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Abstract The high-quality genome of coconut (Cocos nucifera L.) is a crucial resource for enhancing agronomic traits and studying genome evolution within the Arecaceae family. We sequenced the Chowghat Green Dwarf cultivar, which is resistant to the root (wilt) disease, utilizing Illumina, PacBio, ONT, and Hi-C technologies to produce a chromosome-level genome of ~ 2.68 Gb with a scaffold N50 of 174 Mb; approximately 97% of the genome could be anchored to 16 pseudo-molecules (2.62 Gb). In total, 34,483 protein-coding genes were annotated; the BUSCO completeness score was 96.80%, while the k-mer completeness was ~ 87%. The assembled genome includes 2.19 Gb (81.64%) of repetitive sequences, with long terminal repeats (LTRs) constituting the most abundant class at 53.76%. Additionally, our analysis confirms two whole-genome duplication (WGD) events in the C. nucifera lineage. A genome-wide analysis of LTR insertion time revealed ancient divergence and proliferation of copia and gypsy elements. In addition, 1368 RGAs were discovered in the CGD genome. We also developed a web server ‘Kalpa Genome Resource’ ( http://210.89.54.198:3000/ ), to manage and store a comprehensive array of genomic data, including genome sequences, genetic markers, structural and functional annotations like metabolic pathways, and transcriptomic profiles. The web server has an embedded genome browser to analyze and visualize the genome, its genomics elements, and transcriptome data. The in-built BLAST server allows sequence homology searches against genome, annotated transcriptome & proteome sequences. The genomic dataset and the database will support comparative genome analysis and can expedite genome-driven breeding and enhancement efforts for tapping genetic gains in coconut.

Background & objectives: Malaria is one of the critical public health problems globally as well as in India. Recent times have seen an increase in the importance of the possible effects of environmental and demographic factors on the local transmission of malaria. We conducted a community-level study between urban and rural areas to find out the factors associated with malaria infection. Methods: A community-based observational cross-sectional study was conducted between October 2020 and September 2022 among 330 households from urban areas of Chetla, Kolkata and rural areas of Singur district of West Bengal state of India. Households were selected by two stage random sampling method. Study was done by face-to-face interview, review of medical records and observation of the households. SPSS software was used for data analysis. Multivariable logistic regression (hierarchical model) was done and p-value equal to or less than 0.05 was taken as significant. Results: The prevalence of malaria infection among participants and household level risks of malaria infection were found to be 6.1%, 1.8% and 18.8%, 6.7%, respectively in the urban and rural areas. Significant predictors of malaria infection were households with ≥5 family members [AOR=2.91{CI (1.19-7.15)}], households not using any mosquito protective measures [AOR=3.71{CI (1.04-13.13)}], presence of mosquito breeding places [AOR=4.93{CI (1.53-15.93)}], absence of effective window screen [AOR=3.19{CI (1.16-8.71)}], absence of separate kitchen [AOR=2.38{CI (1.06-5.34)}], and inadequate lighting condition in the house [AOR=4.35{CI (1.78-10.64)}]. Interpretation & conclusion: This study provides important insights into the epidemiology of malaria in a high and low-transmission setting in West Bengal, India. Intensified efforts strengthening community mobilization for preventing breeding places for mosquito. Policy should strengthen investment in housing programs that may complement reduction of malaria transmission. Disease reduction effects of Government and local non-governmental organizations should be directed towards those areas in order to decrease disease load.

Reservoir siltation lowers a dam’s effective storage capacity, which is mostly determined by the sediment discharge from soil erosion in the watersheds. The morphometric parameters are significant in determining erosional susceptibility of watersheds. In the present study, morpho-hypsometric aspects of the Surya sub-basin, a major tributary of Vaitarna river, has been considered. This river system and associated dams provide the major source of drinking water supply to the Mumbai Metropolitan Region (MMR). A major part of the river flows through the Deccan Volcanic Province (comprising basalts) and Quaternary alluvial deposits. The seven sub-watersheds (SWs) of Surya sub-basin were analysed using the morphological parameters (linear, areal, and basin shape aspects), along with ratio factors and hypsometric integral (HI) values. The HI values for the SWs range from 0.11 (SW-1) to 0.51 (SW-6) with a HI value of 0.21 for the whole Surya sub-basin. The relatively high HI values of SW-6 (0.51) and SW-7 (0.31) indicate that these SWs are relatively prone to high erosion and sediment discharge resulting in dam siltation, and will be a great threat to livelihood of millions of people in the MMR. Therefore, prioritizing these SWs for proper engineering measures could reduce erosion and improve recharge.

Context: With the ageing of Indian society, providing a healthy life among older people is a public health precedence. Therefore, beforehand discovery and possible forestalment of frailty may help promote healthy ageing and dwindle the social, mental and financial burden of their families and caregivers. Aims: The study aimed to assess the proportion of frailty and its associated factors among the elderly aged 65 years and above in a rural community of West Bengal. Settings and Design: A community-based cross-sectional study was conducted among 270 elderlies selected from 15 villages out of a total 64 villages of Singur under the Hooghly District of West Bengal from January 2019 to February 2020. Materials and Methods: Cluster sampling technique was used. Data was collected using a pre-designed, pre-tested structured schedule including Fried frailty phenotype (FFP), geriatric depression scale short form (GDS 15) and mini nutritional assessment (MNA) tool. Statistical Analysis Used: Associated factors of frailty were assessed by univariate and multivariable logistic regression using SPSS version 16 software and MS Excel 2019. Results: The proportion of frailty was observed to be 23.7% and that of prefrailty 40.7%. Frailty was significantly associated with increasing age [AOR(CI) 1.2(1.1-1.3)], decreasing years of schooling [AOR(CI) 1.3(1.1-1.5)], loss of spouse [AOR(CI) 4.2(1.2-15.2)], financial dependency [AOR(CI) 19.3(2.7-139.0)], staying at home [AOR(CI) 16.3(2.7-98.2)], presence of anaemia [AOR(CI) 3.6(1.3-9.5)], at risk of malnutrition [AOR(CI) 6.5(1.9-22.3)], increasing number of falls in the last 1 year [AOR(CI) 4.3(1.2-15.6)], presence of 3 or more chronic diseases [AOR(CI) 154.7(12.1-1981.9)] and depression [AOR(CI) 8.3(2.5-27.0)]. Conclusion: The burden of frailty among the study population is relatively high. It’s an intimidating situation that needs bettered screening provisions for early discovery with special stress on nutritive upliftment. Screening for depression should also be done regularly.

Introduction: Developing countries like India prevalence of coronary artery disease (CAD) is increasing day to day from 1.6 percent to 7.6 percent in rural areas and 1.0 percent to 13.6 percent in urban areas in last few decades and it is going to be a double burden near 2035. Indians are known to have the highest coronary artery disease (CAD) rates.Objective: To find out the socio-demographic characteristics and clinical profile of the patients suffering from coronary artery disease (CAD) attending a tertiary care hospital. This study also assessed the health-related quality of life (HRQOL) of patients.Method: A hospital based cross sectional study was done in Patients more than 18 years of age with coronary artery disease attending Cardiology OPD SSKM Hospital in Kolkata. The study was done from the year August 2020 to September 2022. The study was done on 220 patients by using a structured pretested Mac New HRQOL questionnaire. Results: The median age of coronary artery disease patients was 56 (50-62) years. Around one-third portion (34.1%) of the study participants achieved a primary level of education. The Median (IQR) of per capita income (Rs/month) of the study participants was 2000 (1250-3938). Nearly three fourth (71.4%) participants had various types of co-morbidities. Clinically, 88.2% had normal heart rates, 51.4% had normal blood pressure and 43.6% had low ejection fraction. MacNew HRQOL score among participants were 4.7,4.8,4.4 in social, emotional and physical domain, respectively. Conclusion: Male gender, lower socio-economic conditions, low level of education, inadequate dietary diversity patterns and substance user outnumbered their counterpart. The HRQOL was found satisfactory but lacking in physical domain.

Introduction: Self-directed learning (SDL) is the process in which individuals take the initiative and learning environment involves all other aspects of the institute. Good SDL ability is the foundation of lifelong learning. Students’ perception of the educational environment plays a subtle role in learning and contributes to learning input and students’ achievement. Self- directed learning is integral to public health teaching. Objectives: To assess the perceptions of learning environment and self-directed learning readiness and association between the two among public health researchers and also to elicit the factors associated with SDLRS. Method: A cross-sectional study was conducted from July to December 2023 in a public health institute in Kolkata. A total of 102 participants across five courses were selected by Complete Enumeration method and their self-directed learning readiness (SDLRS) and perceptions of learning environment were assessed using a self-administered questionnaire. The data was analysed in SPSS, version 16. Ethical approval was taken. Results: The mean age of the study participants was 26.7 years and 64.7% of the study participants were from MBBS background. The median academic hours was 18 hours per week, 37.3% of the participants were studying in the institute for less than 6 months and 20.6% for more than 24 months. The overall perception of learning environment was more positive than negative. There was significant positive correlation between SDLRS and Learning Environment (Spearman’s rho=0.281, p=0.004). Age (p=0.015) and prior academic qualification (p=0.016) were significantly associated with SDLRS. Conclusion: SDLRS was associated with positive Learning Environment. The overall perception of SDLRS was average and the SDL ability improved with duration of study in the institute and deteriorated with age of the study participants.

