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Byline: Ayush. Sopori, Seema. Sharma, Kavya. Sharma, Milap. Sharma Tuberous sclerosis complex (TSC) is a disease of varying presentations characterised by the presence of multiple hamartomas in various organ systems [...]

Introduction: To determine effectiveness and side effects of expectant care in first-trimester miscarriage. An increase in the spontaneous miscarriage rate and its associated complications exerts a burden on the overall health and quality of life of women. Expectant care in a first-trimester miscarriage has shown success ranging 75-80%. This study was designed to search the literature for information on the clinical safety and effectiveness of expectant management on spontaneous miscarriage during the first trimester. Material and methods: The review included studies that included women in expectant care for spontaneous miscarriage in the first trimester. Trial studies were recognized through a methodical and organized database search from PubMed, COCHRANE, MEDLINE, Embase, and bibliography from January 2000 until December 2022. The methodological assessment and risk of bias was assessed using the Joanna Briggs Institute criteria. Results: Eleven studies in systematic review and 7 studies in the meta-analysis were included. The included studies showed a low to moderate risk of bias. The odds of success in expectant intervention were low when compared with surgical intervention (odds ratio - OR: OR: 0.37 [0.28, 0.48]) and medical management (OR: 0.47 [0.36, 0.61]), and the need for surgical evacuation was high (OR: 2.59 [1.88, 3.59]). Conclusions: Future trials should consider women's opinions and the effect on quality of life along with clinical consequences, to provide improved suggestions on the efficiency and adverse effects. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 05-months-old female infant born of non-consanguineous marriage presented with complaints of not gaining weight. Topics include nervous system examination revealing profound muscle wasting in all 4 limbs generalised hypertonia with brisk deep tendon reflexes; and suprasellar region arising from hypothalamus with possibility of glioma.

The article comments on the article "Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Clinical and Sonographic Results at 90 Months," by B. F. H. Ang, P. C. Mohan and M. A. Png, which appeared in the 2021 issue. Topics covered include the extensor tenotomy with variations as a treatment for tennis elbow, the study of patients with recalcitrant tennis elbow in India and the how structured conservative therapy is an effective treatment modality.

The success of cancer chemotherapy has increased greatly the potential areas for its inclusion in clinical trials and therefore has made the experimental design considerations more complex in these trials. New drugs which are launched yet go through the three classic phases of clinical study beginning with clinical pharmacology (Phase I), efficacy screening (Phase 2) and role delineation (Phase 3). The Phase 2 and 3 trials now need to be considered within the overall therapeutic strategies which are required for each of the many diseases which are called cancer. Drugs consumed in chemotherapy, such as cytarabine, work in different ways to stop the growth of cancer cells, either by killing the cells or stopping them from increase exponentially. may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. It is not yet known whether cytarabine is more effective in treating acute myeloid leukemia. The motive of this study is to assess the efficacious and eternal side effects of using combined tretinoin and arsenic trioxide in treating patients with newly detection of acute promyelocytic leukemia. Chemotherapy was identical, except for the addition of DTIC (300 mg/m2) for each course. A new drug may have required a lot of Phase 2 and 3 trials in a variety of tumors before it can be considered appropriately estimated. Essential aspects of valid clinical trials include an adequate protocol which details the study which is viable not for the current status but also for the future aspects. [ABSTRACT FROM AUTHOR]

