Scholars and Fellows program through grant number 5R24TW007988 from the National Institutes of Health,Fogarty International Center through Vanderbilt University,Emory Global Health Institute,and D43 NCDs in India Training Program through award number 1D43HD05249 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and Fogarty International Centersupported by the Fogarty International Center,National Institutes of Health,under award number D43TW008332(ASCEND Research Network)supported by the National Institute of Mental Health supplemental grant under award number:R01MH100390-04S1development team:Mr.Prashant Tandon and Mr.Ajeet Kushwaha.The funding sources were not involved in the data collection,analysis,writing or interpretation of the manuscript or the decision to submit it for publication.
文摘Background:Economic dimensions of implementing quality improvement for diabetes care are understudied worldwide.We describe the economic evaluation protocol within a randomised controlled trial that tested a multicomponent quality improvement(QI)strategy for individuals with poorly-controlled type 2 diabetes in South Asia.Methods/design:This economic evaluation of the Centre for Cardiometabolic Risk Reduction in South Asia(CARRS)randomised trial involved 1146 people with poorly-controlled type 2 diabetes receiving care at 10 diverse diabetes clinics across India and Pakistan.The economic evaluation comprises both a within-trial cost-effectiveness analysis(mean 2.5 years follow up)and a microsimulation model-based cost-utility analysis(life-time horizon).Effectiveness measures include multiple risk factor control(achieving HbA1c<7%and blood pressure<130/80 mmHg and/or LDL-cholesterol<100 mg/dl),and patient reported outcomes including quality adjusted life years(QALYs)measured by EQ-5D-3 L,hospitalizations,and diabetes related complications at the trial end.Cost measures include direct medical and non-medical costs relevant to outpatient care(consultation fee,medicines,laboratory tests,supplies,food,and escort/accompanying person costs,transport)and inpatient care(hospitalization,transport,and accompanying person costs)of the intervention compared to usual diabetes care.Patient,healthcare system,and societal perspectives will be applied for costing.Both cost and health effects will be discounted at 3%per year for within trial cost-effectiveness analysis over 2.5 years and decision modelling analysis over a lifetime horizon.Outcomes will be reported as the incremental cost-effectiveness ratios(ICER)to achieve multiple risk factor control,avoid diabetes-related complications,or QALYs gained against varying levels of willingness to pay threshold values.Sensitivity analyses will be performed to assess uncertainties around ICER estimates by varying costs(95%CIs)across public vs.private settings and using conservative estimates of effect size(95%CIs)for multiple risk factor control.Costs will be reported in US$2018.Discussion:We hypothesize that the additional upfront costs of delivering the intervention will be counterbalanced by improvements in clinical outcomes and patient-reported outcomes,thereby rendering this multi-component QI intervention cost-effective in resource constrained South Asian settings.Trial registration:ClinicalTrials.gov:NCT01212328.
文摘Background:Globally,the threat of infectious diseases,particularly emerging infectious diseases,originating at the human-animal-environment interface,has caught health systems off guard.With forecasts that future pathogen emergence will be centred in hotspots in Asia,Africa,and Latin America,the need to prepare policy frameworks that can combat this threat is urgent.Discussion:Emergence of diseases such as avian influenza and Ebola virus disease,which threatened social disruption,have established the need for intersectoral coordination/collaboration.These events led to the initiation of establishing institutionalised collaborative frameworks in India to adopt a One Health approach to disease prevention and control.However,the gains made in influenza control could not be adapted to other infectious diseases.Intersectoral coordination was briefly carried out,more as a reactive response to threats.The systemic failure to sustain such efforts have therefore,only undermined a coordinated response.The recent draft National Health Policy,2015,has also failed to establish the need for intersectoral coordination in disease control approaches.Neglecting the need to endorse linkages between human health,animal health and husbandry,agriculture,and environmental sectors,has led to duplicative and weak response systems.The absence of health impact assessment with respect to the development agenda in policies,has cast negative effects on the health and wellbeing of man,animal,and the environment.Lack of attention to building core capacity in these critical sectors has further raised challenges in designing and deploying mitigation strategies.With developing countries like India being home to a major portion of the world’s poorest livestock farmers,the absence of a policy discourse that endorses the One Health approach in development and health policies is a major hurdle in eliminating poverty and poverty-related diseases.Conclusions:The adoption of One Health approaches in health and related sectoral policies is a critical policy requirement for India and other developing countries.The goal should be to not just establish preparedness plans,but also to encourage a policy environment where assessment and mitigation of downstream impacts of different agenda are incorporated.
基金We sincerely thank the Odisha Government for providing financial support to AKS to successfully complete his Postgraduate Diploma in Public Health Management.
