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As dance education has moved online, it is imperative to assess the learners' acceptance of e-learning. This research analyses the factors that may determine the utilization of digitalized dance education. The study is based on a sample of 215 online dance learners from 08 urban cities of India, using the UTAUT model framework. The authors have also introduced a new variable, online technology self-efficacy, in the model. The results of the statistical analysis revealed that the exogenous variables (performance expectancy, effort expectancy, social influence, facilitating conditions and technology self-efficacy) have a significant influence on e-learning adoption. The study did not detect any difference in the intent to learn remotely that may stem from socio-demographic characteristics (gender, age and dance experience). The ensuing discussion and suggestions will help dance educators appreciate digital education adoption behaviour and foster successful migration to e-learning platforms that may support the future of performing arts businesses.

Multilingual education is an urgent and pressing concern in the Indian educational scenario. While the National Education Policy (2020) acknowledges multilingualism as a resource in educational contexts and reiterates earlier policies calling for mother tongue-based education in elementary classrooms, it does not provide guidance in terms of how to productively accommodate multiple languages in the classroom. Multilingual education will be much stronger if it is based on a strong understanding of multilinguality--the idea that the human mind is fundamentally multilingual in nature. A new, but substantial paradigm of scholarship addressing multilinguality is that of 'translanguaging', which views named languages as socio-political constructs and argues that multilinguals have a unified linguistic repertoire that they flexibly, creatively and adaptively draw upon. Accepting the grounding assumptions of translanguaging would has important implications for curriculum, pedagogy and assessment in educational spaces. In this article, we describe and critique the translanguaging perspective, even while acknowledging its positive contributions. We point out, especially its failure to provide guidance in terms of how to productively accommodate translanguaging in classrooms.

Purpose: Unsustainable actions have resulted in the deterioration of the environment. Higher education institutions are social entities responsible for developing future leaders who have the skills and abilities to solve societal challenges. This study aims to develop a conceptual assessment model of environmental sustainability in higher education and apply the model to test the environmental sustainability level of a higher education institution. Design/methodology/approach: The fuzzy logic method is used to develop the conceptual model, and a higher education institution in India was selected for evaluating the environmental sustainability level. Findings: The fuzzy environmental sustainability index for the higher education institution selected for the study was computed as (3.58, 4.95, 6.33). The computed value identifies the institution as "environmentally sustainable". The calculation of the fuzzy performance importance index further helped in identifying weak attributes that need improvement. Research limitations/implications: The result of this study would help the management understand their current environmental sustainability level and take corrective measures to improve the weak attributes. It would also assist the institution in reworking its processes and practices. Originality/value: This study has contributed to the literature of environmental sustainability assessment by creating a conceptual model for evaluating environmental sustainability in higher education. This model can be applied to any higher education institution.

Purpose: The purpose of this study is two-fold. First, to identify and encapsulate the enablers that can facilitate technology integration in higher education and second, to understand and analyze the interplay between technology agility enablers. Design/methodology/approach: The study used the Total Interpretive Structural Modeling (TISM) approach to construct a theoretical model of the technology agility enablers in higher education and MICMAC analysis for ranking and segregating the enablers based on their dependence power into four categories: Autonomous, Dependent, Linkage and Independent. Findings: The study helped identify eight technology agility enablers, with the COVID-19 pandemic as the most significant enabler. The COVID-19 pandemic has catalyzed the diffusion of technology across the education sector in India, including tertiary higher education. The study revealed government initiatives and institutional commitment as other enablers that can promote technology agility in higher education. Practical implications: The results of this study would assist the policymakers and management of universities and colleges in understanding the important enablers that can facilitate technology integration in higher education. Originality/value: Research in the past on technology adoption in higher education has looked into each enabler in isolation. This research provides a comprehensive view of the enablers and has attempted to establish a multidirectional interplay between the enablers.

The purpose of this study is two-fold. First, to identify and encapsulate the enablers that can facilitate curriculum agility in higher education and second, to understand the interplay between the factors. Literature review and academic experts helped identify eight factors crucial for driving curriculum agility in higher education. The total interpretive structural modelling (TISM), a widely used method in theory building, was used to develop a hierarchical conceptual framework of the curriculum agility factors. The TISM model helped comprehend the relationship between the factors and the logical reasoning behind the relationship. The cross-impact matrix multiplication applied to classification, also known as MICMAC analysis, was applied to rank the enablers based on their driving power into independent, autonomous, linkage, and dependent zones. The participants for the study included faculty members from higher education institutions in India. A closed-ended questionnaire and scheduled interview helped in gathering data. The TISM model revealed curriculum leader, organisational governance and teacher autonomy as the most crucial factors in driving curriculum agility in higher education. The results of this study would assist the policymakers and management of higher education institutions to understand the critical factors and work around them to add value to the curriculum.