Background: The Post-Graduate Diploma in Public Health Management, launched by the Govt. of India under the aegis of the National Rural Health Mission in 2008, aims to enhance the managerial capabilities of public health professionals to improve the public health system. The Govt. of India invested enormous resources into this programme and requested an evaluation to understand the current processes, assess the graduates' work performance and identify areas for improvement. Methods: Quantitative telephone surveys as well as qualitative in-depth interviews were used. Graduates from the first three batches, their supervisors, peers and subordinates and faculty members were interviewed. Quantitative data were analysed using proportions, means and interpretative descriptions. Qualitative analyses involved transcription, translation, sorting, coding and filing into domains. Results: Of the 363 graduates whose contact details were available, 138 could not be contacted. Two hundred twenty-three (223) graduates (61.43% of eligible participants) were interviewed by telephone; 52 in-depth interviews were conducted. Of the graduates who joined, 63.8% graduates were motivated to join the programme for career advancement and gaining public health knowledge. The content was theoretically good, informative and well-designed. Graduates expressed need for more practical and group work. After graduating, they reported being equipped with some new skills to implement programmes effectively. They reported that attitudes and healthcare delivery practices had improved; they had better self-esteem, increased confidence, better communication skills and implementation capacity. While they were able to apply some skills, they encountered some barriers, such as governance, placements, lack of support from the system and community, inadequate implementation authority and lack of planning by the state government. Incentives (both monetary and non-monetary) played a major role in motivating them to deliver public health services. They suggested that states should nominate candidates expected to make a significant contribution to the health system, recognition from a relevant authoritative national body and need for a placement cell, especially for the self-sponsored candidates. Conclusions: A continuous mechanism for interaction and dialogue with the graduates during and after completion of the programme should be designed. This evaluation helped by providing inputs for refining the programme. [ABSTRACT FROM AUTHOR]

The article discusses the context of positioning and maximizing the output of district level health officers, rendering greater autonomy and streamlining their roles in department of public health in Maharashtra and attempts to articulate challenges faced by existing district level human resources for health (HRH) architecture and discussed possible changes to face these challenges. It cites recommendation for state health directorate to have a full-fledged HR department.

The Indian health care sector will double its size to US$ 100 billion by 2015 from the present US$ 50 billion. However, the government’s contribution on health care is minimal whereas Indian households spend a disproportionate share of their consumption expenditure on health care. The National Rural Health Mission (NRHM) intends to increase the public expenditure on health from 1.1 per cent of GDP to 2–3 per cent of GDP by 2011. This increased funding through the NRHM should be supplemented by efforts to improve efficiency in resource utilization. Health economics is increasingly recognized as a discipline that has much to offer in addressing these issues. However, the information about capacity building initiatives in terms of teaching and training in the field of health economics in India is limited. This article attempts to address this knowledge gap through a systematic research by identifying various institutions offering courses in health economics across India, their intake capacity, areas of specialization and accreditation standards. The article also attempts to estimate the demand for professionals having expertise in health economics and intends to stimulate the discussion around pertinent issues around need and demand mismatch. [ABSTRACT FROM PUBLISHER]

Industrial growth in India has resulted in increased employment opportunities, thereby inflating the size of the workforce engaged in both organized and unorganized sectors. This workforce is exposed to various occupational factors at workplace and hence is susceptible to occupational diseases, which requires trained occupational health manpower. The present study is undertaken to estimate the need and supply gap of occupational health manpower, based on present regulations. The total workforce in the organized sector in India is 26.92 million. There are 254,951 working registered industrial factories in India, with about 11.16 million workers. These factories have employed 6953 factory medical officers (FMOs) and 2308 safety officers (SOs). Hence, for 26.92 million of total workforce engaged in organized sector, we would require a total of 16,728 FMOs and 5619 SOs, thereby estimating the deficit of 58% for FMOs and 59% for SOs based on current ratio of employment. [ABSTRACT FROM PUBLISHER]

This article attempts to answer the obvious question of who are the people that can be included in the definition of Human Resources for Health and what might they be called. To answer the question an extensive search of literature was conducted. The search was aimed at identifying the nomenclature and classifications of human resources for health.The search resulted in a variety of nomenclature and a large number of classification frameworks which were then narrowed down to seven frameworks. It was found that there is a lot of overlap in the definitions used for various nomenclatures. The terms ‘health workers’ and ‘public health workers’ are a major area of disagreement and confusion. The classifications also indicated a lot of difference of opinions on who should be included in the various categories suggested in the different classifications. However, almost all these classifications identify at least three major categories of health workers; the specialist health workers, the specialist public health workers and the health management/support workers.The article points out an important area which is generally neglected in the human resource policy making. An attention to better classification can have a tremendous impact on human resource planning and monitoring. [ABSTRACT FROM PUBLISHER]