Abstract Genome-wide association studies (GWAS) have yielded significant insights into the genetic architecture of myocardial infarction (MI), although studies in non-European populations are still lacking. Saudi Arabian cohorts offer an opportunity to discover novel genetic variants impacting disease risk due to a high rate of consanguinity. Genome-wide genotyping (GWG), imputation and GWAS followed by meta-analysis were performed based on two independent Saudi Arabian studies comprising 3950 MI patients and 2324 non-MI controls. Meta-analyses were then performed with these two Saudi MI studies and the CardioGRAMplusC4D and UK BioBank GWAS as controls. Meta-analyses of the two Saudi MI studies resulted in 17 SNPs with genome-wide significance. Meta-analyses of all 4 studies revealed 66 loci with genome-wide significance levels of p 12% MAF). In conclusion, our results replicated many MI associations, whereas in Saudi-only GWAS (meta-analyses), several new loci were implicated that require future validation and functional analyses.

Abstract Objective This prospective study aimed to evaluate the effects of a health education intervention on cardiovascular disease (CVD) risk factors among school teachers. Methods The study, conducted from August 2016 to May 2017, involved teachers from four schools in Baruipur, West Bengal, India. It was a multicentric, quasi-experimental study with an intervention group receiving tailored health education promoting lifestyle modifications, while the control group received no intervention. Baseline and endline assessments included behavioural and biological characteristics related to cardiovascular health and risk assessment. Data were analysed using JAMOVI. Results The intervention group showed significant improvements in physical activity levels [Cohen’s d (Cd): 0.43, p = 0.006] and the consumption of fruits and vegetables (Cd: 1.00, p =

Introduction: Globally, one-third of current health expenditure had been out-of-pocket expenditure (OOPE). The health system financing of almost all low- and middle-income countries including India rely heavily on out-of-pocket (OOP) payments for health care. OOPE on health payments is particularly hard on any community, especially the poor leading to incomplete or even no treatment during their ill health. This study estimated OOPE among residents of a rural community in West Bengal and explored the associated factors with high OOP expenses. Methods: A community-based cross-sectional study was conducted in a rural community in Singur, West Bengal from June 2019 to February 2020. The study was done among 398 villagers selected from 15 clusters or villages. Households were randomly selected in each village. All members of the selected households were interviewed. SPSS was used for data analysis both for descriptive and inferential statistics. Results: Only 14.6% of morbid persons had catastrophic expenditure. The incidence of catastrophic expenditure was higher among those who opted for private practitioners and or ayurveda, yoga and naturopathy, unani, siddha, and homeopathy (AYUSH) facilities. There was zero catastrophic expenditure for the unqualified sector. There was an increasing trend of OOP payments among the lower socioeconomic groups. Again, low-income individuals had a higher share in cumulative expenditure (Gini coefficient of 0.35). Most of the participants (78.4%) had no health insurance coverage. Conclusion: Promotion for higher utilization of public health facilities may reduce the burden of OOP expenses. Government health insurance schemes must be widened with the inclusion of coverage of outpatient services. Integrating AYUSH services in the public sector is another option to reduce OOP expenses.

Sakit kepala merupakan salah satu gejala yang umum dikeluhkan oleh masyarakat yang hendak melakukan swamedikasi di apotek. Apoteker mempunyai peranan penting untuk memberikan rekomendasi yang tepat pada pasien dengan keluhan sakit kepala yang hendak melakukan swamedikasi. Tujuan penelitian ini adalah mendeskripsikan ketepatan rekomendasi oleh apoteker di apotek dalam dua kasus vignette sakit kepala (sakit kepala tipe tension yang dapat diswamedikasi dan sakit kepala tipe migraine karena penggunaan oral kontrasepsi yang membutuhkan rujukan ke dokter). Desain penelitian adalah kuantitatif cross-sectional pada populasi apoteker di apotek di salah satu kabupaten di Jawa Timur. Instrumen penelitian yang digunakan adalah kuesioner, yang terdiri dari dua bagian: (1) karakteristik apoteker dan apotek, dan (2) dua kasus vignette sakit kepala. Pengambilan data dilakukan dengan wawancara terstruktur dan analisis data dilakukan menggunakan content analysis. Ketepatan rekomendasi dinilai berdasarkan literatur dan opini expert panel. Sebanyak 47 dari total 81 apoteker bersedia menjadi partisipan. Dari 47 apoteker, 36 (77%) dan 23 (49%) apoteker dapat memberikan rekomendasi dengan tepat pada kasus sakit kepala tipe tension, dan tipe migraine secara berturut-turut. Ketepatan rekomendasi oleh apoteker pada kasus sakit kepala bervariasi tergantung kasus yang dihadapi. Optimalisasi ketepatan pemberian rekomendasi pada kasus sakit kepala masih diperlukan, terutama pada kasus sakit kepala yang membutuhkan rujukan ke dokter.

Abstract Background Aboriginal and Torres Strait Islander peoples have a unique place in Australia as the original inhabitants of the land. Similar to other First Nations people globally, they experience a disproportionate burden of injury and chronic health conditions. Discharge planning ensures ongoing care to avoid complications and achieve better health outcomes. Analysing discharge interventions that have been implemented and evaluated globally for First Nations people with an injury or chronic conditions can inform the implementation of strategies to ensure optimal ongoing care for Aboriginal and Torres Strait Islander people. Methods A systematic review was conducted to analyse discharge interventions conducted globally among First Nations people who sustained an injury or suffered from a chronic condition. We included documents published in English between January 2010 and July 2022. We followed the reporting guidelines and criteria set in Preferred Reporting Items for Systematic Review (PRISMA). Two independent reviewers screened the articles and extracted data from eligible papers. A quality appraisal of the studies was conducted using the Mixed Methods Appraisal Tool and the CONSIDER statement. Results Four quantitative and one qualitative study out of 4504 records met inclusion criteria. Three studies used interventions involving trained health professionals coordinating follow-up appointments, linkage with community care services and patient training. One study used 48-hour post discharge telephone follow-up and the other text messages with prompts to attend check-ups. The studies that included health professional coordination of follow-up, linkage with community care and patient education resulted in decreased readmissions, emergency presentations, hospital length of stay and unattended appointments. Conclusion Further research on the field is needed to inform the design and delivery of effective programs to ensure quality health aftercare for First Nations people. We observed that discharge interventions in line with the principal domains of First Nations models of care including First Nations health workforce, accessible health services, holistic care, and self-determination were associated with better health outcomes. Registration This study was prospectively registered in PROSPERO (ID CRD42021254718).

Abstract—Pharmacists’ involvement in the human immunodeficiency virus/acquired-immunodeficiency syndrome (HIV/AIDS) prevention and management program has been globally advocated. However, there is currently a lack of information on whether pharmacists’ roles in the program have been clearly articulated in the national policy records in countries with high scores on power distance and collectivism, such as Indonesia. This study aimed to explore the roles of pharmacists in the prevention and management of HIV/AIDS in Indonesia using a systematic review method. We systematically searched for relevant studies in three large medical databases (CINAHL, EMBASE, and PubMed) and for gray literature in both the Indonesian Pharmacist Association and the Ministry of Health websites, and the national regulation database. Only two studies gave a glimpse of pharmacists’ role in the prevention and management of patients with HIV/AIDS in Indonesia. However, activities conducted by pharmacists in each of these roles were not explicitly described. We found no official national policies mentioned the role of pharmacists in HIV/AIDS prevention and management. Since the practice of pharmacists is closely related to medications, including antiretroviral drugs, more research is needed to explore the role of pharmacists in the prevention and management of HIV/AIDS in a real-world context in Indonesia. Keywords: AIDS, HIV, pharmacist, indonesia Abstrak—Keterlibatan apoteker dalam program pencegahan dan tata laksana human immunodeficiency virus/acquired-immunodeficiency syndrome (HIV/AIDS) di dunia telah direkomendasikan. Akan tetapi, saat ini terdapat keterbatasan informasi mengenai apakah keberadaan peran apoteker dalam program tersebut telah dinyatakan dnegan jelas dalam dokumen kebijakan nasional di negara-negara yang memiliki skor tinggi pada power distance dan kolektivitas, seperti Indonesia. Penelitian ini bertujuan untuk menggali peran apoteker dalam pencegahan dan tata laksana HIV/AIDS di Indonesia menggunakan metode kajian sistematis. Secara sistematis, peneliti melakukan pencarian artikel penelitian terkait di tiga basis data medis yang besar (CINAHL, EMBASE, dan PubMed) dan pencarian gray literature di laman Ikatan Apoteker Indonesia dan Kementerian Kesehatan Republik Indonesia, serta di basis data peraturan nasional. Hanya dua penelitian yang memberikan secercah informasi mengenai peran apoteker dalam pencegahan dan tata laksana pasien dengan HIV/AIDS di Indonesia. Namun demikian, aktivitas spesifik yang dilakukan oleh apoteker tidak secara eksplisit digambarkan lebih lanjut. Peneliti tidak menemukan dokumen kebijakan nasional yang menyebutkan peran apoteker dalam pencegahan dan tata laksana HIV/AIDS. Oleh karena praktik kefarmasian berhubungan erat dengan obat, termasuk obat-obat antiretrovirus, maka dibutuhkan lebih banyak penelitian untuk menggali peran apoteker dalam pencegahan dan tata laksana HIV/AIDS pada konteks dunia-nyata di Indonesia. Kata kunci: AIDS, HIV, apoteker,indonesia