Background: Picture-naming tests (PNTs) evaluate linguistic impairment in dementia due to semantic memory impairment, impaired lexical retrieval or perceptual deficits. They also assess the decline in naming impairment at various stages of dementia and mild cognitive impairment (MCI) that occurs due to progressive cognitive impairment. With the increasing numbers of people with dementia globally, it is necessary to have validated naming tests and norms that are culturally and linguistically appropriate. Aims: In this cross-sectional study we harmonized a set of 30 images applicable to the Indian context across five languages and investigated the picture-naming performance in patients with MCI and dementia. Methods & Procedures: A multidisciplinary expert group formed by the Indian Council of Medical Research (ICMR) collaborated towards developing and adapting a picture naming test (PNT) known as the ICMR-PNT in five Indian languages: Hindi, Bengali, Telugu, Kannada and Malayalam. Based on cross-cultural adaptation guidelines and item-wise factor analysis and correlations established separately across five languages, the final version of the ICMR-PNT test was developed. A total of 368 controls, 123 dementia and 128 MCI patients were recruited for the study. Psychometric properties of the adapted version of the ICMR-PNT were examined, and sensitivity and specificity were examined. Outcomes & Results The ICMR-PNT scores in all languages combined were higher in controls compared with patients with dementia and MCI (F[subscript 2], [subscript 615] = 139.85; p < 0.001). Furthermore, PNT scores for MCI was higher in comparison with patients with dementia in all languages combined (p < 0.001). The area under the curve across the five languages ranged from 0.81 to 1.00 for detecting dementia. There was a negative correlation between Clinical Dementia Rating (CDR) and ICMR-PNT scores and a positive correlation between Addenbrooke's Cognitive Examination--III (ACE-III) and ICMR-PNT scores in control and patient groups. Conclusions & Implications: The ICMR-PNT was developed by following cross-cultural adaptation guidelines and establishing correlations using item-wise factor analysis across five languages. This adapted PNT was found to be a reliable tool when assessing naming abilities effectively in mild to moderate dementia in a linguistically diverse context.

Purpose: The study has a two-fold purpose--first, to identify the enablers of partnering agility in higher education, and, second, to analyze the interplay between the enablers. Design/methodology/approach: Total interpretive structural modelling (TISM) was used to construct a theoretical model of partnering agility enablers, and cross-impact matrix multiplication applied to classification (MICMAC) analysis was used to rank and segregate the enablers into independent, autonomous, dependent and linkage zones on the basis of their driving and dependence power. Findings: The study helped in identifying eight enablers that can be instrumental in driving partnering agility in higher education. According to the TISM model, clarity on roles and responsibilities of partners was found to be the most crucial and vital enabler followed by resource sharing. Practical implications: The conceptual model provides a new direction on how to develop and strengthen higher education partnerships. The model has prioritized all the crucial enablers that the management can work around in order to drive partnering agility in higher education institutions. Originality/value: Studies in the past have majorly focused on academia-industry partnerships. This research has tried to provide a comprehensive view of the enablers and the multidirectional interplay between the enablers that can facilitate partnerships between academia and industry, Indian and international universities, and academia and community.

The study aims to find out the awareness on learning disabilities among elementary school teachers. The sample for the present study consisted of 500 elementary school teachers of Kerala. In this study the investigator used an Awareness Test on Learning Disabilities to measure the Awareness on Learning Disabilities among Elementary School Teachers. The study reveals that elementary school teachers possess an average level of Awareness on Learning Disabilities and also that there exist significant difference in the mean scores of Awareness on Learning Disabilities with respect to gender, locale, type of management but no significant difference exists in the mean scores of Awareness on Learning Disabilities with respect to teaching experience and also that there exists significant difference in the awareness on different dimensions on learning disabilities among elementary school teachers such as as Dyslexia, Dysgraphia, and Dyspraxia.

Aim/Purpose: The objective of the research was to study the relationship of seven independent factors: administrative support, course content, course design, instructor characteristics, learner characteristics, social support, and technical support on quality of e-learning in higher education during the COVID-19 pandemic. Further, the study analyzes the moderating effect(s) of gender and level of the course on the quality of e-learning in higher education during the COVID-19 pandemic. objective of the research was to study the relationship of seven independent factors: administrative support, course content, course design, instructor characteristics, learner characteristics, social support, and technical support on quality of e-learning in higher education during COVID-19 pandemic. Background: The COVID-19 pandemic situation has impacted the entire education system, especially universities, and brought a new phase in education "e-learning." The learning supported with electronic technology like online classes and portals to access the courses outside the classroom is known as e-learning. This study aimed to point out the variables influencing the quality of e-learning, such as administrative support, course content, course design, instructor characteristics, learner characteristics, social support, and technological support. Methodology: An inferential statistics cross-sectional study was conducted of the students of higher education institutions in India and the Kingdom of Saudi Arabia with a self-administered questionnaire to learn the students' perception of e-learning. All levels of undergraduate and postgraduate students took part in the study with a sample size of 784. Ultimately, this study used a Structural Equation Modelling (SEM) approach to find the positive relationship between the quality of e-learning and the seven independent variables and two moderating variables in the higher education sector. Contribution: The study aims to explore the quality of e-learning in higher education from the students' perspective. The study was analyzed based on the student's data collected from the higher educational institutions of India and Saudi Arabia. The study will support the top management and administrators of higher educational institutions in decision making. Findings: The findings revealed that there is a positive relationship between the set of variables and the quality of e-learning in the higher education sector. Also, there is a significant difference in the perception of the students between gender, level of the course, and quality of e-learning in the higher education sector during the COVID-19 pandemic. Recommendations for Practitioners: The results of the study can help top management and administrators of higher educational institutions to improve their actions. Higher educational institutions need to concentrate on the study outcomes related to administrative support, course content, course design, instructor characteristics, learner characteristics, social support, and technological support to enhance the quality of e-learning. The study revealed that there should be a difference in the procedure of providing e-learning based on the level of the course and gender of the students. Recommendation for Researchers: The results were examined and interpreted in detail, based on the perspective of the students, and concluded with a view for future research. The study will be beneficial for academic researchers from different countries with a different set of students and framework. Impact on Society: The study revealed that the positive results of the students' perspective on the quality of e-learning would help the policy-makers of the country in providing the learning process during the COVID-19 pandemic. Also, the result explored the importance of the quality aspects of e-learning for improvement. Future Research: There is a need for future studies to expose the quality of e-learning in higher education in the post-COVID-19 pandemic. Further researchers will bring the performance level of e-learning during the COVID-19 pandemic.

