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Value-oriented education has been an integral facet of education. The need for value education stems from the social malaise in the society and education, being purposeful in making students responsible citizens, must address such deficiencies in values. This study aims to understand the attitude of student teachers and in-service teachers' towards current education and its value systems and seeks their stand on requiring value-oriented education as they are the major stake holders of direct classroom education experience other than students. The case study of Elizabeth Holmes and Annie Dookhan was used to assess how academically strong individuals end up straying into fraudulent ways. The study was administered using an electronic questionnaire, the frequency range was established using SPSS and indexed to percentage values. The data shed light on the attitude of student teachers and in-service teachers feeling that current education fails to inculcate values and suggested some methods of reform in the value systems of current education.

Abstract Breastfeeding provides many health benefits, but its impact on respiratory health remains unclear. This study addresses the complex and dynamic nature of the mother-milk-infant triad by investigating maternal genomic factors regulating human milk oligosaccharides (HMOs), and their associations with respiratory health among human milk-fed infants. Nineteen HMOs are quantified from 980 mothers of the CHILD Cohort Study. Genome-wide association studies identify HMO-associated loci on chromosome 19p13.3 and 19q13.33 (lowest P = 2.4e–118), spanning several fucosyltransferase (FUT) genes. We identify novel associations on chromosome 3q27.3 for 6′-sialyllactose (P = 2.2e–9) in the sialyltransferase (ST6GAL1) gene. These, plus additional associations on chromosomes 7q21.32, 7q31.32 and 13q33.3, are replicated in the independent INSPIRE Cohort. Moreover, gene-environment interaction analyses suggest that fucosylated HMOs may modulate overall risk of recurrent wheeze among preschoolers with variable genetic risk scores (P

Abstract Introduction The India Hypertension Control Initiative (IHCI) emphasizes decentralized patient-centric care to boost hypertension control in public healthcare facilities. We documented the decentralization process, enrolment pattern by facility type, and treatment outcomes in nine districts of Punjab and Maharashtra states, India, from 2018–2022. Methods We detailed the shift in hypertension care from higher facilities to Health and Wellness Centres (HWCs) using the World Health Organization (WHO) health system pillar framework. We reviewed hypertension treatment records in 4,045 public facilities from nine districts in the two states, focusing on indicators including registration numbers, the proportion of controlled, uncontrolled blood pressure (BP), and missed visits among those under care. Results The decentralization process involved training, treatment protocol provision, supervision, and monitoring. Among 394,038 individuals registered with hypertension from 2018–2021, 69% were under care in 2022. Nearly half of those under care (129,720/273,355) received treatment from HWCs in 2022. Care of hypertensive individuals from district hospitals (14%), community health centres (20%), and primary health centres (24%) were decentralized to HWCs. Overall BP control rose from 20% (4,004/20,347) in 2019 to 58% (157,595/273,355) in 2022, while missed visits decreased from 61% (12,394/20,347) in 2019 to 26% (70,894/273,355) in 2022. This trend was consistent in both states. HWCs exhibited the highest BP control and the lowest missed visits throughout the study period compared to other facility types. Conclusion We documented an increase in decentralized access to hypertension treatment and improved treatment outcomes over four years. We recommend operationalizing hypertension care at HWCs to other districts in India to improve BP control.

Abstract Introduction Physicians need an accurate understanding of diabetic retinopathy (DR) severity to optimally manage patients. The aim of this prospective study is to correlate the severity of macular and peripheral retinal vascular abnormalities seen on widefield (WF) optical coherence tomography angiography (OCTA) with DR grading based on WF fundus photography. Methods The study included 150 eyes from 82 patients with treatment-naïve DR. All patients were imaged with WF fundus photography and swept-source WF OCTA. Quantitative and qualitative analyses of the foveal avascular zone (FAZ) size and shape, and measurement of capillary nonperfusion (CNP) areas, were performed from the OCTA images. The mixed-effects model was used to compare the DR grading from WF photography with the vascular changes seen on WF-OCTA, and Bonferroni correction was applied to the gradings. Results The mean [± standard deviation (SD)] age of patients was 55.5 (± 9.4) years. The WF-OCTA showed that an increasing size of the FAZ (from 0.442 (± 0.059) µm to 0.933 (± 0.086) µm) correlated with increasing severity of the DR (as determined with WF photography). The deep capillary plexus, FAZ size, and CNP areas in eyes with proliferative diabetic retinopathy (PDR) differed from those with mild nonproliferative diabetic retinopathy (NPDR) (p

