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Over the years, survival of children with chronic diseases has significantly improved and a large proportion of them now are entering into adulthood. Transition of Care (ToC) of such patients with having childhood onset of chronic diseases to the adult health care system is well organized in developed countries, although it is an emerging concept in India. In situations where the systems for ToC are not in place, such cases are fraught with unsatisfactory health outcomes. With proper ToC in place, these patients are likely to receive uninterrupted care by the adult care physicians and hence reach their full potential. This document highlights the need, rationale and way forward for ToC of youth with special health care needs (YSHCN) across the country. It also describes the standard operating procedures to develop the ToC at a hospital level for clinicians and administrators. [ABSTRACT FROM AUTHOR]

This paper aims to apply a multi-criteria decision-making (MCDM) framework to evaluate the environmental performance of the medical service supply chain using a case study in India. An application of MCDM method, the fuzzy TOPSIS (Technique for order of preference by similarity to ideal solution) model, is used for Medical Support Service Provide firms (MSSPF) environmental performance evaluation. We require multiple and conflicting criteria to fix real-life decision-making challenges, which in turn led to the inception of (MCDM). However, MCDM is contracted with various contradictory requirements in which the knowledge of decision-makers is generally vague and thereby more challenging. In this situation, inclusions of fuzzy set theory in MCDM Methods would be good to solve the MCDM problem. In this study, the authors used a fuzzy TOPSIS MCDM model to solve the evaluation framework. Data were collected from the experts from the MSSPF about the more perfect criteria to assess environmental performance using a questionnaire. Case assesses the environmental performance, based on defined criteria, of three MSSPF by the experts. Fuzzy TOPSIS Method ranks three MSSPF according to environmental performance in the following order: Firm B, Firm A and Firm C. The result suggested that 'Firm B' performed superior environmental performance followed by 'Firm A' and 'Firm C'. This evaluation framework will help MSSPF to identify potential areas of further improvement in Environmental performance, and thereby creates strategies to overcome and formulate new innovations. Notably, this is one of the few studies to have used this method to gauge the environmental performance of the medical service supply chain in India. [ABSTRACT FROM AUTHOR]

Care at Doorstep (CAD) is a home care service that includes medical and social care by skilled professionals. The purpose of this paper is to explore the need for CAD among users of the district mental health programme (DMHP) in Ramanagaram, Karnataka, India who have severe mental illness. The design of this study was descriptive where a qualitative inductive methodology was adopted. Data was collected from interviews of 20 caregivers and 7 mental health service providers linked to the DMHP. Socio demographic information was collected from participants and a semi-structured interview guides were used to explore needs and challenges in delivering care at home by the professionals. The themes that emerged from the manually transcribed and coded data were categorized as needs and challenges and used for developing a CAD model. [ABSTRACT FROM AUTHOR]

This paper focuses on telemedicine implementation, which can be used to extend modern medical knowledge to remote areas in developing countries. By examining doctor- patient interactions in the context of a telemedicine program in India, we posit how the behaviour of the actors interacting over virtual media is determined by interplay between two dominant institutional logics, namely logic of care and logic of choice. The paper draws on the tenets of institutional logics to extend the theoretical understanding about processes of engagement of actors with a new technology and explicates how the engagement evolves with the use of technology. The research emphasizes the essential role of considering the dynamics of logic of care and logic of choice in the design and implementation process. [ABSTRACT FROM AUTHOR]

In the healthcare sector, race, ethnicity and religion have become an increasingly important factor in terms of patient care due to an increasingly diverse population. Health agencies at a national and local level produce a number of guides to raise awareness of cultural issues among healthcare professionals and hospitals may implement additional non-medical services, such as the provision of specific types of food and dress to patients or the hiring of chaplains, to accommodate the needs of patients with religious requirements. However, in an attempt to address the spiritual, cultural and religious needs of patients healthcare providers often assume that ethnic minority groups are homogenous blocks of people with similar needs and fail to recognize that a diverse range of views and practices exist within specific groups themselves. This paper describes the example of the Sikh community and the provision of palliative care in hospitals and hospices. Although, the majority of patients classifying themselves as Sikhs have a shared language and history, they can also be divided on a number of lines such as caste affiliation, degree of assimilation in the west, educational level and whether baptized or not, all of which influence their beliefs and practices and hence impact on their needs from a health provider. Given that it is unfeasible for health providers to have knowledge of the multitude of views within specific religious and ethnic communities and accounting for the tight fiscal constraints of healthcare budgets, this paper concludes by raising the question whether healthcare providers should step away from catering for religious and cultural needs that do not directly affect treatment outcomes, and instead put the onus on individual communities to provide resources to meet spiritual, cultural and religious needs of patients. [ABSTRACT FROM AUTHOR]

India has a vast reservoir of highly skilled, semi-skilled, and unskilled labor force and is one of the major source countries in the global labor market. The current paper is the first of its kind to focus primarily on migration of health professionals from India. In the absence of national-level data on migration, the paper uses data from different sources to outline the magnitude and direction of flow of health care providers from India. The paper also assesses the existing global and national policies on migration and discusses their relevance in the context of migration of health professionals from India. [ABSTRACT FROM AUTHOR]

This paper analyses the ethical considerations using the stakeholder theory on two specific domains of the newly implemented 'Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (PM-JAY)' scheme by the Government of India. The paper recommends a solidarity-based approach over an entitlement based one that focuses on out-of-pocket expenses for the most vulnerable and a stewardship role from the private sector to ensure equity, accountability, and sustainability of PM-JAY scheme. [ABSTRACT FROM AUTHOR]