Resolving urban challenges or 'wicked problems' is a dilemma for most governments, especially in developing countries, and India is a case in point. Collaborative, dialogue-based approaches have been posited as critical to addressing wicked problems. This would require a reform of Indian cities' governance systems to enable citizens to be embedded in decision-making about complex issues. This article contends that while India's traditional forms of civic participation can provide a strong foundation for reform, new forms of representative deliberative, influential public participation, that is, deliberative democracy, will be important. Traditional organic and induced participation examples in India are overviewed in terms of their strengths and gaps. Two deliberative democracy case studies in Pune, India, are described, and their potential for reform is assessed. Traditional, together with innovative, induced and organic participation in governance, will be needed to overcome significant pitfalls in governance if Indian cities are to become more capable of addressing urban sustainability challenges.

The association between felt gender typicality (self-perceived similarity to the same-gender peer group) and psychosocial adjustment (self-esteem, peer social competence, depression, victimization, and aggression) was examined in a sample of early adolescents in New Delhi, India (N = 296, 130 girls, mean age = 12.73 years). We also explored whether adolescents' gender-differentiating cognitions (felt pressure for gender conformity, work sexism, and entity beliefs) affect their adjustment, alone and in interaction with felt typicality. Results indicated that felt typicality was associated with higher self-esteem in girls and in older adolescents, with lower depression in older adolescents, and with higher peer social competence. Gender-differentiating beliefs were especially detrimental to girls' and younger adolescents' psychosocial adjustment, with mixed results for boys' adjustment. Gender beliefs also moderated the influence of felt typicality on adjustment. Felt atypicality was associated with greater depression and aggression when adolescents also reported strongly sexist beliefs; and with greater victimization for older adolescents who had high felt pressure or work sexism. Further, boys with strong entity beliefs failed to derive peer social competence from felt typicality. Results indicate that gender self-discrepancy--a disconnect between how one sees oneself in relation to the same-gender peer group and how one feels one's gender should be--is problematic.

Purpose: The purpose of this paper is to illustrate an Inclusive Digital Literacy Framework for vulnerable populations in rural areas under the Digital India program. Key challenges include addressing multiple literacies such as health literacy, financial literacy and eSafety for low-literate learners in low-resource settings with low internet bandwidth, lack of ICT facilities and intermittent electricity. Design/methodology/approach: This research implemented an educational model based on the proposed framework to train over 1,000 indigenous people using an integrated curriculum for digital literacies at remote settlements. The model uses mobile technology adapted for remote areas, context enabled curriculum, along with flexible learning schedules. Findings: The education model exemplifies a viable strategy to overcome persistent challenges by taking tablet-based digital literacies directly to communities. It engages different actors such as existing civil societies, schools and government organizations to provide digital literacy and awareness thereby improving both digital and life skills. It demonstrates the potential value of a comprehensive Digital Literacy framework as a powerful lever for Digital Inclusion. Practical Implications: Policy makers can use this transformational model to extend the reach and effectiveness of Digital Inclusion through the last mile enhancing existing training and service centers that offer the traditional model of Digital Literacy Education. Originality/value: This innovative mobile learning model based on the proposed Digital Framework for Inclusion instilled motivation, interest and confidence while providing effective digital training and conducting exams directly in the tribal settlements for low-literate learners in remote settings. Through incorporating multiple literacies, this model serves to empower learners, enhance potential, improve well-being and reduce the risk of exploitation.

The longevity of people with intellectual disabilities is increasing in developing nations. However, developing nations lack a proper system of care for aging persons with intellectual disabilities. Until now the care has been provided by parents and relatives in the home environment in developing countries, but this scenario is also changing; therefore, there is a strong need to explore a plan of care for this population which is also feasible and replicable. The National Trust is an autonomous body of the Government of India which has developed a comprehensive plan of care for adults with intellectual disabilities. In this article, the National Trust is discussed using a socioecological model. The replicability and suitability of this model for other developing countries are discussed.

BACKGROUND: Women in South Asia often return to their natal home during pregnancy, for childbirth, and stay through the postpartum period-potentially impacting access to health care and health outcomes in this important period. However, this phenomenon is understudied (and not even named) in the demographic or health literature, nor do we know how it impacts health. OBJECTIVE: The aim of this study is to measure the magnitude, timing, duration, risk factors and impact on care of this phenomenon, which we name Temporary Childbirth Migration. METHODS: Using data from 9,033 pregnant and postpartum women collected in 2019 in two large states of India (Madhya Pradesh and Bihar) we achieve these aims using descriptive statistics and logistic regression models, combined with qualitative data from community health workers about this practice. RESULTS: We find that about one third of women return to their natal home at some point in pregnancy or postpartum, mostly clustered close to the time of delivery. Younger, primiparous, and non-Hindu women were more likely to return to their natal home. Women reported that they went to their natal home because they believed that they would receive better care; this was born out by our analysis in Bihar, but not Madhya Pradesh, for prenatal care. CONCLUSIONS: Temporary childbirth migration is common, and, contrary to expectations, did not lead to disruptions in care, but rather led to more access to care. CONTRIBUTION: We describe a hitherto un-named, underexplored yet common phenomenon that has implications for health care use and potentially health outcomes.

