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Single parent adoption (SPA) is a relatively new construct worldwide and in India. The Ministry of Women and Child Development, Government of India, has laid down criteria for adoption in general and SPA in particular, in conjunction with the Juvenile Justice Act (Care and Protection of Children), 2015. There is scant literature on this topic of SPA, more so in India, that looks into the various psychological nuances of SPA from a mental health professional's (MHP) perspective. This review paper aims to assess SPA from the perspective of a MHP that will focus on its various legal nuances as well as the psychological connotations attached to it. For this, a search strategy was employed that included a thorough literature search from two databases (PubMed and Google Scholar) with relevant keywords related to the topic. The various legal issues pertaining to SPA in the current scenario, the psychological issues and challenges faced by single parents, the behavioral outcomes of adoptees who are adopted by single parents, and ways to deal with the various obstacles of SPA are discussed. [ABSTRACT FROM AUTHOR]

Background: Hyperglycemia-associated micro- and macro-vascular complications remain the leading cause of premature morbidity and mortality among the diabetic population worldwide. Poor glycemic control due to clinical inertia towards insulin treatment is a major cause behind the development of diabetic complications. In this paper, we analyze different strategies of insulin treatment initialization and titration practiced in India. Methods: The response of 367 healthcare professionals (HCPs) across the country was recorded based on a survey on demographics, treatment regimens, and patient behavior. For analysis, the responses from HCPs were segregated into six regions, north, south, east, west, and central, covering the entire country. Results: The survey revealed that 59.1% HCPs preferred using three oral anti-diabetic drugs (OADs) before starting insulin therapy while 12.5% initiated insulin as the last option after trying all available OADs. Besides, 61% HCPs across India considered initiating insulin in type 2 diabetes mellitus (T2DM) patients when the patients (i) failed to achieve glycemic targets with current OADs, or (ii) could not tolerate OADs, or (iii) required a more flexible therapy. In T2DM patients, 52.9% HCPs chose basal only insulin during initiation. In comparison, 63.8% HCPs used basal bolus while initiating insulin in type 1 DM (T1DM) patients. Pan-India, 53.4% HCPs preferred analogue premix while 46.6% HCPs opted for human premix. Next, 98.9% HCPs counselled patients about the risk of hypoglycemia upon initiation of insulin. Conclusion: This survey outlines an urgent need of reducing the clinical inertia against insulin initialization in Indian settings. [ABSTRACT FROM AUTHOR]

Background Ayurveda is not merely a curative science rather it is a lifestyle guide which helps to promote health and prevent diseases. The preventive aspects of Ayurveda are accommodated under the umbrella of Swasthavritta which includes Dinacharya, Ratricharya, Ritucharya, Rules regarding Nidra, the concept of Dharaneeya and Adharaneeya vegas, Ahaaram, Sadvruttam, Rasayanam, etc which help to strengthen the defense mechanism of the body. Ayurveda doctors are supposed to be the ambassadors of these health promotive measures to the common mass. Aim: The present work aimed at assessing the Knowledge, Attitude and Practices of selected Dinacharya procedures among the Ayurveda doctors across India. Materials and methodology: A KAP survey was conducted among the Ayurveda doctors across India by sharing a structured closed ended questionnaire through google form. 311 subjects participated in the study. Results: 1) Knowledge: Majority of the respondents are aware (partially/fully) about the Dinacharya practices. 2)Attitude: Majority of the respondents agree to the health benefits of Dinacharya practices because they have experienced them either personally or have learnt about it from the experiences of others.3)Practices: 23.8% were waking up in Brahma Muhurta, 20.2% were practicing Ushajalapaanam though none of them consumed 8 prasruthi of water as classically advised, 16.7% respondents used herbal toothpastes, 88.4% reported to be practicing Jihwanirlekhanam but none were using metallic or wooden tongue cleaners as classically indicated, only 19.3% respondents used herbal collyrium regularly, 6.7% practiced Pratimarsha nasyam daily, 13.5% practiced gandoosham, 1 % practiced dhumapanam daily, 27% respondents practiced abhyangam and 23.2% respondents practiced vyaayamam daily. Conclusions: There exists a wide gap in the Knowledge and practice of Dinacharya practices even among the ayurveda doctors. ractice of Dinacharya practices even among the ayurveda doctors. [ABSTRACT FROM AUTHOR]

This paper analyzes patient-provider interaction (PPI). More precisely, it deals with the form-function relationship in questions used in counselor-patient interaction. The study is based on naturally occurring primary data collected at the Department of Pediatrics and the Department of Community Medicine, Jawaharlal Nehru Medical College and Hospital (JNMCH), located in Aligarh Muslim University, India. The data are composed of audio-visual recordings of Hindi-Urdu interaction between 8 counselors and 27 patients. We identified compliance and condescension as the two unique functions the counselors seeks to accomplish and/or fulfill through the use of questions in their interaction with the patients. We also found four other functions – information seeking, recall, greeting, and diagnosis, which are sought by the counselors through their use of questions. The findings also suggest that these functions maintain and promote what can be termed as a counselor-centered interaction, and thus reflect asymmetrical power relationship between counselors and their patients. [ABSTRACT FROM AUTHOR]