Using the consumption expenditure data, National Sample Survey, 2009-2010, this paper test the hypothesis that the monthly per capita household health spending of elderly households is significantly higher than non-elderly households in India. The households are classified into three mutually exclusive groups; households with only elderly members (elderly households), households with elderly and non-elderly members and households without any elderly member. The health spending include the institutional (hospitalization) and non-institutional health expenditure of the households, standardized for 30 days. Descriptive statistics and a two part model are used to understand the differentials in health expenditures across households. Results indicate that the monthly per capita health spending increases with economic status, occupation, age and educational attainment of the head of the household. The monthly per capita health spending of elderly households is 3.8 times higher than that of non-elderly households. While the health spending accounts 13 % of total consumption expenditure for elderly households, it was 7 % among households with elderly and non-elderly members, and 5 % among non-elderly households. Controlling for socio-economic and demographic correlates, the per-capita household health spending among elderly households and among household with elderly and non-elderly members was significantly higher than non-elderly households. The health expenditure is catastrophic for poorer households, casual labourer and households with elderly members. Based on the finding we suggest to increased access to health insurance and public spending on geriatric care to reduce the out-of-pocket expenditure on health care in India. [ABSTRACT FROM AUTHOR]

Background: Accidental Injury is a traumatic event which not only influences physical, psychological, and social wellbeing of the households but also exerts extensive financial burden on them. Despite the devastating economic burden of injuries, in India, there is limited data available on injury epidemiology. This paper aims to, first, examine the socio-economic differentials in Out of Pocket Expenditure (OOPE) on accidental injury; second, to look into the level of Catastrophic Health Expenditure (CHE) at different threshold levels; and last, to explore the adjusted effect of various socio-economic covariates on the level of CHE. Methods: Data was extracted from the key indicators of social consumption in India: Health, National Sample Survey Organisation (NSSO), conducted by the Government of India during January-June-2014. Logistic regression analysis was employed to analyse the various covariates of OOPE and CHE associated to accidental injury. Findings: Binary Logistic analysis has demonstrated a significant association between socioeconomic status of the households and the level of OOPE and CHE on accidental injury care. People who used private health services incurred 16 times higher odds of CHE than those who availed public facilities. The result shows that if the person is covered via any type of insurance, the odd of CHE was lower by about 28% than the uninsured. Longer duration of stay and death due to accidental injury was positively associated with higher level of OOPE. Economic status, nature of healthcare facility availed and regional affiliation significantly influence the level of OOPE and CHE. Conclusion: Despite numerous efforts by the Central and State governments to reduce the financial burden of healthcare, large number of households are still paying a significant amount from their own pockets. There are huge differentials in cost for the treatment among public and private healthcare providers for accidental injury. It is expected that the findings would provide insights into the prevailing magnitude of accidental injuries in India, the profile of the population affected, and the level of OOPE among households. [ABSTRACT FROM AUTHOR]

Digital transformation in the health sector can revolutionize a country's healthcare system. However, the effective sustainability of digital health relies on various factors that influence its implementation. Addressing such implementation challenges is crucial in designing and delivering digital health services. Therefore, this systematic review attempted to identify the potential barriers to the implementation of digital transformation in the health sector of India. Systematic searches were employed across databases PubMed, PsycINFO, Science Direct, Web of Science, and Google Scholar for studies that reported digital transformation in India from inception to December 2022. Following narrative synthesis, studies were assessed for quality using JBI and the Mixed Methods Appraisal Tool (MMAT). Out of 1129 initially identified records, 26 studies that met the inclusion criteria were deemed eligible for final analysis. Although digital transformation in India's health sector occurred rapidly, especially during the COVID-19 pandemic, there are still potential barriers that impede its successful implementation in the country. Barriers identified are mainly associated with limited technological and medical infrastructure, data security and privacy, and a lack of physical examination. The need to address these barriers, recommendations for government and healthcare practitioners, and implications for future research are discussed. [ABSTRACT FROM AUTHOR]

Scientific Psychology in India has seen steady development since its inception in the early 1900s. With clinical psychology developing as an independent profession, clinical psychologists have been functioning in various roles, offering a wide range of services in consultation, training, research, and private practice on multidisciplinary teams as well as in independent practice. This paper focuses on the historical roots of clinical psychology in India and highlights the role of clinical psychologists in the general mental health care and the contributions made by the profession in a wide range of public and private health care settings. Ancient Indian systems of Medicine, mental health care and psychotherapy in India, and training-related and organizational issues are discussed. This paper reflects on the growth and development of clinical psychology that has occurred in India in spite of current difficulties and the challenges that lie ahead. [ABSTRACT FROM AUTHOR]

Intellectual disability in India is substantially under-reported, especially amongst females. This study quantifies the prevalence and gender bias in household reporting of intellectual disability by estimating the age-and-gender specific prevalence of the intellectually disabled by education, Socio-Demographic Index (SDI) score, place of residence, (rural/urban) and income of household head. We estimated prevalence (per 100,000) at 179 (95% CI: 173 to 185) for males and 120 (95% CI: 115 to 125) for females. Gender differences declined sharply with increased education, was higher for lower ages and low income and varied little by state development. Under-identification and under-reporting due to stigma are two plausible reasons for the gender differences in prevalence that increase with age. [ABSTRACT FROM AUTHOR]

Empirics of catastrophic healthcare expenditure, especially in the Indian context, are often based on consumption expenditure data that inadequately informs about the ability to pay. Use of such data can generate a pro-rich bias in the estimation of catastrophic expenditure thereby suggesting greater concentration of such expenditures among richer households. To improve upon the existing approach, this paper suggests a multidimensional approach to comprehend the incidence of catastrophic expenditure. Here, we integrate the information on health expenditure with other social and economic parameters of deprivation. An empirical illustration is provided by using nationally representative survey on morbidity and healthcare in India. The results of the multidimensional approach are consistent with the theoretical underpinnings of the ability-to-pay approach and emphasizes on the severity of the problem in rural areas. The suggested methodology is flexible and allows for context-specific prioritization in selection of parameters of vulnerability while estimating the incidence of catastrophic expenditures. [ABSTRACT FROM AUTHOR]