This article is a sharing of emergent ideas about the potential role of languages in teacher education (TE) programmes in multilingual contexts in India. Languages play a critical role in TE programmes where they shape both the learning as well as the future teaching of prospective teachers. This role acquires particular significance in multilingual contexts, such as those encountered in most Indian settings. We draw upon multiple disciplines to develop a theoretical conception of language and language learning that is both socio-culturally located as well as critical in nature. We contextualise the discussion by describing the situation vis-à-vis languages and language teaching in India. Next, we develop and describe a rationale for adopting a bilingual/multilingual position in TE programmes in India. Finally, we describe a few possibilities for the practice of language teaching. The article should be read as an invitation to further study and dialogue, rather than as a definitive position on the issues addressed.

Introduction: Globally, the proportion of elderly individuals is steadily increasing, posing significant challenges for health-care systems. Vaccination plays a crucial role in preventing vaccine-preventable diseases and associated morbidity and mortality in the elderly. In India, there is no national immunization schedule dedicated to the elderly group. This study aimed to explore the vaccination coverage for selected vaccines, namely pneumococcal conjugate vaccine, Influenza, and coronavirus disease 2019 (COVID-19), among the elderly residing in urban Bengaluru. Methods: A cross-sectional study was conducted between January and March 2023. Data were collected from 132 elderly participants living in three wards of Rajajinagar, Bengaluru. A structured questionnaire was used to collect sociodemographic data, health conditions, and vaccination status. The data were analyzed using EPI data 3.1 Software, and the Chi-square test and Fisher’s exact test were used to assess the association of demographic variables with vaccine intake. Results: The results showed that vaccination uptake for influenza and pneumococcal vaccines was nil, while for COVID-19 vaccines, 4.5% of participants had not taken any dose, 6.8% had taken the first dose, 57.6% had taken the second dose, and 31.1% had taken the booster dose. Sociodemographic analysis revealed significant associations between vaccine uptake and variables such as age, socioeconomic status (below the poverty line card holder), and body mass index. Conclusion: The low uptake of vaccines in the elderly population highlights the need for specialized strategies and initiatives to increase vaccination coverage. The study recommends suitable measures to improve vaccination coverage among elderly, creating awareness among healthcare professionals and the general population, and enhancing vaccine accessibility and availability to promote healthy aging in India.

The benefits of large-scale genetic studies for healthcare of the populations studied are well documented, but these genetic studies have traditionally ignored people from some parts of the world, such as South Asia. Here we describe whole genome sequence (WGS) data from 4806 individuals recruited from the healthcare delivery systems of Pakistan, India and Bangladesh, combined with WGS from 927 individuals from isolated South Asian populations. We characterize population structure in South Asia and describe a genotyping array (SARGAM) and imputation reference panel that are optimized for South Asian genomes. We find evidence for high rates of reproductive isolation, endogamy and consanguinity that vary across the subcontinent and that lead to levels of rare homozygotes that reach 100 times that seen in outbred populations. Founder effects increase the power to associate functional variants with disease processes and make South Asia a uniquely powerful place for population-scale genetic studies.

This article presents a series of preliminary, quantitative results on rural PC kiosks in India. An analysis of the data confirms many expected trends and correlations and shows that kiosks still face the challenge of sustainability as a business. This study is based on questionnaires presented to kiosk operators and customers of kiosks operated or franchised by Drishtee and n-Logue, two for-profit rural kiosk companies that operate in various geographies throughout India. Recurring surveys are being run with three questionnaires concerning the daily operation and demographic context of the kiosks. The recurring questionnaires will be repeated once a quarter for three years; the results for this article are from the first two sets only. (Contains 2 notes.)

Background: In July 2021, the Alappuzha district in Kerala, India, reported an unexpected number of acute gastroenteritis (772) cases (Outbreak A). On October 10, 2021, a university in Wayanad, Kerala, reported 25 acute gastroenteritis cases (Outbreak B). We described both the outbreaks and determined the agent, source and risk factors. Methods: We defined a suspected case as the occurrence of vomiting or at least three episodes of loose stools within 24 h and a confirmed case as those with stool samples/rectal swabs positive for norovirus. We did a matched case-control study in Outbreak A and a retrospective cohort study in Outbreak B. We calculated the adjusted odds ratio (aOR) in outbreak A, relative risk (aRR) in outbreak B and population attributable fraction (PAF). We tested stool and water samples for bacteria and viruses. Results: We identified Group II norovirus in stool samples in both outbreaks and 4/5 water samples in Outbreak A. Suspected norovirus infection was associated with drinking inadequately boiled water from the municipal water supply in outbreak A [aOR: 4.5; 95 % C.I: 1.2–15.8; PAF: 0.23] and well water in hostels in outbreak B [aRR: 2.2; 95 % C.I: 1.2–3.9; PAF: 0.15]. In Outbreak A, groundwater from tube wells was mixed in the municipal water supply overhead tanks without chlorination. Conclusion: The gastroenteritis outbreaks were caused by Group II norovirus due to the consumption of inadequately boiled contaminated groundwater (outbreak A) and well water (outbreak B). We recommended superchlorination of overhead tanks and wells and boiled water for drinking.