This paper reports findings from a qualitative study conducted on the Need for Social work interventions in the Emergency Department (ED) at a large tertiary care center in India. The emergency department is an important social work intervention point for individuals with various psychiatric, medical, and social needs who have little or no additional interaction with social services. Social workers are specially trained to understand the impact of social factors on health outcomes and provide interventions that address social barriers to improving health and accessing community resources; social workers are well prepared to provide services in the emergency department. However, limited research is available to understand the impact of psychosocial services in the emergency department. We aimed to identify areas which require integrated social work services and coordination to address the psychosocial issues within the ED. Interviews with 10 healthcare workers are analyzed thematically. Recurring themes throughout the interviews confirm the need for providing social work interventions to ensure the medical, psychological, and social care needs in the emergency department. [ABSTRACT FROM AUTHOR]

Introduction: Poor medical information transfer across healthcare visits and providers poses a potential threat to patient safety. Patient‐held health records (PHRs) may be used to facilitate informational continuity, handover communication and patient self‐management. However, there are conflicting opinions on the effectiveness of PHRs, other than in maternal and child care. Moreover, the experiences of users of PHRs in low‐ and middle‐income countries are critical in policy decisions but have rarely been researched. Aim: This study aimed to explore similarities and differences in the perspectives of patients, carers and healthcare providers (HCPs) on the current PHRs for diabetes and hypertension in Kerala. Methods: A qualitative design was used comprising semistructured interviews with patients with diabetes/hypertension (n = 20), carers (n = 15) and HCPs (n = 17) in Kerala, India. Data were analysed using thematic analysis. Results: Themes generated regarding the experiences with PHRs from each user group were compared and contrasted. The themes that arose were organized under three headings: use of PHRs in everyday practice; the perceived value of PHR and where practice and value conflict. We found that in the use of PHRs in everyday practice, multiple PHRs posed challenges for patients carrying records and for HCPs locating relevant information. Most carers carried all patients' past PHRs, while patients made decisions on which PHR to take along based on the purpose of the healthcare visit. HCPs appreciated having PHRs but documented limited details in them. The perceived value of PHRs by each group for themselves was different. While HCPs placed value on PHRs for enabling better clinical decision‐making, preventing errors and patient safety, patients perceived them as transactional tools for diabetes and hypertension medications; carers highlighted their value during emergencies. Conclusion: Our findings suggest that users find a variety of values for PHRs. However, these perceived values are different for each user group, suggesting minimal functioning of PHRs for informational continuity, handover communication and self‐management. Patient and Public Involvement: Patients and carers were involved during the pilot testing of topic guides, consent and study information sheets. Patients and carers gave their feedback on the materials to ensure clarity and appropriateness within the context. [ABSTRACT FROM AUTHOR]

India and the global community are facing a critical crisis of antimicrobial resistance (AMR), significantly contributed to by on-going and increasing antimicrobial misuse. Information as to what drives misuse of antimicrobials within India is essential to inform strategies to address the crisis. This papers aims to identify perceived influences on antimicrobial use in Hyderabad, India. We conducted semi-structured qualitative interviews conducted with thirty participants (15 doctors, 15 pharmacists) around their experiences of antimicrobials in Hyderabad, India. Thematic analysis was performed and four themes identified around (1) Perceptions of the problem of resistance and antimicrobial use; (2) Social pressures to prescribe/dispense; (3) Financial pressures driving antimicrobial over-use; and (4) Lack of regulation around training and qualifications. We conclude that antimicrobial use within India is embedded with, and occurs as a result of, complex social and economic factors including issues of resource limitation, structural/governance limitations and social relationships. Strategies to address misuse without acknowledging and addressing the critical driving forces of use will be unlikely to induce significant change. [ABSTRACT FROM AUTHOR]

Background: Pneumonia contributes to about 15% of child deaths globally, with 20% of the overall deaths occurring in India. Although WHO recommends the use of pulse oximeters (PO) in first-level facilities for early detection of child pneumonia in low- and middle-income countries (LMICs), this has not yet been implemented in India. We aimed to assess the feasibility and acceptability of introducing PO in integrated management of neonatal and childhood illnesses (IMNCI) services at primary health centres (PHC) in the rural Pune district. Methods: We identified medical officers (MO) and auxiliary nurse midwives (ANM) from six PHCs as study participants due to their involvement in the treatment of children. We developed in-depth interview (IDI) guides for both groups to explore their IMNCI knowledge and attitude towards the program through a qualitative study. We conducted interviews with MOs (n = 6) and ANMs (n = 6) from each PHC. The PO module was added to explore perceptions about its usefulness in diagnosing pneumonia. After baseline assessment, we conducted training sessions on adapted IMNCI services (including PO use) for MOs and ANMs. PO devices were provided at the study PHCs. Results: At baseline, no PO devices were being used at study PHCs; PHC staff demonstrated satisfactory knowledge about paediatric pneumonia management and demanded refresher IMNCI training. They also felt the need to reiterate the PO use for early diagnosis of pneumonia in children and highlighted the challenges encountered in managing pneumonia at PHCs, such as health system-related challenges and parents' attitudes towards care seeking. There was positive acceptance of training and PO started to be used immediately in PHCs. There was increased confidence in using PO at endline. PO use in examining symptomatic children increased from 26 to 85%. Conclusions: Paediatric PO implementation could be integrated successfully at PHC levels; we found pre-implementation training and provision of PO to PHCs to be helpful in achieving this goal. This intervention demonstrated that an algorithm to diagnose pneumonia in children that included PO could improve case management. [ABSTRACT FROM AUTHOR]