Background: Sparse recent data are available regarding the aetiological causes of the right iliac fossa (RIF) mass from Andhra Pradesh. Methods: We prospectively studied the clinical presentation, diagnosis and management of consecutive cases (n = 100) presenting to our tertiary care teaching hospital with a RIF mass over 2 years. Results: Majority of RIF masses were seen in the third and fourth decades of life, and the male-to-female ratio was 2.8:1; 64% of the cases were due to appendicular pathology (appendicular mass [48%] and appendicular abscess [16%]), followed by ileocaecal tuberculosis (TB) (12%) and carcinoma caecum (10%) among others. Carcinoma caecum was more common in males (70%) as compared to females (30%). The majority (78%) were managed surgically; 4% died. Post-operative complications included wound infection and respiratory tract infection. Conclusions: Our observations suggest that appendicular pathology, ileocaecal TB and carcinoma caecum are common aetiological causes for RIF mass. Abdominal ultrasonography and computed tomography will facilitate early localisation.

Abstract Background Epigenetic modifications, particularly DNA methylation (DNAm) in cord blood, are an important biological marker of how external exposures during gestation can influence the in-utero environment and subsequent offspring development. Despite the recognized importance of DNAm during gestation, comparative studies to determine the consistency of these epigenetic signals across different ethnic groups are largely absent. To address this gap, we first performed epigenome-wide association studies (EWAS) of gestational age (GA) using newborn cord blood DNAm comparatively in a white European (n = 342) and a South Asian (n = 490) birth cohort living in Canada. Then, we capitalized on established cord blood epigenetic GA clocks to examine the associations between maternal exposures, offspring characteristics and epigenetic GA, as well as GA acceleration, defined as the residual difference between epigenetic and chronological GA at birth. Results Individual EWASs confirmed 1,211 and 1,543 differentially methylated CpGs previously reported to be associated with GA, in white European and South Asian cohorts, respectively, with a similar distribution of effects. We confirmed that Bohlin’s cord blood GA clock was robustly correlated with GA in white Europeans (r = 0.71; p = 6.0 × 10–54) and South Asians (r = 0.66; p = 6.9 × 10–64). In both cohorts, Bohlin’s clock was positively associated with newborn weight and length and negatively associated with parity, newborn female sex, and gestational diabetes. Exclusive to South Asians, the GA clock was positively associated with the newborn ponderal index, while pre-pregnancy weight and gestational weight gain were strongly predictive of increased epigenetic GA in white Europeans. Important predictors of GA acceleration included gestational diabetes mellitus, newborn sex, and parity in both cohorts. Conclusions These results demonstrate the consistent DNAm signatures of GA and the utility of Bohlin’s GA clock across the two populations. Although the overall pattern of DNAm is similar, its connections with the mother's environment and the baby's anthropometrics can differ between the two groups. Further research is needed to understand these unique relationships.

Introduction: Variety and adequacy of intake of food are required to meet the nutritional needs of the children. Due to poverty/illiteracy, poor families depend on a single food group that is, cereals. Due to the pandemic also, the nutrition of the growing children is affected. Objective: To know the effect of quantity and quality of diet on the nutritional status of under-five children. Methodology: This study had 270 children aged between 1 and 4 years registered at Anganwadi as study participants. Information on sociodemographic variables, quantity of calories and proteins consumed, quality of diet, and anthropometry of children was collected. Percentages and paired t-tests were used to find the difference between nutritional status and diet at different intervals, which was found to be statistically significant (P < 0.05). Results: In our study, we found that as the quantity and quality of diet improved nutritional status, especially weight for age, body mass index (BMI) for age Z score also improved. There was a significant difference between calories consumed at the baseline, 6 months and 1 year with P < 0.05. Protein intake was significant between baseline and six months with P < 0.005. Conclusion: Our study found a high percentage of undernutrition and wasting in the under-five population when diet was not sufficient in quality and quantity. As the quality and quantity of diet improved nutritional status also improved.