Summary: This Viewpoint presents an overview of trials methodology research (TMR) and the case for investing in TMR in India. Randomised controlled trials and other types of clinical research inform evidence-based medicine, but this endeavour is dependent on the quality of such research. TMR is aimed at improving the way in which clinical trials are designed, conducted, analysed, and reported. The evolution of TMR in countries like the UK has been nurtured through dedicated funding support. Similar funding opportunities for TMR in India will help optimise the ethical and methodological rigour of the growing number of trials conducted in India. Such funding could help initiate an interdisciplinary network of key stakeholders in India to lead on TMR priority-setting exercises so that methodological questions of relevance to India are addressed. The establishment of trials methodology hubs will enhance initiatives such as the disease-specific clinical trials networks being set up as part of the National Biopharma Mission in India. We posit that promoting and establishing TMR as a distinct field of study in India will ensure the improvement of our health research ecosystem and call on national and international funding bodies to initiate consultation, consensus building and ringfenced funding for TMR in India.

ObjectivesBreastfeeding and complementary feeding practices in India do not meet recommendations. Community health care workers (CHWs) are often the primary source of information for pregnant and postpartum women about Infant and Young Child Feeding (IYCF) practices. While existing research has evaluated the effectiveness of content and delivery of information through CHWs, little is known about the quality of the interpersonal communication (respectful care). We analyzed the effect of respectful interactions on recommended IYCF practices.MethodsWe use data from evaluation of an at-scale mHealth intervention in India that serves as a job aid to the CHWs (n = 3266 mothers of children

IntroductionCommunity health workers (CHWs) deliver services at-scale to reduce maternal and child undernutrition, but often face inadequate support from the health system to perform their job well. Supportive supervision is a promising intervention that strengthens the health system and can enable CHWs to offer quality services.ObjectivesWe examined if greater intensity of supportive supervision as defined by monitoring visits to Anganwadi Centre, CHW-supervisor meetings, and training provided by supervisors to CHWs in the context of Integrated Child Services Development (ICDS), a national nutrition program in India, is associated with higher performance of CHWs. Per program guidelines, we develop the performance of CHWs measure by using an additive score of nutrition services delivered by CHWs. We also tested to see if supportive supervision is indirectly associated with CHW performance through CHW knowledge.MethodsWe used longitudinal survey data of CHWs from an impact evaluation of an at-scale technology intervention in Madhya Pradesh and Bihar. Since the inception of ICDS, CHWs have received supportive supervision from their supervisors to provide services in the communities they serve. Mixed-effects logistic regression models were used to test if higher intensity supportive supervision was associated with improved CHW performance. The model included district fixed effects and random intercepts for the sectors to which supervisors belong.ResultsAmong 809 CHWs, the baseline proportion of better performers was 45%. Compared to CHWs who received lower intensity of supportive supervision, CHWs who received greater intensity of supportive supervision had 70% higher odds (AOR 1.70, 95% CI 1.16, 2.49) of better performance after controlling for their baseline performance, CHW characteristics such as age, education, experience, caste, timely payment of salaries, Anganwadi Centre facility index, motivation, and population served in their catchment area. A test of mediation indicated that supportive supervision is associated indirectly with CHW performance through improvement in CHW knowledge.ConclusionHigher intensity of supportive supervision is associated with improved CHW performance directly and through knowledge of CHWs. Leveraging institutional mechanisms such as supportive supervision could be important in improving service delivery to reach beneficiaries and potentially better infant and young child feeding practices and nutritional outcomes.Trial registrationTrial registration number:  https://doi.org/10.1186/ISRCTN83902145.

BackgroundMen who have sex with men (MSM) in India are extremely marginalised and stigmatised, and therefore experience immense psychosocial stress. As current HIV prevention interventions in India do not address mental health or resilience to these stressors, we aimed to evaluate a resilience-based psychosocial intervention in the context of HIV and sexually transmitted infection (STI) prevention.MethodsWe did a multicity, randomised, clinical efficacy trial in Chennai (governmental tuberculosis research institute) and Mumbai (non-governmental organisation for MSM), India. Inclusion criteria were MSM, aged 18 years or older, who were at risk of HIV acquisition or transmission, defined as having any of the following in the 4 months before screening: anal sex with four or more male partners (protected or unprotected), diagnosis of an STI, history of transactional sex activity, or condomless anal sex with a man who was of unknown HIV status or serodiscordant. Participants were required to speak English, Tamil (in Chennai), or Hindi (in Mumbai) fluently. Eligible individuals were randomly assigned (1:1) to either a resilience-based psychosocial HIV prevention intervention, consisting of group (four sessions) and individual (six sessions) counselling alongside HIV and STI voluntary counselling and testing, or a standard-of-care control comprising voluntary counselling and testing alone. The primary outcomes were number of condomless anal sex acts with male partners during the past month (at baseline and 4 months, 8 months, and 12 months after randomisation), and incident bacterial STIs (at 12 months after randomisation). Resilience-related mediators included self-esteem, self-acceptance, and depression. Recruitment is now closed. This trial is registered with ClinicalTrials.gov, NCT02556294.FindingsBetween Sept 4, 2015, and June 28, 2018, we enrolled 608 participants; 305 (50%) were assigned to the psychosocial intervention condition and 303 (50%) were assigned to the control condition. 510 (84%) of 608 men completed an assessment at 4 months after randomisation, 483 (79%) at 8 months, and 515 (85%) at 12 months. 512 (99%) of 515 men had STI data from the 12-month assessment. The intervention condition had a 56% larger reduction in condomless anal sex acts (95% CI 35-71; p