Background: There is a constant search across the globe for optimal healthcare solutions with affordability, accessibility, availability, and quality of healthcare services being the burning issue for mankind. The pandemic has further necessitated the need of use of the Telemedicine platform to address healthcare issues which are also non Covid related. Though Telemedicine has been in use for over two decades in India, there have been various challenges and adoption issues which have not yet made the technology an effective solution to address the current healthcare issues. There has been phenomenal growth in the Information and Communication Technology (ICT) over the last decade and its utilization in the healthcare field. Methods: Internet research on the various adoption strategies by healthcare providers coupled with our own experience for using this technology along with guidelines provided by the information and communication technology providers. The Telemedicine Guidelines of 2020 released by the Ministry of Health and Family welfare, India, provides a framework for the implementation of healthcare delivery through this technology. Results: This paper mentions our telemedicine experience in governmental and private institutes and highlights the implementation challenges of this technology and some solutions that made a difference in the execution. However, we discuss to a larger extent the possible challenges and barriers in the implementation of this technology in India. Conclusion: Despite successful work in the field of telemedicine, it is yet to become an integral part of healthcare system because challenges related to adaptability of healthcare users and lack of proper training to fast growing technologies. The future is going to compel the usage of this kind of technology and it is essential for setting up infrastructure and having trained personnel to man these departments to encash the full potential of the telemedicine technology. [ABSTRACT FROM AUTHOR]

Introduction Community health workers are crucial in improving health and bridging gaps between communities and health care services. They are integral to various national health initiatives to prevent diseases and enhance well-being. Providing health care services to adolescents is a pivotal responsibility for auxiliary nurse midwives (ANMs) and Accredited Social Health Activist (ASHA) workers. Objectives This study aims to evaluate the community health workers' comprehension, implementation practices, and viewpoints regarding the implementation of the Rashtriya Kishor Swasthya Karyakram (RKSK) program. Methodology The research was conducted across primary health centers in Hagaribommanahalli and Huvina Hadagali taluks. A two-stage sampling technique was utilized to gather data from 404 participants, who were administered a semi-structured questionnaire. Data analysis was performed using SPSS version 20 software. Results Out of the total community health workers, 336 (83.2%) were ASHA workers, while 68 (16.8%) were ANMs. The mean age of the community health workers was 38 ± 6 years, and 79% had received training in the RKSK program. Of the respondents, 60.9% demonstrated adequate knowledge, and 79.5% correctly executed the RKSK activities. In addition, 80.5% of the participants strongly concurred with statements reflecting their perception of the RKSK program. Conclusion The study findings indicate that community health workers possess a commendable understanding of the RKSK program. Furthermore, their effective implementation practices and positive perceptions regarding the RKSK program and its activities suggest a genuine commitment to supporting the RKSK program and other health-related endeavors targeting adolescents. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to investigate the relationship between inclusive leadership (IL), psychological safety (PS), affective commitment (AC) and organizational citizenship behavior (OCB) at the workplace. By understanding the sequential linkages, the research aims to provide insights for fostering a positive organizational culture that promotes employee commitment and employees' willingness to go the extra mile for the organization. Design/methodology/approach: The authors study how IL and OCB are related through PS and AC. For this purpose, cross-sectional data from 384 nursing professionals in India was collected and structural equation modeling was conducted on the same using IBM AMOS. Findings: The study found that IL has a major impact on OCB. The study further found that perceived IL leads to PS which is associated with OCB through AC. Research limitations/implications: The study has many theoretical and practical implications. This study uses a framework that is based on Affective events theory. In a health-care environment, IL can foster AC by promoting a culture of respect, collaboration and value for diverse perspectives, which enhances health-care professionals' emotional attachment to their work and the organization. Additionally, by encouraging open communication and a sense of belonging, IL contributes to OCB, as health-care staff are more likely to engage in discretionary behaviors that support the overall effectiveness and positive functioning of the health-care team if PS is improved, ultimately improving patient care outcomes. Originality/value: To the best of the authors' knowledge, this is one of the primary studies that looks into the sequential mechanism through which IL impacts OCB. [ABSTRACT FROM AUTHOR]