The response of retinal pathology to interventions in diabetic retinopathy (DR) is often independent of the glycated hemoglobin (HbA1c) values at the point of care. This is despite glucose control being one of the strongest risk factors for the development and progression of DR. Previous preclinical and clinical research has indicated metabolic memory, whereby past cumulative glucose exposure may continue to impact DR for a prolonged period. Preclinical studies have evaluated punitive metabolic memory through poor initial control of DM, whereas clinical studies have evaluated protective metabolic memory through good initial control of DM. In this narrative review, we evaluate the preclinical and clinical evidence regarding metabolic memory and discuss how this may form the basis of preventive care for DR by inducing “metabolic amnesia” in people with a history of uncontrolled diabetes in the past. While our review suggested mitochondrial biology may be one such target, research is still far from a possible clinical trial. We discuss the challenges in such research.

Introduction: Location or distance from healthcare facilities affects the use of health facilities of households. Use of health facilities also have an impact on the socioeconomic conditions. Distance from healthcare facilities significantly affects catastrophic health expenditures. This study aimed to determine the association of physical distance to healthcare facilities with the economic deprivation of households. Objective: This study aims to analyze the distance of healthcare facilities from households in different wealth index categories of Odisha. The study argues that the household wealth index is associated with the distance to healthcare facilities. Methodology: This study is based on six purposively selected districts in Odisha: Rayagada, Kalahandi, Angul, Keonjhar, Khordha, and Kendrapara. A cross-sectional household survey was conducted to collect the data. A total of 902 household data points were collected. Data analysis was carried out in SPSS version 25. Results: A difference is observed among households that need to travel more than one hour to reach a private doctor or private hospital: 42.6% of poor households face this challenge, whereas only 25% of wealthy households do. Among those who cannot reach a public hospital in less than an hour, a larger proportion are from poor households (62.6%). The poor and wealthy segments of the population have nearly equal access to NGO-run healthcare facilities in terms of proximity. We observe that poor households are less likely than wealthy households to reach private pharmacists in less than an hour and are more likely to require over an hour to reach them. Conclusion: Ensuring healthcare facilities is the minimum requirement within one hour of reach for every household in India. Underreporting of illnesses and diseases is one of the major factors of high mortality in the population. Physical accessibility to healthcare facilities can reduce the mortality burden on the population.

Objective: The complex relationship between cancer care and poverty was examined in this study. This study identified the associations of various demographic factors with cancer care. The study also analyzes the family's role and support network in cancer care. Methodology: This study employed a mixed-method approach to understand cancer care in Jharkhand, India, comprehensively. The study was conducted as a cross-sectional survey with 204 reproductive cancer patients. The structured interview schedule covered the socio-demographic variables and cancer care facilities. The study also used case study methods with three eligible adults who underwent or are currently receiving cancer treatment. Descriptive statistics were used to summarize the study findings. The narratives of each case study provide a comprehensive understanding of each patient's journey to cancer care. The study received ethical approval from the Institutional Review Board (IRB) and the Cancer Hospital. Results: The survey results show that 47 percent of the respondents access the treatment. Only 12.7 percent of the respondents had taken the HPV vaccine, and 44.6 percent had received physiotherapy during the treatment. Forty-four percent of the respondents accessed counseling services from health service providers. The respondents' characteristics, such as age and gender, were strongly associated with access to counseling services. Education and family income were statistically associated with access to cancer care treatment. Only 7.4 percent of respondents arranged transport for treatment, and 11.8 percent arranged logistics and various treatment therapies for cancer care. Cancer patients from Jharkhand frequently face discrimination in receiving health care because of their economic condition. The case study revealed differences in wealth, social class and family role in cancer care. As a result, cancer patients often feel hopeless and isolated, leading to depression and anxiety. Conclusion and Implications: Poverty plays a negative role in providing and accessing cancer care in the state of Jharkhand. The role of family and society is essential for cancer survival. Psychological support from the family gives hope to the life of cancer patients. To address the complex relationship between financial burden and cancer care, both government agencies and social structures must implement comprehensive strategies.