The Ayushman Bharat (Hindi for "India blessed with a long life") scheme is a government health insurance program that will cover about 100 million poor and vulnerable families in India providing up to INR 0.5 million per family per year for secondary and tertiary care hospitalization services. In addition, it also proposes to establish 150,000 health and wellness centers all over the country providing comprehensive primary health care. The beneficiaries of the hospital insurance scheme can avail health care services from both public and empanelled private health facilities. This scheme is one of the largest government-sponsored health insurance schemes in the world. Previous experience with government-financed health insurance schemes in India has shown that they are inequitable, inefficient, and do not provide financial protection. There is a lack of clarity on the budgetary provisions over the years when the utilization is likely to increase. The Ayushman Bharat scheme in its current form strengthens the "for profit" private health sector, requiring greater emphasis on its regulation. The scheme, which has primary, secondary, and tertiary care components, places a great focus on the secondary and tertiary care services and requires more investment in comprehensive primary health care. The potential problems of "profit-motivated" supplier-induced demand by private health care providers and corrupt practices are possible ethical burdens of the scheme. For the Ayushman Bharat to meet the ethical principle of justice, it should first address universal coverage of comprehensive primary health care and move on to hospital insurance in a progressive manner. The scheme should have provisions to strictly regulate secondary and tertiary care hospitalization in the private health sector to prevent misuse. It is the ethical responsibility of the government to ensure a strong and robust public health system, but the current provisioning of the Ayushman Bharat scheme does not do this and the reasons for this are explained in this paper. [ABSTRACT FROM AUTHOR]

This paper reports the accessibility and utilization of the healthcare services among a migrant indigenous community inhabiting slums of an eastern Indian city. It is based on data collected through semi-structured interviews conducted with heads of the households. The results indicated that the services of health personnel by visiting households are rare and the service provision was very poor. For curative services, the people heavily depend on private practitioners, including unqualified practitioners, by spending large proportions of their earnings. Due to migration, this community becomes more vulnerable to low utilization of healthcare services. This study warrants evolving a system of healthcare to cater the needs of vulnerable migrant groups in urban areas of India. [ABSTRACT FROM AUTHOR]

The present study is based on an astonishing data found in the Budget 2004 of the State of West Bengal. In spite of rising budgetary provision and actual expenditure on the rural health care services, 11% of the rural populace dies without any medical attention. Use of institutional medical services is still very low (just 14.75% of the reported death cases had used any sort of institutional health care before death). 74% of the populace of rural West Bengal dies after receiving non-institutional means of treatment. In this context, the paper assesses the basic causes of non-utilization of institutional health care services by the rural population of West Bengal. [ABSTRACT FROM AUTHOR]

On October 8, 2005, a major earthquake measuring 7.6 on the Richter scale struck the Himalayan region of Kashmir. Around 90,000 people died in the mass disaster. The Bone and Joint Hospital in Kashmir found itself in a relatively unique situation of having to deal with the orthopedic morbidity generated by this quake. The hospital received 468 patients over a period of 10 days, out of which 463 were received over the initial 5 days. The admission for a single day peaked at 153 patients on the third day. Due to the unprecedented admission in terms of numbers the hospital utilized outreach methods to streamline admission by sending out specialists to the affected areas. Manpower was judiciously utilized to concentrate specialist advise where required. Besides documenting the pattern of trauma, this paper throws light on some unforeseen problems faced in dealing with a large number of patients far exceeding the normal capacity of the hospital. [ABSTRACT FROM AUTHOR]

There are tremendous benefits to view a healthcare system as a flexible system. It helps to promote innovations towards greater quality of service as well as better utilization of the resources. Healthcare System (HCS) in India needs to promote improved customer services, greater collaborations within Health System, improved HCS system designs, re-engineering of the conventional processes, greater emphasis on total quality management, improved flexibility to respond quickly to various system needs and a good IT support. Development of the demonstrative simulation models for alternative HCS can offer alternative solutions to achieve more effective healthcare management systems. The objective of this paper is to study the existing healthcare system design and then propose suggestions towards a more customer friendly (yet efficient and competitive) healthcare system. This paper also presents some insight of the simulation model of the healthcare system (HCS) viewed as a flexible system, A flexible system view offers enormous knowledge that may be utilized to deploy and exploit flexibility (to be more quality oriented towards patient needs and yet remain efficient and competitive) with suitable IT based control strategies. It is like learning the best practices from one domain (Technology Systems) and employing them to another domain (Health Systems) with suitable adaptations. Our paper aims to offer some novel suggestions for HCS and show the benefits of treating it as a flexible system.. [ABSTRACT FROM AUTHOR]

Head and neck cancer (HNC) is third highest prevalent cancer among Indian which constitutes about 25–30% of all the cancer in India. Further, out-of-pocket expenditure (OOPE) covers around 67% of total healthcare expenditure and direct medical cost is key factor responsible for raised OOPE in India. Thus, we aimed to quantify total direct medical cost and OOPE associated with HNC management among HNC patients using "Ayushman Bharat Arogya Karnataka scheme" (ABArK scheme). A retrospective study was conducted for the duration of 6 months to collect the data related to total direct medical cost, coverage of "ABArK Scheme" and OOPE of past 2 years of HNC patients. The data of HNC patients above 18 years of age utilizing "ABArK scheme" were included in the study whereas data of patients utilizing other healthcare schemes and incomplete data on target schemes were excluded. A total of 196 patients (54.1%) utilized the "ABArK Scheme" out of 362 HNC patients treated in past 2 years. Among 196 patients, males (76.5%) were predominant over females (23.5%) with the mean age of 53.60 ± 11.58 years. We found that INR 17,370,279 as the total direct medical expenditure for the management of HNC patients of which around 87.465% was covered by "ABArK Scheme" minimizing the OOPE up to INR 3,297,970. Thus, Introduction and implementation of novel healthcare policies like "ABArK Scheme" can counteract financial burden of cancer management by significantly reducing OOPE which could be milestone achievement for the low-middle income countries like India. [ABSTRACT FROM AUTHOR]