Medical statistics is generally considered a dry, boring, and complex subject and most doctors think that it is not required for them. There has been reluctance amongst doctors including surgeons to learn it. The knowledge of statistics amongst surgeons is poor. To know the attitude and knowledge of the surgeons, we conducted an online survey with Google form. A Google form was created (https://forms.gle/16Be3CJtnVAqtm5t9). It was shared with the heads of the department of general surgery of all medical colleges of Karnataka. We avoided asking personal details to avoid bias. Responders included 16 medical college faculty, 19 PG students in general surgery, and 18 consultant surgeons. 50.1% of responders did not read journals regularly. Only 5.9% understood the statistics part well while reading the journals. 43.1% understood statistics partly and some preferred to skip the statistics part. 88.4% of the responders agreed that statistics should be taught in the undergraduate and postgraduate curriculum. Only 43.4% felt that the medical college teachers have sufficient knowledge of statistics to guide their students. 60.4% approached a statistician and 45.3% searched Google for a solution when they came across a statistical problem. Some suggestions were given by the responders are (a) statistics should be taught in MBBS and MS/MD curriculum. It should be a compulsory subject for the examination. (b) Associations (like ASI) should conduct hands-on workshops on statistics for the benefit of the members. (c) More information on statistics should be provided in our journals etc. [ABSTRACT FROM AUTHOR]

Menstrual cups are considered a sustainable solution for menstrual health and hygiene management, as they are cost-effective, environment-friendly, reusable and offer health benefits over traditional menstrual hygiene products such as pads and tampons. However, in lower middle income countries (LMICs), menstrual cup use is limited. Recently, India's current menstrual hygiene program has included menstrual cups as an option for menstrual health and hygiene management. However, the menstrual cup has not been promoted widely in the Indian context. Even if the use of menstrual cups among female healthcare providers in India is minimal, the manuscript identified the crucial challenges in menstrual health and hygiene management, the role of menstrual cups as a solution and the essential strategies to increase menstrual cup use. Programmatic success requires endorsement from healthcare providers as they are trusted sources of information related to healthcare. Good experiences and leading examples from healthcare providers about using menstrual cups is a welcoming step in the path of the dream of a "pad-free country" for India. [ABSTRACT FROM AUTHOR]

Cognitive enhancement (CE) covers a broad spectrum of methods, including behavioral techniques, nootropic drugs, and neuromodulation interventions. However, research on their use in children has almost exclusively been carried out in high-income countries with limited understanding of how experts working with children view their use in low- and middle- income countries (LMICs). This study examines perceptions on cognitive enhancement, their techniques, neuroethical issues about their use from an LMICs perspective. Seven Indian experts were purposively sampled for their expertise in bioethics, child development and child education. In-depth interviews were conducted using a semi-structured topic guide to examine (1) understanding of CE, (2) which approaches were viewed as cognitive enhancers, (3) attitudes toward different CE techniques and (4) neuroethical issues related to CE use within the Indian context. All interviews were audio recorded and transcribed before thematic analysis. Findings indicate Indian experts view cognitive enhancement as a holistic positive impact on overall functioning and well-being, rather than improvement in specific cognitive abilities. Exogenous agents, and neuromodulation were viewed with skepticism, whereas behavioral approaches were viewed more favorably. Neuroethical concerns included equitable access to CE, limited scientific evidence and over-reliance on technology to address societal problems. This highlights the need for more contextually relevant neuroethics research in LMICs. [ABSTRACT FROM AUTHOR]