Abstract: Nursing care has been mentioned in the Indian culture from the times of the Vedas. However, according to World Health Organization, the nursing workforce in India is still insufficient to meet the needs of the country. The purpose of this article is to examine the status of nursing education and the nursing workforce in India and the challenges faced by the profession. Data supporting the statements made in the article were obtained from the Nursing Council of India, the Ministry of Health and Family Welfare, the Government of India Web sites, printed journals and communication with experts in the field. In India, there is a need to train approximately a million nurses to meet the current shortfall of health workers in the country. The nursing "brain drain" suggests that it may be one of the factors responsible for this shortfall. Further, nursing education faces challenges, such as streamlining nursing education, enriching the curriculum, strengthening faculty development and increasing the use of innovative teaching and learning techniques. [Copyright &y& Elsevier]

Pharmaceutical management is a cross cutting domain across health care systems and the pharmaceutical industry. Also, higher education in pharmaceuticals lies at cross-roads between health and technical education. This has created enormous opportunities for developing synergistic and symbiotic relationships between academic institutions and the pharmaceutical industry for developing human resource trained in various domains of the pharmaceutical. However, there is limited information and data regarding educational institutions offering training in pharmaceuticals as well as supply of human resources trained in pharmaceuticals. This research article intends to fill the above mentioned research gap and stimulate discussion around various pertinent issues like regulation, accreditation and benchmarking of various educational programmes in pharmaceutical management. [ABSTRACT FROM PUBLISHER]

The authors explore their views on public health education in India. They highlight the need for public education to find solutions for multitude of public health problems through building the capacity of public health workforce. They cite a shift in public health education in India and mentions public health programs initiated by few institutions for both medical and nonmedical graduates. They propose building a public health cadre in state health services.

The healthcare industry in India caters to a large population, and the sector is expected to continue growing close to previously projected rates of 10 to 12 per cent. The administrative and management complexities of a large organisation like a hospital need the frequency matching and fine-tuning of all the associated staff with the hierarchy. A qualified man-agement graduate specially trained to work within the health sector would have an advantage in the inter-disciplinary interactions, effective and efficient management of the available resources, coordination along the hierarchy, logistics and supply-chain related issues along with many other issues that are required in a hospital. It is evident that there is a huge backlog of trained hospital managers and administrators to work for hospitals, pharmaceutical companies, health insurance and third-party administration and other health care provider organisations. Despite having a diverse range of options to choose the educational institutions for such managerial courses, there is still a gap between the supply and the demand side, as no exhaustive list of program related data from these institutes is available till date. This article analyses the demand and supply issues surrounding courses offering hospital management in India, thereby attempting to highlight the current mismatch. A systematic, predefined approach was used to collect and assemble the data. All the institutes offering such courses were contacted for detailed infor-mation. Fifty one institutes have been identified which annually produce around 2500 qualified professionals to work in the domain of hospital management. The article also discusses the demand analysis where these prospective students can be placed. To estimate these numbers, various stakeholders of the hospital industry were consulted and desk reviews were performed. An estimated 21,750 professionals would be required based upon the country’s present status, which reflects the dearth in their workforce capacity. The findings could be adapted for future health work force planning in the country. [ABSTRACT FROM PUBLISHER]

Public health education in China and India has a long history that has been both deeply responsive to the unique needs and medical traditions of each country, and sensitive to global influences. The history of public health education in China reaches back several centuries, with substantial input from American and European organizations during the Republican Era, 1911-1949. In India, centuries-old health care traditions were influenced during the colonial period by the British Empire prior to independence in 1947. Political upheaval in both countries during the 1940s further impacted the public health systems as well as public health education. The primary goal of this review is to outline public health education in India and Mainland China, with a focus on describing the historical systems and structures that have promoted the development of formalized public health education. We examine current challenges, and analyze opportunities for improvement. Health reforms in China and India need to consider new and modern models for public health education, perhaps in independent faculties of public health, to reinvigorate public health education and strengthen the position of public health in addressing the health challenges of the 21st century. [ABSTRACT FROM AUTHOR]