文摘Background:Lymphatic filariasis is targeted for elimination in India through mass drug administration(MDA)with diethylcarbamazine(DEC)combined with albendazole(ABZ).For the strategy to be effective,>65%of those living in endemic areas must be covered by and compliant to MDA.Post the MDA 2011 campaign in the endemic district of Odisha,we conducted a survey to assess:(i)the filariasis knowledge in the community,(ii)the coverage and compliance of MDA from the community perspective,and(iii)factors affecting compliance,as well as the operational issues involved in carrying out MDA activities from the drug distributor’s perspective.Methods:A sample of 691 participants-both male and female,aged two years or above-were selected through multistage stratified sampling and interviewed using a semi-structured questionnaire.Additionally,drug distributors and the medical officers in charge of the MDA were also interviewed to understand some of the operational issues encountered during MDA.Results:Ninety-nine percent of the study participants received DEC and ABZ tablets during MDA,of which only just above a quarter actually consumed the drugs.The cause of non-compliance was mostly due to fear of side effects,lack of awareness of the benefits of MDA,and non-attendance of health staff in the villages.Lack of adequate training of drug distributors and poor health communication activities before the MDA campaign commenced and the absence of follow-up by health workers following MDA were a few of the operational difficulties encountered during the MDA campaign.Conclusion:Currently MDA is restricted to the distribution of drugs only and the key issues of implementation in compliance,health education,managing side effects,and logistics are not given enough attention.It is therefore essential to address the issues linked to low compliance to make the program more efficient and achieve the goal of filariasis elimination.
基金This study was financially supported by the PHRI-Research Grant awarded by Public Health Foundation of India with the financial support from Department of Science and Technology,Government of India(No.IN-DL220960833674480).
文摘This study is aimed to estimate the epidemiological burden of dengue in Odisha,India using the disability adjusted life year(DALY)methods and to explore the associated factors in the year 2010-2016.During the period of 2010-2016,27772 cases(68.4%male)were reported in the state.Mean age(years)of male and female was 31.63 and 33.82,respectively.Mean district wise disability adjusted life years(DALY)per 100000 people was higher in the year 2016(0.45)and mean DALY lost per person was highest in the year 2015(34.90 years).Adjusted regression model indicates,every unit increase in humidity and population density increases DALY by 1.05 and 1.02 units respectively.Whereas,unit change in sex ratio(females per 1000 males)and forest coverage increases the DALY by 0.98 units.Our results indicate geographical variation of DALY in Odisha,which is associated with population density,humidity and forest cover.Discrepancies identified between standard incidence and DALY maps suggests,latter can be used to present disease burden more effectively.More prevalence among young males suggests the need of strengthening the targeted prevention and control measures.
基金Sutapa Agrawal and Gagandeep K.Walia are supported by Wellcome Trust Strategic Award grant no.WT084674 to Shah Ebrahim and a Wellcome Trust Capacity Strengthening Strategic Award-Extension phase to the Public Health Foundation of India and a consortium of UK universities(WT084754/Z/08/A).
文摘Objective:Eclampsia is a potentially fatal disorder in pregnant women and remains an im-portant cause of maternal and perinatal child morbidity and death worldwide.We aimed to assess the prevalence of and risk factors for convulsions(not occurring from fever)during pregnancy in Indian women.Convulsion is a key symptom suggestive of eclampsia.Methods:Cross-sectional data from India’s third National Family Health Survey,conducted during 2005-2006 were used.Self-reported information on convulsions during pregnancy was obtained from 39,657 women aged 15-49 years who had a live birth in the 5 years preceding the survey.Multiple logistic regression analysis was used to explore risk factors for convulsion in pregnancy.Results:Overall,1 in 10 women reported having convulsions in their most recent pregnancy.The prevalence was significantly higher in women living in rural areas compared with those liv-ing in urban areas(11.3% vs.7.4%;P<0.0001),with marked state and geographic variation.The odds of convulsions were significantly higher in women with a twin pregnancy[odds ratio(OR)2.12;95% confidence interval(CI)1.45-3.11],a previously terminated pregnancy(OR 1.32;95% CI 1.20-1.45),diabetes(OR 1.37;95% CI 0.99-1.89),or asthma(OR 1.85;95% CI 1.35-2.54),in women who were alerted to pregnancy complications(OR 2.78;95% CI 2.50-3.08),in Sikh wom-en(OR 1.73;95% CI 1.28-2.33),in women in a low social group(OR 1.40;95% CI 1.25-1.58),and in women residing in central India(OR 1.51;95% CI 1.31-1.74)or eastern India(OR 1.33;95% CI 1.14-1.54)with reference to their counterparts.Conclusion:Our findings from a large population-based nationally representative sample of Indian women indicate a high prevalence of convulsions,a symptom suggestive of eclampsia,and its association with several maternal,lifestyle risk factors and sociodemographic characteristics.