Background: The end-of-life (EOL) decisions continue to be debated for their moral and legal standing. The acceptance of these decisions varies, based upon the perceptions and personal choices of the intensivists. Materials and methods: An online questionnaire-based survey was designed and circulated among the practicing intensivists via Indian Society of Critical Care Medicine (ISCCM) e-mail. Results: Out of 200 responses, 165 (82.5%) affirmed that EOL decisions are routinely undertaken in their intensive care units. The most prevalent reasons expressed for avoidance of EOL decisions are moral and ethical dilemmas and fear of litigation. There is notable variability in the practice of withholding (47.7%) vs withdrawal (3.5%) of therapies. A good proportion of intensivists follow do-not-intubate (91%) and do-not-resuscitate (86%) orders, whereas only 18% affirmed to be practicing terminal extubation. About 93% of the respondents acknowledged the use of monitoring toward the EOL, and 49% reported the use of preformatted documents. A meager 2% admitted to facing a medicolegal issue after taking an EOL decision. Conclusion: The survey establishes a general acceptance among the Indian intensivists regarding providing compassionate care to terminally ill patients, especially toward the EOL. The pattern of responses, however, indicates significant dilemmas and hesitancy with regard to the decision-making process. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore 232 service providers' and policymakers' experiences of supporting children's well-being during the pandemic, across sectors, in 22 countries – including Kenya, the Philippines, South Africa, India, Scotland, Sweden, Canada and the USA, in the last quarter of 2020. Design/methodology/approach: A smartphone survey delivered via a custom-built app containing mostly open-ended questions was used. Respondents were recruited via professional networks, newsletters and social media. Qualitative content analysis was used. Findings: The findings reveal numerous system-level challenges to supporting children's well-being, particularly virus containment measures, resource deficiencies and inadequate governance and stakeholder coordination. Those challenges compounded preexisting inequalities and poorly affected the quality, effectiveness and reach of services. As a result, children's rights to an adequate standard of living; protection from violence; education; play; and right to be heard were impinged upon. Concurrently, the findings illustrate a range of adaptive and innovative practices in humanitarian and subsistence support; child protection; capacity-building; advocacy; digitalisation; and psychosocial and educational support. Respondents identified several priority areas – increasing service capacity and equity; expanding technology use; mobilising cross-sectoral partnerships; involving children in decision-making; and ensuring more effective child protection mechanisms. Practical implications: This study seeks to inform resilience-enabling policies and practices that foster equity, child and community empowerment and organisational resilience and innovation, particularly in anticipation of future crises. Originality/value: Using a novel approach to gather in-the-moment insights remotely, this study offers a unique international and multi-sectoral perspective, particularly from low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Background: Perinatal period is considered a high risk period for developing mental health problems. Screening for mental health problems is not routine in obstetric care settings in low and middle income countries. This qualitative study among low-income urban pregnant women in India aimed to understand the facilitators and barriers for discussing mental health problems with their obstetric health-care providers. Materials and Methods: Two focus group discussions with six pregnant women in each group were conducted using a semi structured interview guide. The transcribed data were translated to English and were analyzed and key themes were identified using a thematic analysis approach. Results: Participants had inadequate knowledge about the impact of maternal mental health problems on pregnancy, fetus and infant. The common barriers to discussing mental health problems were families normalizing mental stress, fear that family conflicts being revealed, stigma about being labeled mentally ill, lack of privacy in clinics and obstetric health-care providers being too busy. Women reported that being specifically asked about mental health problems as part of care and a sensitive attitude of the health-care providers encouraged them to discuss their concerns. Conclusion: This study identified more barriers than facilitators in discussing about mental health among pregnant women and the need for sensitive screening for mental health problems. To enhance screening and support for maternal mental health problems, it is necessary to increase awareness about the importance of mental health in the perinatal period among women and families. In addition, training obstetric health-care providers in sensitive screening for mental health problems, ensuring privacy in clinics and reducing stigma related to perinatal mental health problems. [ABSTRACT FROM AUTHOR]

This study aims to assess the perception and attitude of health care personnel regarding integration of nursing education and nursing services. Using purposive and stratified random sampling technique, 92 medical faculty, 32 nursing faculty and 346 nursing officers were enrolled. A three-point Likert scale consisting of 15 items and six open ended questions was used to collect the data. Overall, the concept of integration of nursing education and nursing services at their institute was welcomed by 74.4% of health care personnel. Medical faculty (47.8%), nursing faculty (37.5%) and nursing officers (57.5%) scored the concept of integration as very good. [ABSTRACT FROM AUTHOR]

Background: In 2016, the Government of the southern Indian state of Kerala launched the Aardram mission, a set of reforms in the state's health sector with the support of Local Self Governments (LSG). Primary Health Centres (PHCs) were slated for transformation into Family Health Centres (FHCs), with extended hours of operation as well as improved quality and range of services. With the COVID-19 pandemic emerging soon after their introduction, we studied the outcomes of the transformation from PHC to FHC and how they related to primary healthcare service delivery during COVID-19. Methods: A qualitative study was conducted using In-depth interviews with 80 health system actors (male n = 32, female n = 48) aged between 30–63 years in eight primary care facilities of four districts in Kerala from July to October 2021. Participants included LSG members, medical and public health staff, as well as community leaders. Questions about the need for primary healthcare reforms, their implementation, challenges, achievements, and the impact of COVID-19 on service delivery were asked. Written informed consent was obtained and interview transcripts – transliterated into English—were thematically analysed by a team of four researchers using ATLAS.ti 9 software. Results: LSG members and health staff felt that the PHC was an institution that guarantees preventive, promotive, and curative care to the poorest section of society and can help in reducing the high cost of care. Post-transformation to FHCs, improved timings, additional human resources, new services, fully functioning laboratories, and well stocked pharmacies were observed and linked to improved service utilization and reduced cost of care. Challenges of geographical access remained, along with concerns about the lack of attention to public health functions, and sustainability in low-revenue LSGs. COVID-19 pandemic restrictions disrupted promotive services, awareness sessions and outreach activities; newly introduced services were stopped, and outpatient numbers were reduced drastically. Essential health delivery and COVID-19 management increased the workload of health workers and LSG members, as the emphasis was placed on managing the COVID-19 pandemic and delivering essential health services. Conclusion: Most of the health system actors expressed their belief in and commitment to primary health care reforms and noted positive impacts on the clinical side with remaining challenges of access, outreach, and sustainability. COVID-19 reduced service coverage and utilisation, but motivated greater efforts on the part of both health workers and community representatives. Primary health care is a shared priority now, with a need for greater focus on systems strengthening, collaboration, and primary prevention. [ABSTRACT FROM AUTHOR]