India has one of the largest numbers of men who have sex with men (MSM) globally; however, geographic data on sexually transmitted infection (STI) prevalence and associations with sexual behavior are limited. Six-hundred and eight MSM in Chennai and Mumbai underwent screening for a behavioral trial and were assessed for bacterial STIs (syphilis, chlamydia, gonorrhea), HIV, and past-month self-reported condomless anal sex (CAS). Mumbai (37.8%) had a greater prevalence of any STI than Chennai (27.6%) (prevalence ratio [PR] = 1.37, 95% CI: 1.09, 1.73). This pattern also emerged for gonorrhea and chlamydia separately but not syphilis. Conversely, Mumbai MSM reported lower rates of CAS (mean = 2.2) compared to Chennai MSM (mean = 14.0) (mean difference = -11.8, 95% CI: -14.6, -9.1). The interaction of city by CAS on any STI prevalence (PR = 2.09, 95% CI: 1.45, 3.01, p

BackgroundAnganwadi Workers (AWWs) are a group of 1.4 million community health workers that operate throughout rural India as a part of the Integrated Child Development Services program. AWWs are responsible for disseminating key health information regarding nutrition, family planning, and immunizations to the women and children in their catchment area, while maintaining detailed registers that track key beneficiary data, updates on health status, and supply inventory beneficiaries. There is a need to understand how AWWs spend their time on all of these activities given all of their responsibilities, and the factors that are associated with their time use.MethodsThis cross-sectional study conducted in Madhya Pradesh, collected time use data from AWWs using a standard approach in which we asked participants how much time they spent on various activities. Additionally, we estimated a logistic regression model to elucidate what AWW characteristics are associated with time use.ResultsWe found that AWWs spend substantial amounts of time on administrative tasks, such as filling out their paper registers. Additionally, we explored the associations between various AWW characteristics and their likelihood of spending the expected amount of time on preschool work, filling out their registers, feeding children, and conducting home visits. We found a positive significant association between AWW education and their likelihood of filling out their registers.ConclusionsAWWs spend substantial amounts of time on administrative tasks, which could take away from their ability to spend time on providing direct care. Additionally, future research should explore why AWW characteristics matter and how such factors can be addressed to improve AWWs' performance and should explore the associations between Anganwadi Center characteristics and AWW time use.

BackgroundThe impact of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for diagnosis and management of hypertension on the prevalence of hypertension in India is unknown.MethodsWe analyzed data from the Cardiac Prevent 2015 survey to estimate the change in the prevalence of hypertension. The JNC8 guidelines defined hypertension as a systolic blood pressure of ≥140 ​mmHg or diastolic blood pressure of ≥90 ​mmHg. The 2017 ACC/AHA guidelines define hypertension as a systolic blood pressure of ≥130 ​mmHg or diastolic blood pressure of ≥80 ​mmHg. We standardized the prevalence as per the 2011 census population of India. We also calculated the prevalence as per the World Health Organization (WHO) World Standard Population (2000-2025).ResultsAmong 180,335 participants (33.2% women), the mean age was 40.6 ​± ​14.9 years (41.1 ​± ​15.0 and 39.7 ​± ​14.7 years in men and women, respectively). Among them, 8,898 (4.9%), 99,791 (55.3%), 35,694 (11.9%), 23,084 (12.8%), 9,989 (5.5%) and 2,878 (1.6%) participants belonged to age group 18-19, 20-44, 45-54, 55-64, 65-74 and ​≥ ​75 years respectively. The prevalence of hypertension according to the JNC8 and 2017 ACC/AHA guidelines was 29.7% and 63.8%, respectively- an increase of 115%. With the 2011 census population of India, this suggests that currently, 486 million Indian adults have hypertension according to the 2017 ACC/AHA guidelines, an addition of 260 million as compared to the JNC8 guidelines.ConclusionAccording to the 2017 ACC/AHA guidelines, 3 in every 5 Indian adults have hypertension.

Abstract Introduction LANDMARC (CTRI/2017/05/008452), a prospective, observational real‐world study, evaluated the occurrence of diabetes complications, glycemic control and treatment patterns in people with type 2 diabetes mellitus (T2DM) from pan‐India regions over a period of 3 years. Methods Participants with T2DM (≥25 to ≤60 years old at diagnosis, diabetes duration ≥2 years at the time of enrollment, with/without glycemic control and on ≥2 antidiabetic therapies) were included. The proportion of participants with macrovascular and microvascular complications, glycemic control and time to treatment adaptation over 36 months were assessed. Results Of the 6234 participants enrolled, 5273 completed 3 years follow‐up. At the end of 3‐years, 205 (3.3%) and 1121 (18.0%) participants reported macrovascular and microvascular complications, respectively. Nonfatal myocardial infarction (40.0%) and neuropathy (82.0%) were the most common complications. At baseline and 3‐years, 25.1% (1119/4466) and 36.6% (1356/3700) of participants had HbA1c