ABSTRACT: Objectives: The objectives of this study were to identify the composition of oral microbiota in a cohort of patients with sickle cell anemia (SCA) and a high mean number of decayed, missing, and filled permanent teeth (DMFT) and compare it to a cohort of patients with SCA and a low number of DMFT and elucidate the effect of fetal haemoglobin levels on the oral microbiota composition. Methods: Patients who had been diagnosed with SCA, who were homozygous for sickling β-globin mutation (βS/βS), who had Arab-Indian haplotype, and who ranged in age from 5 to 12 years were included in this study. Oral saliva from each participant (n = 100) was collected in GeneFiX™ Saliva DNA Microbiome Collection tube and DNA was extracted using GeneFiX™ DNA Isolation Kits. The composition of oral 16S rRNA from patients with SCA and high dental caries (n = 27, DMFT ≥5) and low dental caries (n = 73, DMFT ≤4) was analysed. Sequencing was performed on an Ion Personal Genome Machine using, Ion PGM Hi-Q view Sequencing 400-bp kit. Results: We observed an overall increase in abundance of Proteobacteria, Chloroflexi, and Bacteroidetes in the high DMFT index group compared to those with a low DMFT index. In addition, there was an overall increased abundance of microbiota from Proteobacteria, Fusobacteria, Firmicutes, and Bacteroidetes in the patients with SCA with low fetal haemoglobin compared to those with high fetal haemoglobin (P < .05). Enterobacteriaceae species were the most significant abundant species of bacteria found in both the high DMFT index group and low fetal haemoglobin cohort (P < .05). Conclusions: Our data indicate that SCA in Saudi patients with high DMFT have a higher predominance of pathogenic bacteria compared to those with low DMFT. Furthermore, SCA in Saudi patients with low fetal haemoglobin have a higher predominance of pathogenic bacteria compared to those with higher fetal haemoglobin.

Introduction: A structured dedicated health programme for Type 1 diabetes mellitus (T1DM) has been initiated in the state of West Bengal, India. Aim: The aim is to provide comprehensive healthcare to all children, adolescents and young adults living with T1DM, along with the provision of free supply of insulin, glucose measuring devices, blood glucose test strips, and other logistics. The strategic framework for programme implementation is to utilise the infrastructure and manpower of the already existing non-communicable disease (NCD) clinic under National Health Mission. Methodology: Establishing dedicated T1DM clinics in each district hospital by utilising existing healthcare delivery systems, intensive training and hand-holding of named human resources; providing comprehensive healthcare service and structured diabetes education to all T1DM patients; and building an electronic registry of patients are important components of the programme. T1DM clinics run once a week on the same day throughout the state. All T1DM patients are treated with the correct dose of insulin, both human regular insulin and glargine insulin. Patients are routinely monitored monthly to ensure good glycaemic control and prevent complications of the disease. Routine anthropometric examination and required laboratory investigations are conducted in the set-up of the already existing NCD clinic. Ongoing monitoring and evaluation of the T1DM programme are being conducted in terms of glycated haemoglobin (HbA1c) values, growth and development, complication rates, psychological well-being, quality of life, and direct and indirect expenditure incurred by families. Through this programme, any bottlenecks or gaps in service delivery will be identified and corrective measures will be adopted to ensure better health outcomes for those living with T1DM.

Introduction: In spite of falls being a major public health problem, where most of the falls are preventable, there is a lack of epidemiological investigation among those aged 50 and above, especially in developing countries. Hence, we investigate the proportion, pattern, and predictors of falls in this age group. Materials and Methods: This cross-sectional community-based study was done in the Uluberia-II block of Howrah district, West Bengal, from February to July 2021. A multistage cluster sampling method was used to meet the sample size. Data were collected with the help of a structured interview schedule. Predictors were estimated by the SPSS version 16 and defined in adjusted odds ratio (AOR) with a 95% confidence interval. Results: Among 170 study participants, 34.7% (59/170) experienced at least one episode of fall, while 20.6% (35/170) experienced recurrent falls in 12 months. Most (78%; 46/59) falls occurred in the home environment and due to slippage (67.8%; 40/59) on the floor. 84.7% (50/59) sustained any type of injuries, 47.5% (28/59) required either consultation of a physician or medication, and 6.8% (4/59) required hospitalization. Safety Checklist Score measured 75.3% (128/170) had a poor household environment, within that 30.6% (52/170) had a seriously poor household environment, which was an important predictor of falls ([AOR] = 3.59 [1.24–10.38]). Fear of fall (AOR = 6.18 [1.77–21.53]) measured by shortfall efficacy scale and nonformal education (AOR = 5.05 [1.33–19.07]) were also predictors of falls. Conclusion: Considerable proportion of falls occurred in the past year, which can be preventable by improving modifiable environmental factors and detection of fear of fall in persons at different levels of health-care facilities.

Context: Tribal population is vulnerable to all inequities of the society and less penetrated by the service providers. Breastfeeding, 0–23 months old children is important for their development and is boon for their health. Objective: The objective of this study is to estimate the prevalence of optimal breastfeeding practices (OBFs) and elicit its predictors. Materials and Methods: This descriptive cross-sectional study was conducted in the tribal area of Sunderbans, West Bengal, among mothers having children 0–23 months of age, from May 2021 to September 2021. Participants were selected by the cluster sampling technique. OBFs were assessed by initiation of breastfeeding within 1 h of birth, exclusive breastfeeding till 6 months of age, and continuation of breastfeeding along with complementary feed till 23 months of age. Iowa Infant Feeding Attitude Scale was administered to assess attitude toward breastfeeding. Statistical analysis was done using multivariable logistic regression. Results: The mean age of the study participants was 24.8 ± 4.1 years. Early initiation of breastfeeding was done by 76.5% of the participants, but continuation beyond 6 months of age by 70.9%. OBFs were shown by 25.5% of the participants, which has a significant association with the knowledge about the breastfeeding practices (adjusted odds ratio [aOR]: 2.14; 95% confidence interval [CI]: 1.52–3.01) and maternal education (aOR: 3.78; 95% CI: 1.17–12.17). Conclusion: This study showed that only one-fourth of the participants have OBFs. This situation must be addressed with imparting proper knowledge about the importance of breastfeeding. Support group of women in the community should be formulated to aid mothers in continuation of breastfeeding.

BackgroundThe anti-seizure medication vigabatrin (VGB) is effective for controlling seizures, especially infantile spasms. However, use is limited by VGB-associated visual field loss (VAVFL). The mechanisms by which VGB causes VAVFL remains unknown. Average peripapillary retinal nerve fibre layer (ppRNFL) thickness correlates with the degree of visual field loss (measured by mean radial degrees). Duration of VGB exposure, maximum daily VGB dose, and male sex are associated with ppRNFL thinning. Here we test the hypothesis that common genetic variation is a predictor of ppRNFL thinning in VGB exposed individuals. Identifying pharmacogenomic predictors of ppRNFL thinning in VGB exposed individuals could potentially enable safe prescribing of VGB and broader use of a highly effective drug.MethodsOptical coherence topography (OCT) and GWAS data were processed from VGB-exposed individuals (n = 71) recruited through the EpiPGX Consortium. We conducted quantitative GWAS analyses for the following OCT measurements: (1) average ppRNFL, (2) inferior quadrant, (3) nasal quadrant, (4) superior quadrant, (5) temporal quadrant, (6) inferior nasal sector, (7) nasal inferior sector, (8) superior nasal sector, and (9) nasal superior sector. Using the summary statistics from the GWAS analyses we conducted gene-based testing using VEGAS2. We conducted nine different PRS analyses using the OCT measurements. To determine if VGB-exposed individuals were predisposed to having a thinner RNFL, we calculated their polygenic burden for retinal thickness. PRS alleles for retinal thickness were calculated using published summary statistics from a large-scale GWAS of inner retinal morphology using the OCT images of UK Biobank participants.ResultsThe GWAS analyses did not identify a significant association after correction for multiple testing. Similarly, the gene-based and PRS analyses did not reveal a significant association that survived multiple testing.ConclusionWe set out to identify common genetic predictors for VGB induced ppRNFL thinning. Results suggest that large-effect common genetic predictors are unlikely to exist for ppRNFL thinning (as a marker of VAVFL). Sample size was a limitation of this study. However, further recruitment is a challenge as VGB is rarely used today because of this adverse reaction. Rare variants may be predictors of this adverse drug reaction and were not studied here.