India faces a formidable burden of neonatal deaths, and quality newborn care is essential for reducing the high neonatal mortality rate. We examined newborn care services, with a focus on essential newborn care (ENC) in two districts, one each from two states in India. Nagaur district in Rajasthan and Chhatarpur district in Madhya Pradesh were included. Six secondary-level facilities from the districts-two district hospitals (DHs) and four community health centres (CHCs) were evaluated, where maximum institutional births within districts were taking place. The assessment included record review, facility observation, and competency assessment of service providers, using structured checklists and sets of questionnaire. The domains assessed for competency were: resuscitation, provision of warmth, breastfeeding, kangaroo mother care, and infection prevention. Our assessments showed that no inpatient care was being rendered at the CHCs while, at DHs, neonates with sepsis, asphyxia, and prematurity/low birthweight were managed. Newborn care corners existed within or adjacent to the labour room in all the facilities and were largely unutilized spaces in most of the facilities. Resuscitation bags and masks were available in four out of six facilities, with a predominant lack of masks of both sizes. Two CHCs in Chhatarpur did not have suction device. The average knowledge score amongst service providers in resuscitation was 76% and, in the remaining ENC domains, was 78%. The corresponding average skill scores were 24% and 34%, highlighting a huge contrast in knowledge and skill scores. This disparity was observed for all levels of providers assessed. While knowledge domain scores were largely satisfactory (> 75%) for the majority of providers in domains of kangaroo mother care and breastfeeding, the scores were only moderately satisfactory (50-75%) for all other knowledge domains. The skill scores for all domains were predominantly non-satisfactory (< 50%). The findings underpin the need for improving the existing ENC services by making newborn care comers functional and enhancing skills of service providers to reduce neonatal mortality rate in India. [ABSTRACT FROM AUTHOR]

Introduction: To determine effectiveness and side effects of expectant care in first-trimester miscarriage. An increase in the spontaneous miscarriage rate and its associated complications exerts a burden on the overall health and quality of life of women. Expectant care in a first-trimester miscarriage has shown success ranging 75-80%. This study was designed to search the literature for information on the clinical safety and effectiveness of expectant management on spontaneous miscarriage during the first trimester., Material and Methods: The review included studies that included women in expectant care for spontaneous miscarriage in the first trimester. Trial studies were recognized through a methodical and organized database search from PubMed, COCHRANE, MEDLINE, Embase, and bibliography from January 2000 until December 2022. The methodological assessment and risk of bias was assessed using the Joanna Briggs Institute criteria., Results: Eleven studies in systematic review and 7 studies in the meta-analysis were included. The included studies showed a low to moderate risk of bias. The odds of success in expectant intervention were low when compared with surgical intervention (odds ratio - OR: OR: 0.37 [0.28, 0.48]) and medical management (OR: 0.47 [0.36, 0.61]), and the need for surgical evacuation was high (OR: 2.59 [1.88, 3.59])., Conclusions: Future trials should consider women's opinions and the effect on quality of life along with clinical consequences, to provide improved suggestions on the efficiency and adverse effects., Competing Interests: The authors report no conflict of interest., (Copyright © 2023 Termedia.)

Transformational learning is the focus of twenty-first century global educational reforms. In India, there is a need to amalgamate the skills and knowledge of medical, nursing, and public health practitioners and to develop robust leadership competencies among them. This initiative proposed to identify interdisciplinary leadership competencies among Indian health practitioners and to develop a training program for interdisciplinary leadership skills through an Innovation Collaborative. Medical, nursing, and public health institutions partnered in this endeavor. An exhaustive literature search was undertaken to identify leadership competencies in these three professions. Published evidence was utilized in searching for the need for interdisciplinary training of health practitioners, including current scenarios in interprofessional health education and the key competencies required. The interdisciplinary leadership competencies identified were self-awareness, vision, self-regulation, motivation, decisiveness, integrity, interpersonal communication skills, strategic planning, team building, innovation, and being an effective change agent. Subsequently, a training program was developed, and three training sessions were piloted with 66 participants. Each cohort comprised a mix of participants from different disciplines. The pilot training guided the development of a training model for building interdisciplinary leadership skills and organizing interdisciplinary leadership workshops. The need for interdisciplinary leadership competencies is recognized. The long-term objective of the training model is integration into the regular medical, nursing, and public health curricula, with the aim of developing interdisciplinary leadership skills among them. Although challenging, formal incorporation of leadership skills into health professional education is possible within the interdisciplinary classroom setting using principles of transformative learning.