Background: Aging is a global phenomenon. Depression and loneliness among the elderly are significant mental health concerns, often overlooked and underestimated in society. Globally, depression amounts to a loss of 2% disability-adjusted life years. India is 2nd most populous in the world by elderly population, depression and loneliness are often overlooked due to various reasons. Therefore, this study aims to explore the proportion of depression and loneliness and to determine their association with loneliness and other sociodemographic factors. Methodology: A community-based cross-sectional study was conducted among 132 elders (age ≥60 years) in three wards of the urban area of Bengaluru. Geriatric Depression Scale 15 and Three-Item Loneliness Scale were used to assess depression and loneliness, respectively. The association between depression and loneliness was analyzed with other demographic variables using Chi-square and Bivariate logistic regression. Results: The magnitude of depression and loneliness among the elderly population was found to be 75.7% and 91%, respectively. Depression was significantly associated with elderly 60–69 years, females, with minimal education (illiterate), homemakers, number of family members >4, with no income, and dependent on others. Loneliness is significantly associated with the female gender, with illiterates, those who are not working and homemakers, below poverty line card holders, those with chronic diseases, and those dependent on others compared to their counterparts. There is a significant positive correlation between depression and loneliness scores among the elderly. Conclusion: The higher proportion of depression and loneliness among the elderly in our study emphasizes the necessary supportive measures. It needs to be addressed adequately through a coordinated primary care approach with community and social support.

Wetland paddy agro-ecosystems are recognized as important human-made wetland systems. Realizing that paddy lands are important ecological systems, the state of Kerala in southern India passed an act in 2008 preventing their conversion to other uses. The state provides subsidies and production bonuses to encourage paddy farmers and imposes penalties for non-compliance. However, the economic benefits associated with the conversion of paddy lands are considerably higher than the current subsidies and bonuses. As such, the conversion of paddy lands continues unabated despite the incentives and disincentives provided in the act. This study examines the ecological rationale for preventing paddy land conversion through a comparative assessment of the ecological health of paddy lands against that of lands with competing uses. Ecological health is assessed in terms of the amphibian population—specifically, frog abundance and diversity across different land uses, as frogs are considered bio-indicators of ecological health. The results reveal that the conversion of paddy lands adversely affects the survival of amphibians, especially frogs, thus emphasizing the role of paddy lands in maintaining the ecological health of a region. The study also provides empirical evidence for creating “Pigouvian subsidies” or ecological incentives for paddy farmers.

Introduction and Objectives: Lately, there has been a steady increase in early liver transplantation for alcohol-associated hepatitis (AAH). Although several studies have reported favorable outcomes with cadaveric early liver transplantation, the experiences with early living donor liver transplantation (eLDLT) are limited. The primary objective was to assess one-year survival in patients with AAH who underwent eLDLT. The secondary objectives were to describe the donor characteristics, assess the complications following eLDLT, and the rate of alcohol relapse. Materials and Methods: This single-center retrospective study was conducted at AIG Hospitals, Hyderabad, India, between April 1, 2020, and December 31, 2021. Results: Twenty-five patients underwent eLDLT. The mean time from abstinence to eLDLT was 92.4 ± 42.94 days. The mean model for end-stage liver disease and discriminant function score at eLDLT were 28.16 ± 2.89 and 104 ± 34.56, respectively. The mean graft-to-recipient weight ratio was 0.85 ± 0.12. Survival was 72% (95%CI, 50.61–88) after a median follow-up of 551 (23-932) days post-LT. Of the 18 women donors,11 were the wives of the recipient. Six of the nine infected recipients died: three of fungal sepsis, two of bacterial sepsis, and one of COVID-19. One patient developed hepatic artery thrombosis and died of early graft dysfunction. Twenty percent had alcohol relapse. Conclusions: eLDLT is a reasonable treatment option for patients with AAH, with a survival of 72% in our experience. Infections early on post-LT accounted for mortality, and thus a high index of suspicion of infections and vigorous surveillance, in a condition prone to infections, are needed to improve outcomes.

OBJECTIVE: To assess the prevalence and determinants of food insecurity among people living with HIV (PLWH) in Pune, India and its association with biomarkers known to confer increased risks of morbidity and mortality in this population. DESIGN: Cross-sectional analysis assessing food insecurity using the standardized Household Food Insecurity Access Scale. Participants were dichotomized into two groups: food insecure and food secure. Logistic regression models were used to assess associations between socio-economic, demographic, clinical, biochemical factors and food insecurity. SETTING: Antiretroviral therapy (ART) centre of Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals (BJGMC-SGH), Pune, a large publicly funded tertiary and teaching hospital in western India.ParticpantsAdult (≥18 years) PLWH attending the ART centre between September 2015 and May 2016 who had received ART for either ≤7d (ART-naïve) or ≥1 year (ART-experienced). RESULTS: Food insecurity was reported by 40 % of 483 participants. Independent risk factors (adjusted OR; 95 % CI) included monthly family income

INTRODUCTION:Millions of children in India still suffer from poor health and under-nutrition, despite substantial improvement over decades of public health programmes. The Anganwadi centres under the Integrated Child Development Scheme (ICDS) provide a range of health and nutrition services to pregnant women, children

The perspective of the paper is the geopolitical contestation between China–India–Pakistan, which frames the contours of the nuclear trilemma that is nested in the broader global nuclear weapons framework. Territorial disputes harbor the potential for conflict under the nuclear overhang between China–India and India–Pakistan. The two dyads are structurally separate but are also connected. Beliefs systems that shape nuclear doctrine have commonality in the China–India dyad. But such is not the case in the India-Pakistan dyad. There is, however, political recognition of the dangers that inhabit the unexplored space of conventional war under the nuclear over hang. The greater danger of nuclear war in both dyads is concealed in the inability to control escalation of conflicts that may have small beginnings but can potentially spin out of control. The paper uses Clausewitz escalation model to highlight this crucial issue. The policy prescriptions are therefore directed on never testing the boundaries of the nuclear threshold and relate to reduction of alert levels. A Global No First Use Treaty is proposed and one that is possible only if the dangers of nuclear war are publicized at the global level thus forcing the hand of political leaders. This is an imperative step to free the leadership from the shackles of varied impractical nuclear strategies that are unable to answer the question – what happens after the first nuclear weapon is fired.