文摘Background: Life-threatening bleeding is a major cause of trauma-related deaths. Stop the Bleed—Active bleeding control (ABC) program in Hyderabad recently showed that lay first responders can be effectively trained. However, the willingness of high school students to train in bleeding control is unknown. We report Stop the Bleed training needs assessment from high schools in India and estimate the potential multiplier effect. Methods: A cross-sectional survey was conducted from 12 randomly selected schools in Hyderabad. The study was to understand current knowledge, skills and willingness to get trained and respond to life-threatening bleeding from injuries. 107 Participants (35 Teachers and 72 students) were purposively selected for telephonic interviews with a structured questionnaire. Results: Response rate was 93% overall. 80% of participants have never been trained in bleeding control. 84% reported willingness to be trained, train others and help bleeding victims. All the teachers reported that stop the bleed training would be useful in high schools. 70.6% of teachers recommended that training could start from middle school (10 to 15 years), 47% preferred the online training mode. Only 20% of participants had prior training in lifesaving first aid and 32% did not know the number of emergency medical services (EMS). Each trained participant has the potential to train 3 to 4 people at the household level and perhaps more at the community level. Conclusion: The surveyed schools in Hyderabad do not have the knowledge, skills, or training curriculum in Stop the Bleed. Students and teachers are willing to be trained and train others, with great potential for a “multiplier-effect” in the community.
基金No specific funding was received for this research.However,the work of RM,UK and DAG was funded by the Federal Ministry of Education and Research of Germany(BMBF)under the project AECO(number 01Kl1717)part of the National Research Network on Zoonotic Infectious Diseases of Germany.
文摘Asia and its Hindu Kush Himalayan(HKH)region is particularly vulnerable to environmental change,especially climate and land use changes further influenced by rapid population growth,high level of poverty and unsustainable development.Asia has been a hotspot of dengue fever and chikungunya mainly due to its dense human population,unplanned urbanization and poverty.In an urban cycle,dengue virus(DENV)and chikungunya virus(CHIKV)are transmitted by Aedes aegypti and Ae.albopictus mosquitoes which are also competent vectors of Zika virus(ZIKV).Over the last decade,DENV and CHIKV transmissions by Ae.aegypti have extended to the Himalayan countries of Bhutan and Nepal and ZIKV could follow in the footsteps of these viruses in the HKH region.The already established distribution of human-biting Aedes mosquito vectors and a naïve population with lack of immunity against ZIKV places the HKH region at a higher risk of ZIKV.Some of the countries in the HKH region have already reported ZIKV cases.We have documented an increasing threat of ZIKV in Asia and its HKH region because of the high abundance and wide distribution of human-biting mosquito vectors,climate change,poverty,report of indigenous cases in the region,increasing numbers of imported cases and a naïve population with lack of immunity against ZIKV.An outbreak anywhere is potentially a threat everywhere.Therefore,in order to ensure international health security,all efforts to prevent,detect,and respond to ZIKV ought to be intensified now in Asia and its HKH region.To prepare for possible ZIKV outbreaks,Asia and the HKH region can also learn from the success stories and strategies adopted by other regions and countries in preventing ZIKV and associated complications.The future control strategies for DENV,CHIKV and ZIKV should be considered in tandem with the threat to human well-being that is posed by other emerging and re-emerging vector-borne and zoonotic diseases,and by the continuing urgent need to strengthen public primary healthcare systems in the region.
文摘Objective:There has been a steady increase in the demand for cancer follow-up care in India.Compared with Western countries,there is little evidence on the capacity of the Indian primary care workforce to accommodate such tasks.We explored the perceptions of oncologists,general practitioners,and patients with regard to the involvement of primary care in cancer follow-up care.Methods:We undertook semistructured focus-group discussions with eight oncologists,nine general practitioners,and 17 cancer patients to gain an understanding of their perceived roles and responsibilities with regard to primary care in delivering follow-up care and the potential concerns.Data from the focus groups were transcribed verbatim,translated,and analyzed with use of a the-matic approach.Results:Most general practitioners felt that their job is to see‘normal’patients,and cancer patients were exceptions to routine care.Oncologists were apprehensive with regard to the com-petence of general practitioners and patient trust.Patients consult oncologists for cancer follow-up care as they perceive it to be very specialized.Patients expressed difficulty in accessing follow-up care and want specialized oncological care by trained personnel in their vicinity.Conclusion:Despite the growing number of cancer survivors,we found a disconnect between primary care and cancer follow-up care.