Background: Microscopic, biochemical, molecular, and computer-based approaches are extensively used to identify and classify bacterial populations. Advances in DNA sequencing and bioinformatics workflows have facilitated sophisticated genome-based methods for microbial taxonomy although sequencing of the 16S rRNA gene is widely employed to identify and classify bacterial communities as a cost-effective and single-gene approach. However, the 16S rRNA sequence-based species identification accuracy is limited because of the occurrence of multiple copies of the 16S rRNA gene and higher sequence identity between closely related species. The availability of the genomes of several bacterial species provided an opportunity to develop comprehensive species-specific 16S rRNA reference libraries. Methods: Sequences of the 16S rRNA genes were retrieved from the whole genomes available in the Genome databases. With defined criteria, four 16S rRNA gene copy variants were concatenated to develop a species-specific reference library. The sequence similarity search was performed with a web-based BLAST program, and MEGA software was used to construct the phylogenetic tree. Results: Using this approach, species-specific 16S rRNA gene libraries were developed for four closely related Streptococcus species (S. gordonii, S. mitis, S. oralis, and S. pneumoniae). Sequence similarity and phylogenetic analysis using concatenated 16S rRNA copies yielded better resolution than single gene copy approaches. Conclusions: The approach is very effective in classifying genetically closely related bacterial species and may reduce misclassification of bacterial species and genome assemblies.

This research was motivated by the difficulty of beginning reading in Bahasa Indonesia subject in online learning of the 3rd grade students at SDN 01 in Cikoko, South Jakarta. This research was conducted with the aim of overcoming students' beginning reading difficulties and looking for any factors that made students have difficulty reading and also describing the role of the teacher to be used as a solution in overcoming beginning reading difficulties. This research was conducted using qualitative research with descriptive methods using instrument values, observations, interviews, and document multiplication as data collection techniques. The research subjects were teachers and students of the third grade at SDN 01 Cikoko, South Jakarta. The results of this study are expected that students who have the difficulty on beginning reading can partake the teaching and learning activities in class well, have no difficulty when teaching and learning activities are carried out by online learning, the teacher can find solutions and what media are suitable to be used to overcome the difficulties of beginning reading experienced by some students of the third grade at SDN 01 Cikoko, South Jakarta.

Introduction: Awareness regarding Gestational Diabetes Mellitus (GDM) among antenatal women is necessary for early diagnosis and management of the disease for ensuring a safe motherhood and a healthy child. Objective: This study envisaged to assess the awareness regarding GDM and its determinants among antenatal women attending healthcare facilities in a rural area of West Bengaland to explore the perspectives of health workers with regard to gaps in proper awareness generation activities among antenatal women. Method: This mixed-method study was conducted from April 2021 to July 2021 at 4 health facilities in Singur, West Bengal. Quantitative data were collected from 195 antenatal women using a pretested questionnaire which were analysed using SPSS software. Qualitative data were collected via in-depth interviews among 6 health workers working in the health facilities and were analysed thematically. Results: Overall, 75.4% of participants were not aware of GDM. Multivariable logistic regression analysis showed that secondary education and below (AOR=3.48, 95% CI=1.63-7.42), no history of GDM among family & relatives (AOR=7.24,95% CI=2.12-24.66), lesser number of antenatal visits (AOR=3.48, 95% CI=1.63-7.42) and non-receipt of counselling regarding GDM during antenatal visits (AOR= 3.09, 95% CI =1.45–6.58) had a significant association with poor awareness. From health workers’ perspectives, lack of reorientation training, shortage of supplies for testing, and overburdening with other responsibilities were the major gaps identified in proper awareness generation activities. Conclusion: Present study revealed majority of study participants possessed poor knowledge regarding GDM. Reorientation training of health workers, organizing awareness campaigns at the community level, and relevant counselling regarding GDM during each antenatal visit should be given utmost priority for improving knowledge about the disease.

Background: Noncommunicable diseases (NCDs) are increasing, for which some behavioral risk factors are major concerns. mHealth has been found to be effective in changing these behavioral patterns. Objective: To assess effectiveness of mHealth technology in modification of dietary habits and physical activity, among individuals having NCDs or their risk factors, in primary healthcare settings in South East Asian Region Countries. Materials and Methods: A systematic review and meta-analysis was done with the primary outcome as effectiveness of mHealth for improving dietary practices and increasing physical activity. Articles were retrieved from PubMed, Cochrane Central, Google Scholar, and Pre-print servers followed by forward and backward searching. Quality and risk of bias of included studies were assessed. Meta-analysis was performed using RevMan v. 5.4.1 software. Heterogeneity was tested using χ2 test and measured using I2 statistic, with Forest plots as the final outcome. Results: Nine publications from seven studies, of which seven were conducted in India and two in Bangladesh, qualified for the review. All studies used varied mHealth interventions. Most studies reported beneficial effects in reducing inadequate/improper diet and insufficient/improving physical activity, at community/workplace settings, except two studies reporting no apparent impact, both being from Bangladesh. Meta-analysis revealed statistically significant differences between intervention and control groups for pooled estimates of reduced dietary energy and increased fruits/vegetables. Although heterogeneity is absent between studies considered for fruits/vegetables, both studies were compromised in quality and bias. Studies on dietary energy intake had high statistical heterogeneity, in addition to having high risk of bias. Hence, the results need to be interpreted with caution. No effect was observed on increasing physical activity. Conclusion: mHealth interventions have huge potential to facilitate behavior change. However, more research is needed before its potential scale-up.

Background: Use of maternal near-miss (MNM) cases as an adjunct has been advocated to understand the processes of obstetric care because they share similar pathways as maternal deaths. Identifying the predictors and care pathway is crucial to improve the quality of care and end preventable maternal deaths. Materials and Methods: This case–control study was conducted at a tertiary care facility in Kolkata from May 2019 to March 2020. Women admitted with complications during pregnancy, childbirth, or within 42 days of postpartum, who met the World Health Organization (WHO) near-miss criteria, were identified as cases, and equivalent age-group matched controls were recruited. Sample size of 60 cases and 60 controls was estimated, assuming a power of 80%, level of significance 0.05, and case–control ratio of 1. After obtaining approval from the institutional ethics committee and informed written consent from the participants, data was collected through face-to-face interview and review of records. Statistical analysis including care pathway analysis (using three-delay model) was performed using Statistical Package for Social Sciences version 16. Results: Joint family type (adjusted odds ratio [AOR] [CI] = 5.06 [1.48, 7.28]), lack of antenatal checkups (AOR [CI] = 7.85 [1.47, 12.09]), previous history of cesarean section (AOR [CI] = 3.94 [1.09, 14.33]), first delay in seeking care (AOR [CI] = 13.84 [3.62, 32.83]), and preexisting medical disorders (AOR [CI] = 11.03 [4.62, 22.80]) were identified as significant predictors of MNM in the adjusted model. Significant difference in the proportion of first and second delays in the care pathway was observed between cases and controls. Conclusions: Identification of risk factors of MNM and pattern of delays in the care pathway will help improving quality of obstetric care.

Background and Objectives: Pregnancy, an altered physiological state, is specifically vulnerable to psychological distress (PD), more so during the coronavirus disease 2019 (COVID-19) pandemic. This can impart detrimental consequences to both mother and child. This study assessed the magnitude of PD and associated factors among pregnant women in rural West Bengal. The proportion of pregnant women with COVID-19 symptomatology and its relationship with PD was also determined. Methods: This cross-sectional study was done among 130 pregnant women availing antenatal care in health centers during August–October 2020. Patient Health Questionnaire (PHQ-4) was used to assess PD and a “Perception on COVID-19 Pandemic” (PCP) Scale was used to assess the perception of the COVID-19 pandemic (Cronbach's alpha = 0.75). Statistical analyses were done in SPSS Inc., SPSS for Windows, Chicago, USA. Results: The proportion of study participants with PD was 49.2%. Unsatisfactory antenatal care (AOR = 19.4, CI = 2.5-152.7), COVID-19 case within family/neighborhood (AOR = 6.3, CI = 1.2-34.9), strenuous spousal relationship (AOR = 7.3, CI = 1.1-50), increasing score in perceived susceptibility domain of PCP Scale (AOR = 1.3, CI = 1.1-1.6), and decreased daily sleep duration (AOR = 2.8, CI = 1.6-4.9) were found to be associated with PD. 38.5% of participants reported COVID-19 related symptoms. Conclusion: The magnitude of PD among pregnant women in the study area is high. Thus, proper counseling of pregnant mothers during antenatal visits by public health nursing personnel to alleviate fears about the pandemic would go a long way to reduce the negative impact of PD on mother and child.