In this paper, the author reports on a One Health trip to India that he recently led as part of Yale-NUS Learning Across Boundaries Program. It is an attempt not only to integrate OH education into non-medical programs but also to integrate environmental ethics education into OH curricula. [ABSTRACT FROM AUTHOR]

Respecting patients' rights is a fundamental aspect of providing quality healthcare. The present investigation attempts to explore the awareness among patients about their rights in a coastal township in India. A questionnaire-based cross-sectional study was carried out among 215 patients admitted to the wards of a tertiary care teaching hospital in Mangalore. Awareness among patients regarding their rights varied for various issues and ranged between 48.4 and 87.4 %. Awareness about patients' rights was independent of gender, socio-economic and educational status. Doctors were found to be the most common source of information for patient's about their rights in the study. Doctors must conform to the relevant legislations and involve patients in all aspects of healthcare. There is a need to increase awareness among patients about their rights to ensure informed decisions and better health care services. [ABSTRACT FROM AUTHOR]

'Palliative care', a branch of medicine, aims to alleviate pain and enhance quality of life in the patient suffering from life-threatening illnesses. In addition to regular curative treatment for the patient, it also provides bereavement support to the family thereafter. Search for exhaustive literature on palliative care initiatives and current status in India confirms a dearth for nationwide awareness as well as published literature concerning the performance of palliative care units. While only few institutions are involved in disseminating palliative care initiatives, the services are quite limited, demanding a need to consider this topic holistically. Conclusively, palliative care should address every aspect of health care and support to the ailing patient and their family members. The purpose of this paper is to analyse the palliative care process adopted by the case institution, i.e. a renowned Palliative Care and Training Centre (PCTC-1) in India, to discuss the palliative care initiatives and their performance outcomes. A situation-actor-process and learning-action-performance (SAP-LAP) model of inquiry has been applied for the case study (PCTC-1). It considers the present operations of the centre and actors as participants influencing the situation through different processes. Several pertinent issues leading to actions have been analysed, which have considerable impact on the delivery of palliative care services. Responses elicited through in-depth interviews with the actors form the basis of primary data along with the published secondary sources. PCTC-1 has undertaken numerous initiatives such as 'care beyond cure', 'wearing smiles' and rendering health care at the centre as well as homes. Issues related to spreading awareness and holistic services on palliative care demands priority. The government national healthcare system needs to include palliative care as a core programme for people inclusion. Presently, palliative care services in India are negligible, and people lack awareness about it. This study uses SAP-LAP inquiry as a novel approach, which attempts to analyse and synthesise the processes holistically in a single study on the performance of palliative care services rendered only by the case organisation (PCTC-1). The findings of this study could be widely used for managerial problem-solving experienced by other palliative care centres. Further empirical tests can be undertaken in the palliative care sector for deriving deeper linkages in the model. [ABSTRACT FROM AUTHOR]

India has also joined the club of ageing countries in the world with a rapid health transition and experienced demographic ageing. The rapid growth of the older adult population has raised serious concerns about their health and healthcare utilization. However, very limited research has been done on the effects of demographic ageing on health and healthcare utilization. With this perspective, the present study looked at patterns in morbidity prevalence and health-seeking behaviour among older adults in India. The data was used from the National Sample Survey Organization, 75th round (2017–18) government of India. The total sample for the analysis is 1,26,42 older adults aged 60 and above. Univariate, bivariate, and binary logistic regression analysis was employed to understand the effects of socio-demographic conditions on morbidity prevalence among older adults and their healthcare-seeking behaviour. The prevalence of non-communicable diseases were found to be higher (14.4%) than communicable diseases (5.4%), and other morbidities (8.5%) among older adults (≥ 60) in India during 2017–18. The prevalence of communicable (6.3%), non-communicable (21.8%), and Other diseases (11.7%) were higher among the oldest-older adults (80 + years) compared to other groups. The prevalence of the non-communicable disease was considerably higher among male older adults as compared to females. The morbidity pattern of older adults varies remarkably across the states of India. More than half of the older adults (54%) visited private health care facilities for seeking their in-patient care. The utilization of private health facilities was higher among male than female older adults in India. The findings of this study are essential in assisting policymakers and healthcare providers in identifying individuals at risk, and might be incorporated into present initiatives for older people's social, economic, and health security. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the advocacy of the INDO-US group on the need for pediatric emergency medicine (PEM) in India.

Surgicaltraining programs across the globe have the responsibility of preparing the future generation of surgeons while promoting quality and patient safety. Surgical training differs significantly between countries, which can be based on the requirements of local accrediting bodies, different patient populations, different healthcare delivery systems and cultural and traditional patterns unique to that particular training environment. In this article, we reviewed General surgery residency training in the USA, UK, and India to identify strengths and challenges. We also highlighted salient aspects of training, including duration of the training, resident work-hours, operative opportunities, rotation and supervision, essential skill development, research activity, assessment, and regulation. [ABSTRACT FROM AUTHOR]

The availability of fracture healing therapies to the general public is limited in India. The infrastructure of the health system in India, involving both public and private sectors, does not provide adequate opportunity for rural and low-income inhabitants to access needed care. Also the lack of funding from the government and the overall lack of physicians place a large strain on the system. This paper will take an in-depth look at the state of the current health care system and how it affects bone stimulation therapy in India. The Indian Journal of Orthopaedics was used as a reference for the bone stimulation therapies currently utilized in India. A general search of the therapies and technologies was performed to determine protocols and indications. A table of fracture healing therapies and technologies was composed which provides a description of each therapy, as well as its specific indications and protocols. This information was then used by the authors to hypothesize the most feasible methods of fracture healing to meet the Indian demographic. Based on an assessment of the health system of India, the most practical methods of bone stimulation therapy were determined. It was also determined that nearly all forms of therapy could be made available if sufficient resources were set aside for it. Bone stimulation therapy in India remains a large void in the health care system. [ABSTRACT FROM AUTHOR]