With an increase in the number of institutes offering public health education, there is a need for discussion on future directions and challenges. The World Health Report 2006 identified the need to improve the quality of public health education. There are various mechanisms and bodies that look after accreditation issues in several countries. The Council on Education for Public Health in the USA assists in the accreditation of schools of public health, as well as public health programmes. The Australian Network of Academic Public Health Institutions is actively engaged in discussions to improve the quality of its programme and institutions. In Europe, the European Agency for Accreditation in Public Health Education is responsible for accreditation. The South-East Asia Public Health Education Institutes Network facilitates accreditation of public health education in the region. In India, public health education varies across institutes. India needs an accreditation system to ensure that public health education is of the desired quality. Certain initiatives, such as conferences, consultation and the Calcutta Declaration, have been taken in the past two decades. However, the ideas mooted have yet to be translated into reality. The broad framework for accreditation may entail an institutional self-assessment against set standards, preparation of a database, cataloguing, and site visits by a peer team. There is a need for an apical body with all stakeholders participating in the process. Accreditation has specific benefits, but there are critical challenges as well. For example, the autonomy of the institutions needs to be protected, the accreditation bodies should exhibit professionalism and substantial financial resources are required. Before tackling specific criteria for accreditation, it is necessary to define a collective vision for schools of public health in India., (Copyright 2013, NMJI.)

Veterinary public health (VPH) is ideally suited to promote convergence between human, animal and environmental sectors. Recent zoonotic and emerging infectious disease events have given rise to increasing calls for efforts to build global VPH capacities. However, even with their greater vulnerability to such events, including their economic and livelihood impacts, the response from low-and middle-income countries such as India has been suboptimal, thereby elevating global health risks. Addressing risks effectively at the human-animal interface in these countries will require a clear vision, consistent policies, strategic approach and sustained political commitment to reform and refine the current VPH capacity-building efforts. Only then can the discipline serve its goal of disease prevention, poverty alleviation and support for sustainable livelihoods through improvements in human and animal health.

'Health promotion is the process of enabling people to increase control over and to improve their health'. This stream of public health is emerging as a critical domain within the realm of disease prevention. Over the last two decades, the curative model of health care has begun a subtle shift towards a participatory model of health promotion emphasizing upon practice of healthy lifestyles and creating healthy communities. Health promotion encompasses five key strategies with health communication and education as its cornerstones. Present study is an attempt to explore the current situation of health promotion education in India with an aim to provide a background for capacity building in health promotion. A systematic predefined method was adopted to collect and compile information on existing academic programs pertaining to health promotion and health education/communication. Results of the study reveal that currently health promotion education in India is fragmented and not uniform across institutes. It is yet to be recognized as a critical domain of public health education. Mostly teaching of health promotion is limited to health education and communication. There is a need for designing programmes for short-term and long-term capacity building, with focus on innovative methods and approaches. Public health institutes and associations could play a proactive role in designing and imparting academic programs on health promotion. Enhancing alliances with various institutes involved in health promotion activities and networking among public health and medical institutes as well as health services delivery systems would be more productive.

Public Health Management has taken a momentous leap and seeks to provide a plausible answer to many issues related to public health. A key area identified to aid the public health objectives in the country is human resource management. The country faces a dire crunch in the available work force in almost all the healthcare network. Countering the current health situation in the country, various institutes have come up offering specialized courses in public health management. The wide gap between supply and demand for trained health care managers/ administrators to work for hospitals, pharmaceutical companies, health insurance and third party administration and other health care provider organizations needs attention. The paper is a situational analysis of all such courses offered pan India. A systematic, predefined approach was used to collect and assemble the data. All the institutes offering such courses were contacted for detailed information. Fifty one institutes have been identified which annually produce around 2122 qualified professional to work in the domain of public health management. The paper also discusses the demand analysis where these prospective students can be placed. An estimated 19,930 professionals would be required based upon the country's present status, which reflects the dearth in their workforce capacity. The paper also enlighten the scope of strengthening the existing system, by effectively training the existing workforce for their capacity building, and highlights training opportunities for working professional to pursue a related academic program.