Background: India has launched Ayushman Bharat Digital Mission (ABDM), to provide an integrated digital health infrastructure. The success of digital health systems lies in their ability to achieve universal healthcare and incorporate all levels of disease prevention. The objective of this study was to develop an expert consensus on how Community Medicine (Preventive and Social Medicine) can be integrated into ABDM. Methods: A total of 17 and 15 participants, who were Community Medicine professionals with more than 10 years experience in the Public Health Sector and/or Medical Education in various parts of India, participated in round 1 and 2 of this Delphi study respectively. The study explored three domains: 1. Advantages and challenges of ABDM, and possible solutions; 2. Intersectoral convergence in Unified Health Interface (UHI) and 3. Way ahead in medical education and research. Results: Participants envisaged improved accessibility, affordability, and quality of care due to ABDM. However, awareness generation, reaching out to marginalized populations, human resource constraints, financial sustainability, and data security issues were anticipated challenges. The study identified plausible solutions addressing six broad challenges of ABDM and classified them based on the priority of implementation. Participants listed out nine key roles of Community Medicine professionals in digital health. The Study identified about 95 stakeholders who play direct and indirect roles in public health and can be connected to the general public through the Unified Health Interface of ABDM. Further, the study explored the future of medical education and research in the digital era. Conclusion: The Study contributes to broadening the scope of India's digital health mission, with elements of Community Medicine in its cornerstone. [ABSTRACT FROM AUTHOR]

Introduction: In mid-March 2020, the Kerala government implemented additional preventive measures to the steps already taken to reduce the transmission of COVID-19. Strategies were taken by a non-governmental palliative care organisation (Pallium India) with Coastal Students Cultural Forum -- a coastal area-based collective of young educated people in the coastal region to address the medical needs of people living in this community. The facilitated partnership lasted 6 months (July--December 2020) and addressed the palliative care needs of the community in the selected coastal regions during the first wave of the pandemic. Volunteers sensitised by the NGO identified more than 209 patients. The current article highlights the reflective narratives of key players in this facilitated community partnership. Materials and Method:The current article is dedicated to highlighting the reflective narratives of key players in this facilitate community partnership to the readers of this journal. The palliative care team's overall experience was collected from selected key participants to understand the program's impact, identify areas of improvement, and discuss possible solutions if there were any challenges. The contents below are their statements on the experience of the entire program. Conclusion: Palliative care delivery programmes must be configured to respond to local needs and customs, be community-based and integrated with local health and social care and have accessible referral pathways between and across services. They must also be responsive to changing individual and population needs and shifts in local and national health structures. [ABSTRACT FROM AUTHOR]

Purpose: The agglomeration of specialist health-care facilities has often been restricted to metropolitan areas. This study aims to understand how health-care professionals with transformational leadership behaviors and entrepreneurial aims with a similar vision and expertise play pertinent roles in providing essential specialized health care in rural and semi-urban areas and achieving the United Nations Sustainable Development Goals (UNSDGs). Design/methodology/approach: Qualitative synthesis using focused-group discussions and interviews was conducted in a phased manner. For this, this study has used stakeholder-theory, and dynamic-capabilities approaches. Findings: This study explores the intricacies of collaborative entrepreneurship (CE)-based health-care ventures in developing regions and reveals five pertinent attributes: strategic control, synergy, commitment, empathy and satisfaction. This study recommends that entrepreneurial collaboration, especially by transformational health-care leaders, can significantly contribute to creating an endogenous health-care ecosystem with advanced facilities and technology-enabled modern infrastructure and augmenting regional development. Research limitations/implications: This study was conducted in semi-urban settings in India. Future research should include other sectors and regions to generalize the findings. Practical implications: This study benefits health-care professionals having an analogous vision, skills and entrepreneurial aims. Social implications: Collaboration of health-care professionals and using transformational leadership behaviors can considerably contribute to providing specialist health care in developing areas and enhance patient satisfaction. Originality/value: To the best of the authors' knowledge, this is the first study to discuss the importance of CE in health care in developing areas. In addition, it discusses the benefits of the CE model in achieving the UNSDGs and offers valuable suggestions for health-care professionals and administrators. [ABSTRACT FROM AUTHOR]