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The Indian Council of Medical Research-National Institute of Cancer Prevention and Research (ICMR-NICPR) has been conducting online cancer screening training certificate courses since 2017. Thereafter, multiple cohorts have been trained successfully in cancer screening using the Extensions for Community Healthcare Outcomes (ECHO) platform. A 14-week course was designed for various cadres of healthcare professionals (HCP), through which they were trained in cancer screening and their roles and responsibilities in implementing the population-based cancer screening, as per the operational framework released by the Ministry of Health and Family Welfare. Then, a contact program was held to upskill the participants in cancer screening techniques. Eight cohorts have been successfully trained using the hybrid model of online training and hands-on training. Cancer screening conducted utilizing the hybrid model, consisting of the online ECHO model, followed by hands-on training is a suitable training model to train large cohorts, such as the one in populous countries like India. [ABSTRACT FROM AUTHOR]

Health facility stigma impedes HIV care and treatment. Worry of contracting HIV while caring for people living with HIV is a key driver of health facility stigma, however evidence for this relationship is largely cross-sectional. This study evaluates this relationship longitudinally amongst nursing students and ward staff in India. Worry of contracting HIV and other known predictors of intent to discriminate were collected at baseline and 6 months in 916 nursing students and 747 ward staff. Using fixed effects regression models, we assessed the effect of key predictors on intent to discriminate over a 6-month period. Worry of contracting HIV predicted intent to discriminate for nursing students and ward staff in care situations with low and high-risk for bodily fluid exposure, confirming prior cross-sectional study results and underscoring the importance of addressing worry of contracting HIV as part of health facility HIV stigma-reduction interventions. [ABSTRACT FROM AUTHOR]

India has a considerable skilled manpower deficit in the area of child and adolescent mental health, given its population and their needs. To address this deficit, in the recent past, various centres in India have begun specialty training in the field of child and adolescent psychiatry with the lead being taken by the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. This is a welcome step in the right direction. However, specialty training of this nature cannot exist in a vacuum. There is a need for a comprehensive and cohesive child and adolescent mental health policy which must include adopting certain standards in training in the various sub-specialties of child and adolescent mental health. From this national policy, provisions must be made for a spectrum of care from specialized tertiary care to high-quality community-based care. Dedicated, skilled mental health professionals who will impart training at the highest level as well help train a cadre of specialists (psychiatrists, pediatricians) and non-specialists with various degrees of exposure and training in the field of child and adolescent mental health are the need of the hour to have a stepped model of care. This will go a long way in ensuring effective and equitable distribution of the sparse human resources. Similar issues may operate in other low- and middle-income countries and thus the discussion may be relevant to such populations as well. [ABSTRACT FROM AUTHOR]

Justification: Gaucher disease (GD) is amongst the most frequently occurring lysosomal storage disorder in all ethnicities. The clinical manifestations and natural history of GD is highly heterogeneous with extreme geographic and ethnic variations. The literature on GD has paucity of information and optimal management guidelines for Indian patients.Process: Gaucher Disease Task Force was formed under the auspices of the Society for Indian Academy of Medical Genetics. Invited experts from various specialties formulated guidelines for the management of patients with GD. A writing committee was formed and the draft guidelines were circulated by email to all members for comments and inputs. The guidelines were finalized in December 2016 at the annual meeting of the Indian Academy of Medical Genetics.Objectives: These guidelines are intended to serve as a standard framework for treating physicians and the health care systems for optimal management of Gaucher disease in India and to define unique needs of this patient population.Recommendations: Manifestations of GD are protean and a high index of suspicion is essential for timely diagnosis. Patients frequently experience diagnostic delays during which severe irreversible complications occur. Leucocyte acid β-glucosidase activity is mandatory for establishing the diagnosis of Gaucher disease; molecular testing can help identify patients at risk of neuronopathic disease. Enzyme replacement therapy for type 1 and type 3 Gaucher disease is the standard of care. Best outcomes are achieved by early initiation of therapy before onset of irreversible complications. However, in setting of progressive neurological symptoms such as seizures and or/neuroregression, ERT is not recommended, as it cannot cross the blood brain barrier. The recommendations herein are for diagnosis, for initiation of therapy, therapeutic goals, monitoring and follow up of patients. We highlight that prevention of recurrence of the disease through genetic counseling and prenatal diagnosis is essential in India, due to uniformly severe phenotypes encountered in our population. [ABSTRACT FROM AUTHOR]

Purpose: India faces multiple challenges to mitigate a high burden of psychiatric disorders. The risk of developing psychiatric disorder among the rural Indian population is poorly investigated. This study aims to understand the factors associated with probable psychiatric disorder (PPD) among a select rural Indian population.Methods: Data from the Birbhum population project of the society for health and demographic surveillance, West Bengal, India, were utilized. Cross-sectional data covering a sample of 31,135 respondents (male 15,384 and female 15,751) aged ≥ 16 years were used. The General Health Questionnaire-28 was administered and the responses were computed into three categories: psychological case, psychological caseness, and normal. Bivariate and multivariate ordered logit regression analyses were applied to attain the study objective.Results: Of the total population, 26% of respondents were identified with PPD. People aged ≥ 60 years, females, divorced/separated/widowed individuals, the unemployed and people with no formal education, individuals from the poorest economic group, and people with a history of selling or mortgaging assets towards their healthcare expenditure had a higher prevalence of psychiatric case within their respective group.Conclusions: A high burden of PPD was estimated in the select rural community. While designing an intervention for measuring and addressing psychiatric disorders, the socioeconomic gradient of PPD could be helpful. [ABSTRACT FROM AUTHOR]