BACKGROUND: Multi-transfused thalassemic children are at higher risk of acquiring transfusion-transmitted infections (TTIs). There are limited data available on TTIs among thalassemic children, especially on its impact on their quality of life (QoL). AIM: The aim of this study is to find out the proportion of multi-transfused β-thalassemia major (β-TM) children suffering from TTIs, its risk factors and impact on QoL. METHODS: This was a hospital-based, analytical observational study, cross-sectional in design, conducted among 328 β-TM children and their caregivers attending thalassemia day care unit of a medical college during May 2015–April 2016, with a structured schedule. Data were analyzed with appropriate statistical methods using the Statistical Package for the Social Sciences. RESULTS: Two-fifth (39.9%) of them were found to have TTIs with hepatitis C being the most common (34.5%), followed by hepatitis B (4.5%) and human immunodeficiency virus (1.8%). In the multivariable model, place of residence (adjusted odds ratio [AOR] – 2.23 [1.19–4.17]), per capita monthly family income (AOR – 1.84 [1.10–3.07]), and blood transfusion frequency (AOR – 1.19 [1.10–1.29]) were significant predictors of TTIs adjusted with their age, age at diagnosis, last pretransfusional hemoglobin level, size of spleen, and caregivers knowledge regarding the disease. The study participants with TTIs had a lower QoL compared to others as there were significant differences in between the total QoL scores ([49.9 ± 15.6 vs. 57.4 ± 15.5], P ≤ 0.001) and its various domains. CONCLUSION: There was high burden of TTIs among multi-transfused β-TM children and it has significant negative impact on their quality of lives.

Context: Multimorbidity is considered as a priority for global health research. It is defined as the coexistence of two or more chronic health conditions in an individual. It is increasingly being recognized as a major concern for primary care physicians due to its huge impact on individual, family, and societal level. Aim: The aim of this study was to find the quantum of gender-related inequalities and determinants of multimorbidity among the elderly people in a rural part of West Bengal. Materials and Methods: This is a cross-sectional study carried out among 246 elderly people (60 years and above) in a community setting from Oct 2017 to Sep 2018. Logistic regression analysis was done to find out the predictors of multimorbidity. Data were analyzed using the SPSS software (version 16.0. Chicago, SPSS Inc.). Results: Approximately 82% of the study subjects were suffering from multi-morbidity with a significant difference between males (80.9%) and females (88.5%). In binary logistics, people of both the genders aged >70 years, who had less than primary level education, had more than three children, whose source of income was from their children (sons/daughters), were dependent on others for daily routine were at high risk of being multimorbid; whereas depression was a significant predictor of multimorbidity in females and not in males. In multivariable analysis, age remained the only significant predictor for both the gender and for females; depression remained significant after adjusting with significant variables in binary logistics. Conclusion: Morbidity screening at each visit, individual as well as family counseling and lifestyle modifications help to cope with the rising burden of multimorbidity at the primary care level. More insight into the epidemiology of multi-morbidity is necessary to take steps to prevent it, lower its burden and align health-care services as per needs.

IntroductionGenome-wide association studies have discovered common polymorphisms in regions associated with schizophrenia. No genome-wide analyses have been performed in Saudi schizophrenia subjects.MethodsGenome-wide genotyping data from 136 Saudi schizophrenia cases and 97 Saudi controls in addition to 4,625 American were examined for copy number variants (CNVs). A hidden Markov model approach was used to call CNVs.ResultsCNVs in schizophrenia cases were twice as large on average than CNVs in controls (p = 0.04). The analyses focused on extremely large >250 kilobases CNVs or homozygous deletions of any size. One extremely large deletion was noted in a single case (16.5 megabases on chromosome 10). Two cases had an 814 kb duplication of chromosome 7 spanning a cluster of genes, including circadian-related loci, and two other cases had 277 kb deletions of chromosome 9 encompassing an olfactory receptors gene family. CNVs were also seen in loci previously associated with schizophrenia, namely a 16p11 proximal duplication and two 22q11.2 deletions.DiscussionRuns of homozygosity (ROHs) were analyzed across the genome to investigate correlation with schizophrenia risk. While rates and sizes of these ROHs were similar in cases and controls, we identified 10 regions where multiple cases had ROHs and controls did not.

Colour agnosia is a disorder that impairs colour knowledge (naming, recognition) despite intact colour perception. Previously, we have identified the first and only-known family with hereditary developmental colour agnosia. The aim of the current study was to explore genomic regions and candidate genes that potentially cause this trait in this family. For three family members with developmental colour agnosia and three unaffected family members CGH-array analysis and exome sequencing was performed, and linkage analysis was carried out using DominantMapper, resulting in the identification of 19 cosegregating chromosomal regions. Whole exome sequencing resulted in 11 rare coding variants present in all affected family members with developmental colour agnosia and absent in unaffected members. These variants affected genes that have been implicated in neural processes and functions (CACNA2D4, DDX25, GRINA, MYO15A) or that have an indirect link to brain function, development or disease (MAML2, STAU1, TMED3, RABEPK), and a remaining group lacking brain expression or involved in non-neural traits (DEPDC7, OR1J1, OR8D4). Although this is an explorative study, the small set of candidate genes that could serve as a starting point for unravelling mechanisms of higher level cognitive functions and cortical specialization, and disorders therein such as developmental colour agnosia.

Objective: A comprehensive understanding of the requirements of elderly is necessary to preserve their “functional capacity”, an important indicator of their health status. This study aimed to assess the functional status of the elderly and their rehabilitation needs. Materials and Methods: A mixed-method study was conducted from November 2021 to June 2022 at a health centre in Chetla, West Bengal, India. Quantitative data, collected from 172 elderly persons using a pretested questionnaire, were analyzed by logistic regression analysis. Qualitative data, collected via focus group discussions, were analyzed thematically. Results: Overall, 11.62% and 66.86% participants were functionally dependent in one or more activities of daily living (ADL) and instrumental activities of daily living (IADL), respectively. Significant association of age ≥70 years (AOR = 4.06, 95% CI= 1.13-14.63), male gender (AOR= 5.21, 95% CI= 1.57-17.28) and assistive device use (AOR= 6.92, 95% CI= 1.85-25.83) was found with ADL limitations. Increasing age (AOR= 1.29, 95% CI= 1.13-1.50), female gender (AOR= 13.97, 95%CI= 3.61-54.00), residence in joint family (AOR= 3.95, 95%CI=1.47-10.61), without spouse (AOR= 3.59, 95% CI= 1.12-11.44) and daily intake of multiple medications (AOR= 4.99, 95%CI= 1.45- 17.13) were factors significantly associated with IADL limitations. Major identified needs of the elderly were related to development of peer support groups, transportation systems and delivery of services from the health system. Conclusion: Rehabilitative services like providing assistive devices to the needy, developing elderly support groups, undertaking household visits for bedridden and those with restricted mobility, and building supportive environments within families and communities should be ensured.

Introduction: Oral cancer is a major public health problem in India. Screening of the disease has an important role in early detection resulting in improved patient outcomeswith reduced mortality and morbidity. The present study was undertaken to assess the awareness about oral cancer and attitude towards screening among patientsattending a rural hospital in West Bengal and elicit its associated factors if any. Method: This cross-sectional study was conducted from September to December 2020 among 244 adults attending the Dental OPD ofAmtala Rural Hospital, South 24 Parganas, West Bengal. Data collection was done via face-to-face interview using a pre-tested structured questionnaire.Knowledge regarding oral cancer and attitude towards screening was assessed using an 18-itemand 8-item questionnaire respectively. Logistic regression analysis was done to find out the factors associated with satisfactory knowledge and favourable attitude. Results: Satisfactory knowledge of oral cancer was observed among 26.6%, while favourable attitude towards screening among 29.9% of the participants. Younger age,educational level above secondary and non-usage of smokeless tobacco were significantly associated with satisfactory knowledge of the disease. Educational level above secondary, nuclear family membersand smokers hada significant association with favourable attitude towards screening. Conclusion:There was a lack of awareness about oral cancer and an unfavourable attitude towards screening among a significant proportion of the participants. Intensive health education for increasing community-level awareness about the disease and benefits of routine screening would help in the reduction of the burden of oral cancer in the future.

Abstract Background Various pharmacist services are available to improve medication adherence, including consultation, brochure, etc. Challenges arise on which services are best implemented in practice. Knowledge about patients’ and pharmacists’ preferences can help to prioritize services. This study explores the pharmacists’ and patients’ perceptions about the importance of pharmacist services to improve medication adherence among patients with diabetes in Indonesia. Methods This questionnaire-based cross-sectional study involved adult outpatients with diabetes type 2 and pharmacists from community health centers (CHCs) and hospitals in Surabaya, Indonesia. Random sampling was used to identify 57 CHCs in the study. In addition, based on convenient sampling, three hospitals participated. All pharmacists working at the CHCs and hospitals, who were willing to participate, were included in the study. For patients, minimum sample size was calculated using Slovin’s formula. Patients and pharmacists were asked to rank five pharmacist service types (consultation, brochure/leaflet, patient group discussion, medication review, and phone call refill reminder) according to their importance to improve medication adherence. A face validity test of the self-developed questionnaire was conducted before the data collection. Rank ordered probit models were estimated (STATA 15th software). Results A total of 457 patients from CHCs, 579 patients from hospitals, and 99 pharmacists from both medical facilities were included. Consultation (CHC patients 56.0% vs hospital patients 39.7% vs pharmacists 75.2%) and brochure (CHC patients 23.2% vs hospital patients 27.5% vs pharmacists 11.9%) were the most preferred pharmacist services. Patients with experience getting medication information from pharmacists valued consultation higher than brochure and patient group discussions. Older patients ranked a brochure higher than other services. Patients without formal education in CHCs had a lower probability of giving a high rank to a brochure to improve medication adherence. There was significant positive correlation between the ranking of phone call refill reminder and medication review (0.6940) for patients in CHCs. Conclusion For both patients and pharmacists, consultation, brochure, and group discussion were the highest-ranked services. Education, age, experience with pharmacist services, and medical facility features need to be considered when evaluating which pharmacist services to implement in Indonesia.