Abstract Background Cancer is the major cause of morbidity and mortality worldwide. The cancer burden varies within the regions of India posing great challenges in its prevention and control. The national burden assessment remains as a task which relies on statistical models in many developing countries, including India, due to cancer not being a notifiable disease. This study quantifies the cancer burden in India for 2016, adjusted mortality to incidence (AMI) ratio and projections for 2021 and 2025 from the National Cancer Registry Program (NCRP) and other publicly available data sources. Methods Primary data on cancer incidence and mortality between 2012 and 2016 from 28 Population Based Cancer Registries (PBCRs), all-cause mortality from Sample Registration Systems (SRS) 2012–16, lifetables and disability weight from World Health Organization (WHO), the population from Census of India and cancer prevalence using the WHO-DisMod-II tool were used for this study. The AMI ratio was estimated using the Markov Chain Monte Carlo method from longitudinal NCRP-PBCR data (2001–16). The burden was quantified at national and sub-national levels as crude incidence, mortality, Years of Life Lost (YLLs), Years Lived with Disability (YLDs) and Disability Adjusted Life Years (DALYs). The projections for the years 2021 and 2025 were done by the negative binomial regression model using STATA. Results The projected cancer burden in India for 2021 was 26.7 million DALYsAMI and expected to increase to 29.8 million in 2025. The highest burden was in the north (2408 DALYsAMI per 100,000) and northeastern (2177 DALYsAMI per 100,000) regions of the country and higher among males. More than 40% of the total cancer burden was contributed by the seven leading cancer sites — lung (10.6%), breast (10.5%), oesophagus (5.8%), mouth (5.7%), stomach (5.2%), liver (4.6%), and cervix uteri (4.3%). Conclusions This study demonstrates the use of reliable data sources and DisMod-II tools that adhere to the international standard for assessment of national and sub-national cancer burden. A wide heterogeneity in leading cancer sites was observed within India by age and sex. The results also highlight the need to focus on non-leading sites of cancer by age and sex. These findings can guide policymakers to plan focused approaches towards monitoring efforts on cancer prevention and control. The study simplifies the methodology used for arriving at the burden estimates and thus, encourages researchers across the world to take up similar assessments with the available data.

To explore if psychiatrists in India carry out less research as opposed to psychiatrists of Indian origin working in the United Kingdom (UK), we carried out a small-scale survey of psychiatrists practicing in India and psychiatrists of Indian origin working in the UK. In light of the findings of this survey and from the three authors' experience of teaching, training, working, and engaging in research in India and the UK, we try to answer questions such as “why do psychiatrists in India carry out less research? Should it change, and if so how? What can one learn?” Here, we do not assume or advocate that one system (East or West) has all the answers. We merely wish to discuss the place of research in psychiatric training and psychiatric practice.

Although educational apps have emerged as an easily available and accessible alternative to classroom learning, particularly at the time of pandemics like COVID-19, no research has attempted to identify learners intentions behind the usage of different educational apps. The current study developed a valid and reliable research instrument to measure the motivations behind using educational apps. Using the mixed method approach commonly used in uses and gratification (U&G) research, i.e., open-ended essays & national survey (N = 552), this study identified seven gratifications behind learners intention to use educational apps: academic assistance, convenience, entertainment, social influence, novelty, engagement and activity. The result suggests that academic assistance, convenience and social influence were the significant predictors of the intention to use educational apps. The current research also identified the moderating effect of gender in selecting educational apps. One of the most significant contributions of the present study is that it extended the uses and gratification theory applications beyond the traditional media to explain the intention to use educational apps.

Abstract Anaemia control programmes in India are hampered by a lack of representative evidence on anaemia prevalence, burden and associated factors for adolescents. The aim of this study was to: (1) describe the national and subnational prevalence, severity and burden of anaemia among Indian adolescents; (2) examine factors associated with anaemia at national and regional levels. Data (n = 14,673 individuals aged 10–19 years) were from India's Comprehensive National Nutrition Survey (CNNS, 2016–2018). CNNS used a multistage, stratified, probability proportion to size cluster sampling design. Prevalence was estimated using globally comparable age‐ and sex‐specific cutoffs, using survey weights for biomarker sample collection. Burden analysis used prevalence estimates and projected population from 2011 Census data. Multivariable logistic regression models were used to analyse factors (diet, micronutrient deficiencies, haemoglobinopathies, sociodemographic factors, environment) associated with anaemia. Anaemia was present in 40% of girls and 18% of boys, equivalent to 72 million adolescents in 2018, and varied by region (girls 29%–46%; boys 11%–28%) and state (girls 7%–62%; boys 4%–32%). Iron deficiency (ferritin 3.5% or any HbS) (OR: 2.81, 95% CI: [1.66,4.74]), vitamin A deficiency (serum retinol