Justification: India, home to almost 1.5 billion people, is in need of a country-specific, evidence-based, consensus approach for the emergency department (ED) evaluation and management of the febrile child. Process: We held two consensus meetings, performed an exhaustive literature review, and held ongoing web-based discussions to arrive at a formal consensus on the proposed evaluation and management algorithm. The first meeting was held in Delhi in October 2015, under the auspices of Pediatric Emergency Medicine (PEM) Section of Academic College of Emergency Experts in India (ACEE-INDIA); and the second meeting was conducted at Pune during Emergency Medical Pediatrics and Recent Trends (EMPART 2016) in March 2016. The second meeting was followed with futher e-mail-based discussions to arrive at a formal consensus on the proposed algorithm. Objective: To develop an algorithmic approach for the evaluation and management of the febrile child that can be easily applied in the context of emergency care and modified based on local epidemiology and practice standards. Recommendations: We created an algorithm that can assist the clinician in the evaluation and management of the febrile child presenting to the ED, contextualized to health care in India. This guideline includes the following key components: triage and the timely assessment; evaluation; and patient disposition from the ED. We urge the development and creation of a robust data repository of minimal standard data elements. This would provide a systematic measurement of the care processes and patient outcomes, and a better understanding of various etiologies of febrile illnesses in India; both of which can be used to further modify the proposed approach and algorithm. [ABSTRACT FROM AUTHOR]

In India men who have sex with men and engage in sex work (i.e., male sex workers; MSW) have a high risk of transmitting HIV. Globally, sex workers have become more spatially mobile due to advances in mobile-phone technology. In 2012 in-depth qualitative feedback was garnered from 40 interviews with MSW and four focus groups with 35 key informants (KIs) who had expert knowledge of the local MSW community to inform the design of an HIV-prevention intervention among MSW in Chennai, India. All MSW were recruited during outreach by employees of a Chennai-based organization for MSM (men who have sex with men). The data were analyzed using a descriptive qualitative approach. MSW and KIs discussed the need for intervention content that went beyond basic HIV psychoeducation. They emphasized the importance of addressing psychological distress, alcohol-related risk, and sexual communication skills. Concerns were raised about confidentiality, privacy, and scheduling. Participants endorsed a combination of in-person and mobile-phone-delivered sessions as well as the integration of mobile-phone messaging. These findings served as the basis for the development of a theoretically driven, manual-based intervention incorporating mobile phones. An open pilot assessed the feasibility and acceptability of the intervention with eight MSW. Assessments and HIV testing were administered at baseline, 3, and 6 months post-baseline. Exit interviews were conducted at the conclusion of the intervention. Retention for session attendance and assessment follow-up was 100 %. There was a high level of acceptability for the format, structure, and content. These data show initial promise, feasibility, and acceptability of the intervention. [ABSTRACT FROM AUTHOR]

Despite being newcomers, immigrants often exhibit better health relative to native-born populations in industrialized societies. We extend prior efforts to identify whether self-selection and/or protection explain this advantage. We examine migrant height and smoking levels just prior to immigration to test for self-selection; and we analyze smoking behavior since immigration, controlling for self-selection, to assess protection. We study individuals aged 20-49 from five major national origins: India, China, the Philippines, Mexico, and the Dominican Republic. To assess self-selection, we compare migrants, interviewed in the National Health and Interview Surveys (NHIS), with nonmigrant peers in sending nations, interviewed in the World Health Surveys. To test for protection, we contrast migrants' changes in smoking since immigration with two counterfactuals: (1) rates that immigrants would have exhibited had they adopted the behavior of U.S.-born non-Hispanic whites in the NHIS (full "assimilation"); and (2) rates that migrants would have had if they had adopted the rates of nonmigrants in sending countries (no-migration scenario). We find statistically significant and substantial self-selection, particularly among men from both higher-skilled (Indians and Filipinos in height, Chinese in smoking) and lower-skilled (Mexican) undocumented pools. We also find significant and substantial protection in smoking among immigrant groups with stronger relative social capital (Mexicans and Dominicans). [ABSTRACT FROM AUTHOR]

Programming platforms need to recognize the diversity of malnutrition epidemiology in India and choose appropriate implementation designs. With severe chronic malnutrition as the dominant epidemiologic entity, the net needs to be cast wide, focusing on: food security, health care, agriculture, water and sanitation, livelihoods and women's empowerment. Community-based malnutrition treatment and prevention programs need to collaborate to complement treatment with socioeconomic and preventive interventions. Expansion of nutrition rehabilitation centers should be limited to areas/districts with high wasting. Pediatric services with nested nutrition services (including counseling) requires urgent strengthening. Continuum of Care is a weak link and requires strengthening to make both hospital and community-based models meaningful. [ABSTRACT FROM AUTHOR]

Objective: To study the prevalence, clinical presentation and management of infants with ankyloglossia. Methods: A retrospective file review of infants less than 6 months of age with a diagnosis of ankyloglossia. Results: Of the 25786 babies born during the assessment period (2007-2015), 134 (0.52%) had ankyloglossia. Sixty-four (47.7%) infants who presented with breastfeeding difficulties were diagnosed significantly earlier than the asymptomatic group ( P<0.05). Of the symptomatic group, 85.9% underwent frenotomy with satisfactory results. Seventy asymptomatic infants were managed conservatively with counselling. Conclusions: Frenotomy seems to be a safe and effective procedure in infants with symptomatic ankyloglossia. [ABSTRACT FROM AUTHOR]

This is a study of the emergence of new institutional arenas for ayurveda and yunani medicine, collectivized at the time as 'indigenous medicine,' in a semi-autonomous State (Mysore) in late colonial India. The study argues that the characteristic dimensions of this process were compromise and misalignment between ideals of governance and modes of pedagogy and practice. Running counter to a narrative that the Princely States such as Mysore were instrumental for the 'preservation' of ayurveda, this study analyzes the process of negotiation and struggle between a variety of actors engaged with shaping the direction of institutionalized 'indigenous medicine'. In examining the entanglements over the priorities of the state administration and the conflicting desires and ideals of protagonists, the study problematizes the idea of studying the encounter between the 'state' and 'indigenous medicine,' in order rather to highlight their co-production and the tensions which were generated in the process. While institution-making for ayurveda and yunani in Mysore State assumed distinctive translocal forms, themes of divergence that were unresolved during the time of this study, over the role of the state, the politics of validation, appropriate curricula and pedagogy, and their relation to practice and employment, continue to inform the trajectories of state-directed health provision through 'indigenous medicine' on larger scales [India, health-care, ayurveda, yunani, education]. [ABSTRACT FROM AUTHOR]