Abstract Background With increasingly tough graduated driver licensing laws in all Australian States and Territories, driver licensing support programs are recognised as being important to support Aboriginal and Torres Strait Islander peoples to obtain a driver licence. Such programs appear to improve licensing attainment rates, but few studies have examined the broader impact that these programs can have. This research aims to 1) examine the impact of a New South Wales (NSW) based driver licensing support program (Driving Change) on client employment outcomes; 2) assess the influence of geographical area of program delivery on driver licence attainment. Methods Driving Change was delivered from February 2013 to August 2016 in 4 urban and 7 regional Aboriginal communities of NSW. Clients were followed-up at 6 months or more following contact with the program as part of routine program operations. Descriptive statistics and regression models were used to analyse data. Results From 933 clients contacted 254 agreed to provide feedback, a response rate of 27%. Those that responded were mostly female (57%), aged 24 years and under (72%), unemployed (85%) with secondary education or less (71%) and from a regional area (74%). Adjusted logistic regression indicated that clients who achieved an independent licence were more likely (OR: 2.5, 95% CI: 1.22–5.24, p = 0.011) of reporting a new job or change in job than those who did not attain a licence. Clients from regional areas were more likely (OR: 1.72, 95% CI: 1.27–2.33, p

Chiral Metal-Organic Frameworks (CMOFs) are unique crystalline and porous class of materials which is composed of organic linkers and metal ions. CMOFs surpass traditional organic and inorganic porous materials because of their tunable shape, size, functional diversity, and selectivity. Specific applications of CMOFs may be exploited by introducing desired functional groups. CMOFs have chiral recognition abilities, making them unique for chiral compound synthesis and separation. The CMOFs can be synthesized through different approaches. Two main approaches have been discussed, i.e., direct and indirect synthesis. Synthetic strategies play an essential role in getting desired properties in MOFs. CMOFs find potential applications in adsorption, asymmetric catalysis, luminescence, degradation, and enantioselective separation. The MOFs’ porosity, stability, and reusability make them an attractive material for these applications. The plethora of applications of CMOFs have motivated chemists to synthesize novel MOFs and number of MOFs have been ever-escalating. Herein, the synthetic methods of CMOFs and their various applications have been discussed.

Objective: A woman’s multifaceted feelings, knowledge, and perceptions of their intimate relations greatly influence their contraceptive behavior. In addition, women empowerment has been increasingly recognized as a key factor in family planning and reproductive health outcomes. This study aimed to assess modern contraceptive usage and its determinants among currently married women of reproductive-age (WRA) in rural Bengal. Materials and Methods: This mixed-method study was conducted in a rural area of Hooghly District, West Bengal from April to September 2021. The quantitative strand of the study was conducted by interviewing 210 currently married WRA. The qualitative strand was conducted via focussed group discussions among husbands/mothersin-law and in-depth interviews with healthcare workers. SPSS software was utilized for quantitative data analysis and factors associated with contraceptive usage were analyzed using logistic regression models. Qualitative data were analyzed thematically. Result: Currently 114 (54.8%) study participants were using modern contraceptive methods. Education (aOR=7.65, 95% CI=1.85-31.67), empowerment through freedom from family domination (aOR=5.56, 95% CI=1.30-23.66), attitude on contraception (aOR=4.67, 95% CI=1.26-17.19), and family planning counselling (aOR=4.41, 95% CI=1.12-17.33) were found to be significantly associated with modern contraceptive usage. Lack of couple counselling, family support, and knowledge gap was identified as the major barriers to contraceptive usage. Conclusion: Since a woman’s decision-making ability significantly affects their sexual and reproductive health outcomes, effective measures should be undertaken to empower them by creating awareness regarding their rights and freedom to make strategic life choices. Couple counselling should be prioritized to enhance male involvement and eliminate perceived barriers.

Abstract Objective Resistance to antiseizure medications (ASMs) is one of the major concerns in the treatment of epilepsy. Despite the increasing number of ASMs available, the proportion of individuals with drug‐resistant epilepsy remains unchanged. In this study, we aimed to investigate the role of rare genetic variants in ASM resistance. Methods We performed exome sequencing of 1,128 individuals with non‐familial non‐acquired focal epilepsy (NAFE) (762 non‐responders, 366 responders) and were provided with 1,734 healthy controls. We undertook replication in a cohort of 350 individuals with NAFE (165 non‐responders, 185 responders). We performed gene‐based and gene‐set‐based kernel association tests to investigate potential enrichment of rare variants in relation to drug response status and to risk for NAFE. Results We found no gene or gene set that reached genome‐wide significance. Yet, we identified several prospective candidate genes – among them DEPDC5, which showed a potential association with resistance to ASMs. We found some evidence for an enrichment of truncating variants in dominant familial NAFE genes in our cohort of non‐familial NAFE and in association with drug‐resistant NAFE. Interpretation Our study identifies potential candidate genes for ASM resistance. Our results corroborate the role of rare variants for non‐familial NAFE and imply their involvement in drug‐resistant epilepsy. Future large‐scale genetic research studies are needed to substantiate these findings.

Introduction: Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases. Thus, regular and accurate measurement of Blood Pressure (BP) is essential for its early diagnosis and follow-up. There is a surge in popularity of digital sphygmomanometer due to its convenience of use and functionality. In contrast, the traditional universally accepted sphygmomanometer is aneroid type, hence there arise a need for comparison of digital and universally accepted Aneroid Sphygmomanometer in terms of agreement and correlation. Aim: To evaluate the agreement and correlation between blood pressure measurement by digital and aneroid sphygmomanometer. Materials and Methods: The clinic based cross-sectional study was conducted in the Out Patient Department (OPD) of Urban Heath Centre, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India. Adults visiting the OPD on two chosen days of the week, between June 2019 to July 2019 were selected using systematic random sampling. A total of 400 participants were included. Agreement and correlation between BP measurements by digital and aneroid sphygmomanometer was analysed by Cohen’s Kappa, Bland Altman Plot along with sensitivity, specificity and predictive values using Microsoft Excel and Statistical Package for the Social Sciences (SPSS) version 16.0. the p-value

Abstract Background From a secondary prevention perspective, it is useful to know who is at greatest risk of progressing from substance initiation to riskier patterns of future use. Therefore, the aim of this study was to determine relationships between age at first use of alcohol, tobacco and cannabis and patterns of cannabis use, frequency of use and whether age of substance use onset is related to having a cannabis use disorder (CUD). Methods We analysed data from Ireland’s 2010/11 and 2014/15 National Drug Prevalence Surveys, which recruited 5134 and 7005 individuals respectively, aged 15 years and over, living in private households. We included only those people who reported lifetime cannabis use. Multinomial, linear and binary logistic regression analyses were used to determine relationships between age of substance use onset and patterns of cannabis use, frequency of use and having a CUD. Results When compared to former users, the odds of being a current cannabis user were found to be reduced by 11% (OR = 0.89; 95% CI: 0.83, 0.95) and 4% (OR = 0.96; 95% CI: 0.92, 1.00) for each year of delayed alcohol and cannabis use onset, respectively. Among current users, significant inverse linear relationships were noted, with increasing age of first use of tobacco (β = − 0.547; P

Introduction: The high prevalence among elderly individuals and potential adverse impact on their overall life quality make chronic musculoskeletal pain a significant public health concern. Chronic musculoskeletal pain is an important cause of self-medication, which must be addressed to avoid various side effects and improve elderly health. This study aimed to determine the prevalence of chronic musculoskeletal pain and its associated factors among individuals (age ≥60 years) in rural West Bengal and explore their perspectives and perceived barriers regarding pain and its management. Methods: This mixed-method study was conducted in rural West Bengal from December 2021 to June 2022. The quantitative strand was conducted by interviewing 255 elderly participants (age ≥60 years) using a structured questionnaire. The qualitative strand was conducted via in-depth interviews of 10 patients with chronic pain. Quantitative data were analyzed using SPSS version 16, and chronic pain-related factors were analyzed using logistic regression models. Qualitative data were analyzed thematically. Results: Among the participants, 56.8% reported chronic musculoskeletal pain. The most frequently affected site was the knee joint. Comorbidity (adjusted odds ratio [aOR]=7.47, 95% confidence interval [CI]=3.2–17.5), age (aOR=5.16, 95% CI=2.2–13.5), depression (aOR=2.96, 95% CI=1.2–6.7) and over-the-counter drug usage (aOR=2.51, 95% CI=1.1–6.4) were significantly associated with chronic pain. Analgesic dependency, lack of motivation to adopt lifestyle modifications, lack of knowledge on analgesic side effects were considered pain management barriers. Conclusion: Managing comorbidities, providing mental support, generating awareness of analgesic side effects, strengthening healthcare facilities should be prioritized for holistic chronic musculoskeletal pain management.