Background: India's neonatal and perinatal mortality is among the highest in the world. Intrapartum-related conditions contribute to a significant proportion of neonatal deaths and stillbirths. Fetal heart rate monitoring, a recommended norm to assess fetal well-bring, is not practiced as per standard guidelines in public health facilities. A standardized Doppler along with training on fetal heart rate monitoring was implemented across different levels of healthcare in three states. Methods: Facilities were selected purposively to implement the Doppler. Baseline data for 3 months were collected. Interviews of health providers and observation of labor were conducted quarterly. Data were analyzed through a comparison of baseline and intervention on a number of delivery and monitoring indicators. Results: Among 22,579 total deliveries, monitoring frequency increased along with increase in detection of abnormal fetal heart rate (FHR) while cesarean section and stillbirths reduced slightly. Cases never monitored reduced in the District Hospitals (7.98–2.07, P < 0.01) and in Community Health Centers (14.7–1.67, P < 0.001). Stillbirth rate reduced at the medical college (3.6–1.1, P < 0.001). Interviews with providers revealed acceptance of the device due to its reliable readings. Conclusion: The Doppler demonstrates acceptability and serves as a useful aid to improve intrapartum FHR monitoring. [ABSTRACT FROM AUTHOR]

This article aims to identify the factors prevalent among health science librarians toward vaccine hesitancy. With the development of COVID-19 vaccines in 2021, numerous efforts are being taken to vaccinate people to control the spread of coronavirus. Recent research has shown a high level of vaccine hesitancy among various groups in various fields but no study has been conducted to explore the factors responsible for vaccine hesitancy among library professionals. A cross-sectional online survey of Indian health science librarians was conducted. Data was collected through an online questionnaire designed on Google Forms and analyzed using MS-Excel. Descriptive statistics were used in the study. The majority of respondents (77%) showed a high level of vaccine hesitancy due to issues of safety, negative information, and confusion over vaccines. Measures to increase vaccination uptake and authentic sources with respect to COVID-19 vaccines have been discussed. [ABSTRACT FROM AUTHOR]

Background: Evidence on obstetric violence is reported globally. In India, research shows that almost every woman goes through some level of disrespect and abuse during childbirth, more so in states such as Bihar where over 70% of women give birth in hospitals.Objective: 1) To understand how women experience and attach meaning to respect, disrespect and abuse during childbirth; and 2) document women's expectations of respectful care.Methods: 'Body mapping', an arts-based participatory method, was applied. The analysis is based on in-depth interviews with eight women who participated in the body mapping exercise at their homes in urban slums and rural villages. Analysis was guided by feminist relational discourse analysis.Findings: Women reported their experiences of birthing at home, public facilities, and private hospitals in simple terms of what they felt 'good' and 'bad'. Good experiences included being spoken to nicely, respecting privacy, companion of choice, a bed to rest, timely care, lesser interventions, obtaining consent for vaginal examination and cesarean section, and better communication. Bad experiences included unconsented interventions including multiple vaginal examinations by different care providers, unanesthetized episiotomy, repairs and uterine exploration, verbal, physical, sexual abuse, extortion, detention and lack of privacy.Discussion: The body maps capturing birth experiences, created through a participatory method, accurately portray women's respectful and disrespectful births and are useful to understand women's experience of a sensitive issue in a patriarchal culture. An in-depth understanding of women's choices, experiences and expectations can inform changes practices in and policies and help to develop a culture of sharing birth experiences. [ABSTRACT FROM AUTHOR]

Background: Dysphagia is a disorder of swallowing and/or feeding. It is associated with malnutrition, dehydration, pulmonary pneumonia and increased mortality. Timely assessment and management of dysphagia carried out by speech and language pathologist is necessary. Speech Language Pathologist (SLP) evaluates and treats patients with dysphagia by using dysphagia therapy, postural changes, swallowing maneuvers and recommends texture modified dysphagia diet. Objective: The aim of the present study was to explore the level of awareness medical practitioner have regarding dysphagia and speech and language pathologist's role in dysphagia. Methodology: A non-experimental, descriptive survey was conducted for the purpose of this research. Information was gathered by mean of a self-designed questionnaire. The data was collected from Sumandeep Vidhyapeeth University, Vadodara, Gujarat. The sample of the study consists of 100 medical practitioners (60 males and 40 females) working in different department, in which speech and language services were available and speech and language pathologists were accessible fulltime. Results: The data analysis was carried out with SPSS version 17.0 for windows. The score obtained by the participants were shows that medical practitioners do not have adequate knowledge regarding the assessment and management of patients who suffer from eating and drinking difficulties. Conclusion: On the basis of the present research, it was concluded that medical practitioners lack in their knowledge and understanding of basic dysphagia assessment and management practices. Their lack of awareness of SLP role results in decrease SLP referrals. [ABSTRACT FROM AUTHOR]