Access to reproductive cancer care in India is significantly affected by social determinants of health. Reproductive cancers, including cervical, ovarian, and uterine cancers, constitute a significant health challenge for women in India. This cross-sectional survey aims to comprehensively assess the landscape of reproductive cancer care among women in India, exploring access, awareness, and barriers to timely diagnosis and treatment. This study highlights challenges in delivering care for reproductive cancers among women in India. A cross-sectional survey design was adopted, involving a representative sample of women from four diverse geographical regions, urban and rural settings, and varying socioeconomic backgrounds. Structured interviews were conducted, and questionnaires were used to collect data on participants’ awareness of reproductive cancers, utilization of healthcare facilities, and experiences related to access to cancer care. The study adopted a convenient sampling approach and captured data from 509 women diagnosed with reproductive cancer. The collected data were analysed using the SPSS 25 version. Univariate, bivariate and multivariate analyses were performed. The survey identified one-fourth of the respondents as having ovarian cancer, and 23.4% were diagnosed with cervical cancer. One-third of the study respondents were diagnosed with breast cancer, and 18% had other reproductive system cancers. The survey also assesses the prevalence of risk factors contributing to the incidence of reproductive cancers. Socioeconomic status, education level, rural‒urban settings, and cultural beliefs influence the healthcare-seeking behavior of the study participants. Insufficient knowledge, the stigma of reproductive health problems, and a lack of family income frequently discourage women from obtaining timely medical treatment.

Background: Maternal smoking has been linked to adverse health outcomes in newborns but the extent to which it impacts newborn health has not been quantified through an aggregated cord blood DNA methylation (DNAm) score. Here, we examine the feasibility of using cord blood DNAm scores leveraging large external studies as discovery samples to capture the epigenetic signature of maternal smoking and its influence on newborns in White European and South Asian populations. Methods: We first examined the association between individual CpGs and cigarette smoking during pregnancy, and smoking exposure in two White European birth cohorts (n=744). Leveraging established CpGs for maternal smoking, we constructed a cord blood epigenetic score of maternal smoking that was validated in one of the European-origin cohorts (n=347). This score was then tested for association with smoking status, secondary smoking exposure during pregnancy, and health outcomes in offspring measured after birth in an independent White European (n=397) and a South Asian birth cohort (n=504). Results: Several previously reported genes for maternal smoking were supported, with the strongest and most consistent association signal from the GFI1 gene (6 CpGs with p0.05) among South Asians, likely due to a lack of smoking in this group. The same score was consistently associated with a smaller birth size (–0.37±0.12 cm, p=0.0023) in the South Asian cohort and a lower birth weight (–0.043±0.013 kg, p=0.0011) in the combined cohorts. Conclusions: This cord blood epigenetic score can help identify babies exposed to maternal smoking and assess its long-term impact on growth. Notably, these results indicate a consistent association between the DNAm signature of maternal smoking and a small body size and low birth weight in newborns, in both White European mothers who exhibited some amount of smoking and in South Asian mothers who themselves were not active smokers. Funding: This study was funded by the Canadian Institutes of Health Research Metabolomics Team Grant: MWG-146332.

Summary: The prevalence of type 2 diabetes (T2D), associated systemic disorders, diabetic retinopathy (DR) and current health policies in south Asian countries were analysed to assess country-specific preparedness to meet the 2030 Sustainable Development Goals. The south Asian countries were classified by human development index, socio-demographic index, multidimensional poverty indices, and eye health resources for epidemiological resource-level analysis. In south Asia, the prevalence of diagnosed and undiagnosed T2D in adults aged 40 years or above, was higher in Pakistan (26.3%) and Afghanistan (71.4%), respectively; India has the highest absolute number of people with DR, and Afghanistan has the highest prevalence of DR (50.6%). In this region, out-of-pocket spending is high (∼77%). This Health Policy is a situational analysis of data available on the prevalence of DR and common eye diseases in people with T2D in south Asia and available resources to suggest tailored health policies to local needs. The common issues in the region are insufficient human resources for eye health, unequal distribution of available workforce, and inadequate infrastructure. Addressing these challenges of individuals with T2D and DR, a 10-point strategy is suggested to improve infrastructure, augment human resources, reduce out-of-pocket spending, employ targeted screening, and encourage public-private partnerships.