Allopathic medical professionals in developed nations have started to collaborate with traditional, complementary, and alternative medicine (TCAM) to enquire on the role of religion/spirituality (r/s) in patient care. There is scant evidence of such movement in the Indian medical community. We aim to understand the perspectives of Indian TCAM and allopathic professionals on the influence of r/s in health. Using RSMPP (Religion, Spirituality and Medicine, Physician Perspectives) questionnaire, a cross-sectional survey was conducted at seven (five TCAM and two allopathic) pre-selected tertiary care medical institutes in India. Findings of TCAM and allopathic groups were compared. Majority in both groups (75 % of TCAM and 84.6 % of allopathic practitioners) believed that patients' spiritual focus increases with illness. Up to 58 % of TCAM and allopathic respondents report patients receiving support from their religious communities; 87 % of TCAM and 73 % of allopaths believed spiritual healing to be beneficial and complementary to allopathic medical care. Only 11 % of allopaths, as against 40 % of TCAM, had reportedly received 'formal' training in r/s. Both TCAM (81.8 %) and allopathic (63.7 %) professionals agree that spirituality as an academic subject merits inclusion in health education programs ( p = 0.0003). Inclusion of spirituality in the health care system is a need for Indian medical professionals as well as their patients, and it could form the basis for integrating TCAM and allopathic medical systems in India. [ABSTRACT FROM AUTHOR]

This article provides global and Indian scenario with strengths and limitations of present health care system. Affordability, accessibility and availability of health care coupled with disproportionate growth and double burden of diseases have become major concerns in India. This article emphasizes need for mindset change from illness-disease-drug centric curative to person-health-wellness centric preventive and promotive approaches. It highlights innovation deficit faced pharmaceutical industry and drugs being withdrawn from market for safety reasons. Medical pluralism is a growing trend and people are exploring various options including modern, traditional, complementary and alternative medicine. In such a situation, knowledge from Ayurveda, yoga, Chinese medicine and acupuncture may play an important role. We can evolve a suitable model by integrating modern and traditional systems of medicine for affordable health care. In the larger interest of global community, Indian and Chinese systems should share knowledge and experiences for mutual intellectual enrichments and work together to evolve a novel model of integrative medicine. [ABSTRACT FROM AUTHOR]

Cutaneous zygomycosis remains underdiagnosed despite being frequently encountered. Delay in the diagnosis contributes to delay in treatment, and a resultant high morbidity and mortality. A retrospective analysis of the reported cases of cutaneous zygomycosis from India was made using various search engines and cross-referencing from available manuscripts. A total of 42 publications from India on the topic were identified, since the first reported case of primary cutaneous zygomycosis by Veliath et al. (). There are 130 described cases of cutaneous zygomycosis with an overall mortality of 35 %. The commonest zygomycete identified was Apophysomyces elegans, and the commonest predisposing factor was breach of the skin. Surprisingly, diabetes was reported only in 36 cases (27.69 %). It is important to be aware of this unusual but fatal infection in order to manage it properly and have a good outcome. [ABSTRACT FROM AUTHOR]

The article focuses on the introduction of qualitative research to Indian pediatrics. It notes that qualitative research asks what, how and why questions rather than how often or how many offering important information about the delivery of health services otherwise unavailable through quantitative research methodologies. It cites that qualitative research allows examination and interpretation of observations, essential to figure out their true meaning. Qualitative research techniques enable better understanding of one's perspectives about an illness.

This qualitative inquiry explored the meaning of healthy aging, health status of the elderly they serve, availability of programs and services, and knowledge of policies specific to seniors from the perspective of health service providers in India. To this end, 100 physicians, allied and alternative health care providers were recruited using snowball sampling method and interviewed in person. The health service providers showed an overall tendency toward holistic definitions including aspects of physical, mental and social wellbeing and reported widely prevalent health problems in each of those domains (e.g., physical health problems, social health concerns resulting from changing family structure). In discussing programs and services available to seniors, a wide range was evident; however the need for expanded health and social support was clear. In order to adequately respond to this need, policy development and implementation relating to the aging population is necessary and three key considerations are highlighted. [ABSTRACT FROM AUTHOR]

Length of stay (LOS) in hospital for inpatient treatment is a measure of crucial recovery time. Using nationwide data on inpatient healthcare in India, a three-component finite mixture negative binomial model was found to provide a reasonable fit to the heterogeneous LOS distribution. Associated risk factors for short-stay, medium-stay and long-stay subgroups were identified from the respective negative binomial components. In addition, significant heterogeneities within each group were also found. [ABSTRACT FROM AUTHOR]

In India the public health-care system is unable to keep pace with the growing need, and the country has witnessed unprecedented growth in the number of private health-care institutions. However, the pattern of utilization of public and private health-care facilities and the cost of treatment in these hospitals remains unclear; thus, this is the main objective of this study. The study explores the data of 6,726 inpatients hospitalized for treatment of diarrheal diseases, heart disease, tuberculosis, urological diseases and gynecological disorders from a nationally representative survey on health care conducted by the National Sample Survey Organization (NSSO, ) in its 60th round in 2004. A multilevel model, with patients (first level) nested in states (second level), was used to unearth the adjusted costs of hospitalization for people of different backgrounds. Logistic regression was used to obtain the adjusted odds of choosing public facilities compared to private facilities by ailment type, hospital characteristics and patient backgrounds. The analysis revealed that more than 58 percent of the patients have utilized private health-care facilities in India. As expected, the mean cost of treatment in private hospitals is Rs. 5,019 after adjusting for confounders compared to Rs. 1,307 for public hospitals. The mean adjusted cost of treatment of heart diseases is Rs. 5,981, followed by Rs. 5,402, Rs. 4,616, Rs. 2,478 and Rs. 891 for urological diseases, gynecological disorders, tuberculosis and diarrheal diseases, respectively. Better off patients incurred the highest out-of-pocket costs, in the range of Rs. 4,967 to Rs. 8,457. It is evident that for the diseases considered in the study, the private sector plays an important role in providing health facilities. The cost of hospitalization in private health facilities is considerably higher compared to that of public facilities as far as the five ailments are concerned. Among the ailments, chronic conditions were seen to consume higher costs of treatment. However, more people opted for the unregulated private facilities. [ABSTRACT FROM AUTHOR]