Background: Aphasia is one of those clinical conditions, where the role of affiliated professionals, mainly speech language pathologists (SLPs) is substantial in diagnostic assessments, therapy, and rehabilitation. There is no study to focus on neurologists, with respect to their perceptions and practices about aphasia, the disease, as well as the profession of SLP. Objective: To reach out to the neurologist community in India and learn about their perceptions and practices about the nature of the ailment and role of speech language therapy (SLT). Our premise was that observations and inferences from a questionnaire-based survey will be subsequently helpful in planning educational activities targeted to neurologists with more focus on specific gaps in perceptions and practices. Material and Methods: Three neurologists and two SLPs collaboratively developed the questionnaire. The aim was to probe the issues which were likely to have a bearing upon optimum service delivery to persons with aphasia by a dyad of neurologist and SLP. The survey was set in "Google Forms" and sent by "WhatsApp" and email to approximately 500 practicing neurologists in India. We employed a nonprobability sampling design for ease of administration with a combination of "chunk sampling" and "snowball sampling." Telephonic reminders were made to almost all. Results and Discussion: We received 100 responses. The mean age of respondents was 50.64 (SD +/- 12.60) with a range of 28-78 years. The mean number of years of experience as a neurophysician was 19.88 (SD. +/- 12.72) with range of 1-47 years. Females were only 8%. Apparently, the proportion of neurologists working in large corporate and large public sector institutions from tier one and tier two cities was higher, who are more likely to have SLP and related rehabilitation facilities in their institutions and hence harbor more conducive attitudes to SLT in aphasia. The ground reality from tier three cities and small private and public sector hospital and solo practitioners may be somewhat worse than this. Many responses were in conformity with facts and in tune with desirable attitudes as per guidelines like aphasia being a detrimental factor in stroke recovery, doing assessment of handedness, paying attention to neuroimaging correlations and associated cognitive functions, not resorting to unnecessary pharmacotherapy, being aware about efficacy of SLT, and fairly good chances of recovery. However, many more answers highlighted a need for emphasis in Continuing Medical Education like not being aware about community burden of aphasia in comparison to a few better known neurological diseases, not paying attention to psychosocial aspects apart from biological ones in assessment and rehabilitation, not using a standardized and validated battery, not confidant about role of SLT in chronic stable aphasia and need for longer and intensive therapy, and being unconcerned for the value of advocacy for aphasia, like the role of Self-Help Groups. Conclusion: The thrust areas, pertaining to gaps in perception and practices identified through this study, can be viewed as "an in-time input." We hope that changes in some of the perceptions and practices can be attained through an emphasis on education and training at multiple levels right from the undergraduate to the practicing physicians. A few more themes and domains will need advocacy actions targeted to different stakeholders. [ABSTRACT FROM AUTHOR]

Background: Spontaneous or voluntary reporting of suspected adverse drug reactions (ADRs) is one of the vital roles of all health professionals. In India, under-reporting of ADRs by health professionals is recognized as one of the leading causes of poor ADR signal detection. Therefore, reviewing the literature can provide a better understanding of the status of knowledge, attitude and practice (KAP) of Pharmacovigilance (PV) activities by health professionals. Methods: A systematic review was performed through Pubmed, Scopus, Embase and Google Scholar scientific databases. Studies pertaining to KAP of PV and ADR reporting by Indian health professionals between January 2011 and July 2015 were included in a meta-analysis. Results: A total of 28 studies were included in the systematic review and 18 of them were selected for meta-analysis. Overall, 55.6% (95% CI 44.4–66.9; p<0.001) of the population studied were not aware of the existence of the Pharmacovigilance Programme in India (PvPI), and 31.9% (95% CI 16.3–47.4; p<0.001) thought that "all drugs available in the market are safe". Furthermore, 28.7% (95% CI 16.4–40.9; p<0.001) of them were not interested in reporting ADRs and 74.5%, (95% CI 67.9–81.9; p<0.001) never reported any ADR to PV centers. Conclusion: There was an enormous gap of KAP towards PV and ADR reporting, particularly PV practice in India. There is therefore an urgent need for educational awareness, simplification of the ADR reporting process, and implementation of imperative measures to practice PV among healthcare professionals. In order to understand the PV status, PvPI should procedurally assess the KAP of health professionals PV activities in India. [ABSTRACT FROM AUTHOR]

Past researches tried to explore the impact of disease awareness advertising only on relationship between drug manufacturers and consumers. As physicians are a significant stakeholder, it is important for marketers to know views of physicians before any communication planning. The present research intends to primarily understand the views of Indian health care professionals about effectiveness of disease awareness advertising. The objective of the research is to understand attitudes of health care professionals towards disease awareness advertising as a pharma marketing communication tool. Result shows that most physicians think positively regarding the nature of disease awareness advertising. However, there is mixed feeling about impact of disease awareness advertising on patients. Physicians have a feeling that disease awareness advertising may cause confusion and unnecessary fear among patients as the concept is new to them and they might not be mature enough to understand campaign objectives. There is also a view that disease awareness advertising should be co-sponsored with not-for-profit organization (NGO)/non-profit organization (NPO) to neutralize perception of commercial interest of pharma companies behind awareness advertisements. Communication effectiveness may be further increased if the campaign is endorsed by popular celebrities. Result from this study will help pharmaceutical companies operating in India to understand effectiveness of disease awareness advertising as an important marketing communication tool. To the best of our knowledge, this is the first academic research study of its kind in India. [ABSTRACT FROM PUBLISHER]