Introduction: Despite policy actions and strategic efforts for improving the reproductive and sexual health of adolescents by promoting the uptake of adolescent reproductive and sexual health (ARSH) services, the utilisation rate remains significantly low, especially in rural areas of India. This study aimed to assess the utilisation of these services by adolescents in rural West Bengal and its associated determinants. Methods: This mixed-method study was conducted from May to September 2021 in the Gosaba rural block of South 24 Parganas, West Bengal. Quantitative data were collected from 326 adolescents using a pre-tested structured questionnaire. Qualitative data were collected via four focus group discussions among 30 adolescents and key-informant interviews among six healthcare workers. Quantitative data were analysed using SPSS, while qualitative data were analysed thematically. Results: Ninety-six (29.4%) adolescents had utilised ARSH services at least once during adolescence. The factors associated with non-utilisation of ARSH services were younger age, female sex, increasing reproductive health stigma and decreasing parent–adolescent communication related to sexual health. Qualitative exploration revealed that unawareness regarding services, perceived lack of privacy and confidentiality at healthcare facilities and disruption of services post-emergence of the COVID-19 pandemic were some major barriers to ARSH service utilisation. Conclusion: A multi-component strategy, including promotion of adolescent-friendly health clinics, community support interventions associated with motivation and counselling of parents regarding the importance of adolescent reproductive health, is needed to improve the utilisation of ARSH services. Necessary steps to correct the deficiencies at the facility level should also be prioritised.

Background: Barbers are occupationally predisposed to blood borne viral infection (BBVI) such as human immunodeficiency virus, hepatitis B and C. Unhygienic workplaces, improper disinfection and inadequate wound-care can increase the susceptibility of both clients and barbers to BBVI. There is paucity of studies on practices regarding BBVI among barbers, especially in India. Objectives: To identify the pattern and predictors of practices related to BBVI transmission among male barbers in a rural area of West Bengal. Methods: A cross-sectional study was conducted from June 2017 to August 2019 in Indas block of Bankura district among 138 male barbers, who were permanent residents and worked for >6 months. Barbers, randomly selected from 10 Gram Panchayats according to probability proportionate to size, were interviewed. Two barbering sessions were observed. Data were analyzed using SPSS version 16 software. Univariate and multiple linear regression was carried out to identify predictors of better practices. P < 0.05 was considered for statistical significance. Results: Dangerous practices such as reuse of blades (8, 5.8%) and face-towel (77, 55.8%), sale/distribution of used blades (77, 55.8%), improper disinfection of sharps (79, 57.2%), reuse of alum without disinfection (129, 93.5%), and improper wound care (71, 51.4%) were observed. Predictors of better practice regarding BBVI were better attitude regarding BBVI (B = 0.172, standard error [SE] = 0.046, P = 0.000) and increased years of schooling (B = 0.054, SE = 0.021, P = 0.012). Conclusion: Inimical infection control practices were noticed. They are serving the general people and therefore they should be imbibed with correct BBVI knowledge and must do away with all hazardous practice during their barbering activities.

Context: Garment Industry is considered to be the second-largest employment sector in India. Occupational health problems among workers are often ignored, work-related musculoskeletal disorders (WMSD) accounts for the majority of it. The leverage of a healthy workforce is indispensable in the smooth running of the country's economic machinery. Aims: To find out the prevalence of WMSD among the workers and to assess the relationship of WMSDs with sociodemographic, behavioral, and occupational factors. Settings and Design: A cross-sectional study was conducted from June 2017 to August 2019 among 222 workers in three garment factories located in a municipality area of south 24 Parganas District, West Bengal. Methods and Material: Sociodemographic and behavioral characteristics, occupational differentials, and morbidity profiles were assessed using a pre-designed, pre-tested schedule. Statistical Analysis Used: Data were analyzed by SPSS ver. 16.0. Logistic regression was done to determine the associates of WMSDs. Results: Most of the workers were males (70.27%), belonged to the age-group of 36–55 (42.34%) and were illiterate (33.78%). WMSD was prevalent among 70.72% of the workers. Presence of WMSD was significantly associated with educational status{illiterate (OR: 3.59; CI: 1.56–8.22), below secondary (OR-2.89;CI: 1.26-6.62)}, sitting job (OR: 2.02; CI: 1.01-4.03), unsatisfactory working environment (OR: 8.38; CI:1.95–36.06), and level of distress {mild (OR-2.89;CI: 1.26-6.62), moderate-severe (OR: 6.98; CI: 1.46–33.25)}. Conclusions: Improving health awareness and periodic health check-up is the need of the hour for the sustenance of the massive workforce, which can be achieved through the integration of basic occupational health services (BOHS) with primary health care (PHC) infrastructure.

Context: Tobacco smoking is one of the preventable causes of death. Global Adult Tobacco Survey 2 report showed that 19% Indian males were current smokers. It is important to find out factors which help smokers on smoking cessation, ultimately to prevent of lung and other morbidities. There are few community-based studies on intention and attempt to quit smoking in rural area. Aims: The present study aimed to determine the factors associated with intention and attempt to quit smoking among current smokers. Settings and Design: A cross-sectional study was conducted from June to September 2019 among 198 male daily smokers residing in the rural field practice area of AllH and PH, Kolkata. Subjects and Methods: After cluster sampling, data were collected by predesigned schedule by the face-to-face interview. Results: 151 (76.3%) study subjects intended to quit smoking. 63 (31.8%) study subjects attempted to quit in last 1 year. Thirty-one (47.5%) showed high-to-medium nicotine dependence. There was a significant association of intention to quit with agriculture as occupation (acquisitive crime [AOR]-2.17, confidence interval [CI]-1.01–4.63), low nicotine dependence (AOR-2.98, CI-1.43–6.21), doctor's advice (AOR = 2.84, CI-1.27–6.33), and family pressure (AOR = 2.16, CI-1.07–4.38). Attempt to quit was significantly associated with low nicotine dependence (AOR = 5.85, CI-2.85–12.00), family pressure (AOR = 2.94, CI-1.47–5.91). Conclusion: Along with counseling to reduce nicotine dependence, comprehensive approach both from family members as well as health care providers, is vital to escalate the quitting behaviour in smoking habit.

Background: Village Health and Nutrition Day (VHND) is a community participation program focusing on pregnant women, lactating mothers, children (0–5 years), and adolescent girls. Objectives: To assess the status of VHND functioning in the rural areas, and to determine the facilitators and barriers of health care service utilization among the beneficiaries. Also, to explore the challenges faced by the front-line workers while conducting the program. Methods: A cross-sectional descriptive study with a mixed-methods approach was conducted among the beneficiaries and the service providers in twelve selected VHND sessions from March to July 2019 in Singur, Hooghly district, West Bengal. Both quantitative and qualitative methods of research were applied to assess the status of the functioning of 12 VHNDs. Results: Among the beneficiaries who attended the sessions; 28.57% were pregnant women, 16.53% were lactating mothers and 17.44% were under-five children. Nonavailability of line-list of adolescent girls and nonavailability of Vitamin A in oil were major observations. Barriers leading to poor service utilization among beneficiaries were the long-distance of the VHND session site, lack of counseling on proper lifestyle practices, poor and inadequate infrastructure. House visits by the Accredited Social Health Activists regarding the information on VHND sessions found to be an important facilitating factor for beneficiaries. Major challenges identified among the healthcare workers were lack of logistics supply, inadequate workforce, and improper the maintenance of the VHND session site. Conclusion: Proper resource mobilization, maintenance and cleanliness of the session sites, appropriate and wholesome counseling can vastly improve the quality of VHND with the concurrent improvement of maternal and child health.

Introduction: Diabetes is one of the major disease burdens in the world. Globally around 463 million people (at a prevalence of 9.3%) suffered from diabetes recently. Apart from morbidity and mortality, diabetes poses high economic burden on healthcare systems, especially on national economies in developing countries like India. Estimation of the cost burden of diabetes can help decision-makers to understand the magnitude of the problem, prioritize research efforts and interventions, and plan resource allocation, especially in resource-poor settings. The focus of our review was to summarize cost burden of diabetes and its determinants from existing literature in the last 10 years in India. Materials and Methods: All literatures published in the period 2010–2020 were accessed through two databases: PubMed and Google Scholar. Reference lists of the article were again searched for further literatures. Cost calculated in different times was converted to current price in 2020 for ease of comparison. Results: Studies reported a wide range of expenditures in different settings of care. Inequity of expenses across income quintiles among patients was found. Complication of diabetes, insulin therapy, treatment in private facility, and events of hospitalization were the factors associated to high expenditure burden. Conclusion: Financial risk protection for vulnerable people and control over medicine market price will reduce out-of-pocket expenditure for diabetes. Comprehensive strategy to delay onset of complication as well as its early detection can be an opportunity to cut down diabetes-related economic burden.