Diabetes was estimated to be responsible for 109 thousand deaths, 1157 thousand years of life lost and for 2263 thousand disability adjusted life years (DALYs) in India during 2004. However, health systems have not matured to manage diabetes effectively. The limited studies available on diabetes care in India indicate that 50 to 60% of diabetic patients do not achieve the glycemic target of HbA1c below 7%. Awareness about and understanding of the disease is less than satisfactory among patients, leading to delayed recognition of complications. The cost of treatment, need for lifelong medication, coupled with limited availability of anti-diabetic medications in the public sector and cost in the private sector are important issues for treatment compliance. This article attempts to highlight the current constraints in the health system to effectively manage diabetes and the need for developing workable strategies for ensuring timely and appropriate management with extensive linkage and support for enhancing the availability of trained manpower, investigational facilities and drugs. [ABSTRACT FROM AUTHOR]

Poor care seeking contributes significantly to high neonatal mortality in developing countries. The study was conducted to identify care-seeking patterns for sick newborns in rural Rajasthan, India, and to understand family perceptions and circumstances that explain these patterns. Of the 290 mothers interviewed when the infant was 1 to 2 months of age, 202 (70%) reported at least one medical condition during the neonatal period that would have required medical care, and 106 (37%) reported a danger sign during the illness. However, only 63 (31%) newborns with any reported illness were taken to consult a care provider outside home, about half of these to an unqualified modern or traditional care provider. In response to hypothetical situations of neonatal illness, families preferred home treatment as the first course of action for almost all conditions, followed by modern treatment if the child did not get better. For babies born small and before time, however, the majority of families does not seem to have any preference for seeking modern treatment even as a secondary course of action. Perceptions of ‘smallness’, not appreciating the conditions as severe, ascribing the conditions to the goddess or to evil eye, and fatalism regarding surviving newborn period were the major reasons for the families’ decision to seek care. Mothers were often not involved in taking this critical decision, especially first-time mothers. Decision to seek care outside home almost always involved the fathers or another male member. Primary care providers (qualified or unqualified) do not feel competent to deal with the newborns. The study findings provide important information on which to base newborn survival interventions in the study area: need to target the communication initiatives on mothers, fathers and grandmothers, need for tailor-made messages based on specific perceptions and barriers, and for building capacity of the primary care providers in managing sick newborns.Journal of Perinatology (2008) 28, S31–S37; doi:10.1038/jp.2008.167 [ABSTRACT FROM AUTHOR]

To assess symptom-specific care-seeking practices for newborns and behavioral factors associated with them to inform strategies to enhance newborn care seeking in urban Lucknow, Northern India. This was a prospective follow-up study of consecutive 326 neonates delivered at an urban reproductive and child health (RCH) center. Focused Group Discussions (n=5) were also conducted in urban slums (n=3) at the RCH center (n=1) and at a district hospital (n=1). Overall, 326 neonates were recruited within 48 h of birth and 289 (88.7%) were followed up at 6 weeks (±15 days) at home. Parents of 51.2% (148/289) neonates reported at least one symptom of illness. Among these, 27.3% (79/289) neonates had at least one reported Integrated Management of Neonatal and Childhood Illnesses (IMNCI) danger sign, of which 15 (18.9%) did not receive any modern medical care, 5(33.3%) of which were dead by early infancy. Care seeking from unqualified providers (spiritual/traditional) was 33.3% (3/9) for persistent diarrhea and 23.5% (4/17) for pneumonia. Qualitative data from Focused Group Discussions showed that when pictures of some danger signs were shown like sunken eyes, reduced skin turgor, chest in-drawing and bulged fontanel, care seeking for these as well as fast breathing were influenced by ‘local beliefs’, which considered them to be untreatable by modern medicines alone. Thus, care seeking from multiple providers and use of traditional/home remedies delayed appropriate and timely medical care seeking. Almost half of the neonates had an illness symptom of which half had an IMNCI danger sign, of which one fifth did not receive medical care. Therefore, there is an urgent need to introduce a locally modified community IMNCI program here, for promoting care seeking from qualified providers for sick neonates.Journal of Perinatology (2008) 28, S69–S75; doi:10.1038/jp.2008.169 [ABSTRACT FROM AUTHOR]

The year 1986 saw first case of HIV infection as well as first report of AIDS case in India. Since then the epidemic has spread throughout the country. In the recent years there is evidence of epidemic being stabilized with decrease in new infections reported from some parts of the country. The absolute number of HIV infections in the country is expected to be close to 2.5 million and National AIDS Control Programme, phase III is geared to contain the epidemic. HIV viruses circulating in India predominantly belong to HIV-1 subtype C. However, there have been occasional reports of HIV-1 subtype A and B. Matter of concern is reports of A/C and B/C mosaic viruses that are being reported from different parts of the country. The data on HIV drug resistance from India is rather limited. Most of the studies have shown that the virus strains from drug naïve patients do not show significant level of drug resistance mutations. The few immunological studies in Indian patients show that the Indian HIV infected patients show both HIV-specific CTL responses as well as neutralizing antibody response. Mapping of CTL epitopes showed that while Indian patients identify same regions of Gag antigen as recognized by South African subtype C infected patients, some regions are uniquely recognized by Indian patients. There are very few studies on host genetic factors in India in context with HIV infection. However there are evidences reported of association of host genetic factors such as HLA types and haplotypes and HIV disease. [ABSTRACT FROM AUTHOR]