Abstract Background Classifying pathogenicity of missense variants represents a major challenge in clinical practice during the diagnoses of rare and genetic heterogeneous neurodevelopmental disorders (NDDs). While orthologous gene conservation is commonly employed in variant annotation, approximately 80% of known disease-associated genes belong to gene families. The use of gene family information for disease gene discovery and variant interpretation has not yet been investigated on a genome-wide scale. We empirically evaluate whether paralog-conserved or non-conserved sites in human gene families are important in NDDs. Methods Gene family information was collected from Ensembl. Paralog-conserved sites were defined based on paralog sequence alignments; 10,068 NDD patients and 2078 controls were statistically evaluated for de novo variant burden in gene families. Results We demonstrate that disease-associated missense variants are enriched at paralog-conserved sites across all disease groups and inheritance models tested. We developed a gene family de novo enrichment framework that identified 43 exome-wide enriched gene families including 98 de novo variant carrying genes in NDD patients of which 28 represent novel candidate genes for NDD which are brain expressed and under evolutionary constraint. Conclusion This study represents the first method to incorporate gene family information into a statistical framework to interpret variant data for NDDs and to discover new NDD-associated genes.

Context: Anemia is a serious public health concern especially in women of reproductive age (WRA) as it causes a high burden of morbidity and mortality and persists through intergenerational cycle. As most of the risk factors are preventable, a thorough understanding of its risk factors is necessary to design better interventions. Aims: Current study aimed to estimate the burden of anemia as well as explore determinants of various grades of anemia among WRA in a rural area. Settings and Design: A community-based cross-sectional study was conducted among non-pregnant, non-lactating women of reproductive age in rural field practice area of All India Institute of Hygiene and Public Health. Methods and Materials: House to house visit was conducted for interviewing with pre-designed pre-tested questionnaire along with blood hemoglobin and anthropometric measurement. Statistical Analysis Used: Descriptive statistics and test of significance like multinomial logistic regression and Kruskal-Wallis test (with post-hoc) were used. Results: Majority (70.8%) of participants were anemic. Proportion of mild, moderate, and severe anemia were 24.16%, 37.5%, and 9.16%, respectively. Different levels of anemia were significantly associated with higher age, lower education, poor iron-rich food intake, lack of dietary diversity, and adiposity. Significantly low hemoglobin level in both underweight and obesity was noticed suggesting U shaped relationship between BMI and anemia. Conclusion: Periodic screening for anemia among WRA especially in both extremes of malnutrition, i.e., undernutrition and obesity should be considered at the policy level. Year-round behaviour change communication campaigns must be carried out for the promotion of necessary food groups in diet.

Context: In India, despite implementation of the strategies under National Tobacco Control Programme [NTCP], women are easily exposed to tobacco consumption that is smokeless (SLT) and smoking tobacco along with second-hand smoke [SHS], making them highly susceptible to tobacco hazards. Aims: This study aimed to assess the exposure of women to tobacco use and SHS at home and to elicit predictors of tobacco exposure in a rural community of West Bengal. Methodology: A community based, cross-sectional study was conducted among 176 women aged 18 years and above. Data was collected by cluster sampling technique (16*11) using predesigned pretested structured schedule. Tobacco exposure was measured using a composite score including tobacco consumption and SHS at home. Results: Tobacco use (SLT and smoking tobacco) was significantly associated with educational attainment [AOR = 2.12], occupation [AOR = 2.13] and knowledge [AOR = 1.22]. There was significant association between SHS at home with knowledge [AOR = 1.16] and attitude of the study subjects. [AOR = 1.93]. Overall tobacco exposure (SLT, smoking tobacco, and SHS), was found to be 79.5%. Significant association was found between high tobacco exposure with age group [AOR = 3.82], educational attainment [AOR = 1.74] and knowledge regarding hazards of tobacco [AOR = 1.31]. Conclusion: Prevalence of SLT use as well as exposure of women to SHS at home is unexpectedly high in the study population. Women specific information and education campaigns focusing on tobacco hazards (both tobacco use and SHS) through existing primary health care infrastructure should be strategized under NTCP.

Context: Rheumatoid arthritis (RA) is a known chronic debilitating disease accounting for a large percentage of disability globally. Pain and stiffness, decreased work function, depression and emotional state alteration, fatigue, disability, and social handicaps are some patient reported outcomes, which if considered with priority the health-related quality of life (HRQOL) of patients with RA could improve. Aims: This study was conducted with the aim to assess the HRQOL of the patients with RA and the determinants related to it. Settings and Design: This was a cross-sectional study conducted at Rheumatology Department of a tertiary care hospital, Kolkata. Subjects and Methods: A total of 252 patients with RA were selected in this study through systematic random sampling. Statistical Analysis Used: Data were analyzed using appropriate statistical measures with Statistical Package for the Social Sciences(SPSS) version 16.0 (Armonk, NY: IBM Corporation) software program, version 16.0. Univariate and multivariable logistic regression were carried out. Results: In the study, the mean age of the patients was 43.1 years (mean age ±SD: 43.05±10.63 years). The proportion of female subjects was 84.5%. Unsatisfactory QOL was found in 59.9% study participants. In multivariable logistic regression unsatisfactory quality of life was significantly associated to moderate to high functional disability [AOR: 6.04, CI: 2.86, 12.78], disease activity moderate to high [AOR: 5.41, CI: 1.87, 15.69], presence of comorbidity [AOR: 2.90, CI: 1.39, 6.04], extra-articular manifestations [AOR: 3.14, CI: 1.41, 6.96] and delay in starting Disease-Modifying Anti-Rheumatoid Drugs (DMARDs) [AOR: 1.24, CI: 1.08, 1.42]. Conclusion: Findings of this study clearly indicate the presence of high proportion of unsatisfactory QOL among the patients with RA. Early identification and prompt referral are the key strategies to prevent any permanent damage. Regular follow-up of the patients should be carried out to prevent or delay the disability progression and provide high-quality physical and mental health.

Background: The prevalence of metabolic syndrome (MetS) is increasing dramatically of late, across all ages irrespective of gender, socioeconomic status, and ethnicity. People with MetS have twice the likelihood of developing and dying from cardiovascular disease and more than seven times the risk of developing diabetes. Objectives: This study was undertaken to determine the prevalence of MetS among adults who were in their first three decades of adulthood and to find out the risk factors of MetS among them. Methods: This was a community based cross-sectional study among 388 subjects aged 18–49 years selected by multistage random sampling in an area of Kolkata, India, from November 2016 to October 2018 over 2 years. Data collection was done using a structured questionnaire along with anthropometry, blood pressure measurement, and relevant blood tests. Physical activity was classified by the International Physical Activity Questionnaire Short-Form questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (version 16.0), and descriptive statistics were calculated as frequency and percentage. Logistic regression was done to determine the strength of association between MetS and different risk factors. Results: The prevalence of MetS was 44.6% (35.4% in males and 55.6% in females), and female gender, poor economic status, sedentary lifestyle, poor diet, and addiction of tobacco were found to be the risk factors of MetS in the final model using multivariable logistic regression. Conclusion: This research revealed the high prevalence of MetS in the community. The effective primordial and primary level of prevention along with prevailing secondary or tertiary level of prevention should have been employed to curtail the epidemic of MetS.

Context: With the aging of Indian society, maintaining salubrious cognitive health in late life is a public health priority. Early detection and possible prevention of cognitive impairment (CI), thus, will help in increasing the quality of life of elderly people and decreasing the social, psychological, and economic burden of their families and caregivers. Aims: The study aimed to assess proportion of CI and its predictors. Settings and Design: This community-based cross-sectional study was conducted among 135 elderly people selected from 15 villages out of a total 64 villages in rural field practice area Singur of AIIH&PH, Kolkata. Methods and Material: Cluster sampling technique was used and villages were selected according to probability proportional to size method. Data was collected using a predesigned, pretested structured schedule, which included sociodemographic and behavioral variables, Montreal cognitive assessment tool, Geriatric depression scale short form (GDS 15), and mini nutritional assessment tool. Statistical Analysis Used: Predictors of CI were assessed by univariate and multivariable logistic regression using MS-Excel 2016 and SPSS version 16 software. Results: Mean age of the study participants was 67.03 ± 6.7 years with 51.9% of them being females. Proportion of CI was observed to be 48.1% which was significantly associated with increasing age [AOR = 1.1 (1.02–1.13)], decreasing years of schooling [AOR = 1.1 (1.01–1.2)], depression [AOR = 2.7 (1.3–5.8)], and malnourished group [AOR = 4.5 (1.01–20.3)] Conclusion: The burden of CI among the study population was found to be quite high. It is an alarming situation which needs improved screening facility for early detection. Nutritional upliftment and screening for depression should also be done on a regular basis.