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Sustainable Development Goal 6.2 aims to end open defecation by 2030 by ensuring universal access to private household toilets. However, private toilets might not be feasible for poor households. As a result, policy makers and academics have suggested well-managed shared sanitation facilities as an alternative solution. Less is known about the associations between shared sanitation use and health. Using data from the fifth round of the National Family Health Survey from 2019 to 2021, we estimated the association between usual defecation location and child anthropometry outcomes among children under 2 years in India. The primary exposure was usual defecation location at the household level. We compared both shared improved toilet use and open defecation to private, improved toilet use. We used linear regression to estimate the associations between the exposures and linear outcomes: height-for-age Z-score, weight-for-height Z-score, and weight-for-age Z-score. We used Poisson regression with a log link to estimate the prevalence ratios of stunting, wasting, and underweight. After controlling for environmental, maternal, socioeconomic, and child confounders, we found no differences in six child anthropometry outcomes when comparing shared toilet use or open defecation to private toilet use. This finding was consistent across both urban and rural households. Our findings confirm the null associations between private toilet use and child growth found in previous studies, and that this association does not vary if the toilet is being shared. Future research should examine these differences between private and shared toilets in the context of other health outcomes.

The Sustainable Development Goals have set an ambitious target to end open defecation by 2030 by building private household toilets. These toilets are categorized based on quality indicators. However, toilets that are shared among households are considered "limited," disincentivizing governments and implementers from investing in this infrastructure despite being more appropriate in certain contexts. Furthermore, unlike private toilets, shared toilets are not distinguished based on their quality. As such, there is a need to understand what attributes constitute well-managed shared toilets. These types of facilities could play an important role in helping people move up the sanitation ladder away from open defecation in certain contexts. Therefore, we conducted 41 one-on-one in-depth interviews with users of managed shared sanitation facilities. We found that maintenance and accessibility are key indicators of well-managed shared sanitation. Maintenance includes the provision of water for flushing and self-cleaning, cleaning, and high-quality built infrastructure. Accessibility is defined by the distance people have to walk to reach the facility, the amount of time they have to wait in line, and design features of the facility that encourage use. These findings could help distinguish managed versus unmanaged shared sanitation and could help inform global sanitation policies.

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.

Swachh Bharat Abhiyan, India's flagship sanitation intervention, set out to end open defecation by October 2019. While the program improved toilet coverage nationally, large regional disparities in construction and use remain. Our study used ethnographic methods to explore perspectives on open defecation and latrine use, and the socio-economic and political reasons for these perspectives, in rural Bihar. We draw on insights from social epidemiology and political ecology to explore the structural determinants of latrine ownership and use. Though researchers have often pointed to rural residents' preference for open defecation, we found that people were aware of its many risks. We also found that (i) while sanitation research and "behavior change" campaigns often conflate the reluctance to adopt latrines with a preference for open defecation, this is an erroneous conflation; (ii) a subsidy can help (some) households to construct latrines but the amount of the subsidy and the manner of its disbursement are key to its usefulness; and (iii) widespread resentment towards what many rural residents view as a development bias against rural areas reinforces distrust towards the government overall and its Swachh Bharat Abhiyan-funded latrines in particular. These social-structural explanations for the slow uptake of sanitation in rural Bihar (and potentially elsewhere) deserve more attention in sanitation research and promotion efforts.

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

In 2017, the Joint Monitoring Programme estimated that 520 million people in India were defecating in the open every day. This is despite efforts made by the government, Non-Governmental Organizations (NGOs), and multilaterals to improve latrine coverage throughout India. We hypothesize that this might be because current interventions focus mostly on individual-level determinants, such as attitudes and beliefs, instead of considering all possible social determinants of latrine ownership. Given this, we ask two questions: what is the association between the amount of dwelling space owned by households in rural India and their likelihood of toilet ownership and what proportion of the variation in household latrine ownership is attributable to villages and states? We used multilevel modeling and found significant associations between the amount of household dwelling space and the likelihood of latrine ownership. Furthermore, considerable variation in latrine ownership is attributable to villages and states, suggesting that additional research is required to elucidate the contextual effects of villages and states on household latrine ownership. Thus, sanitation interventions should consider household dwelling space and village and state context as important social determinants of latrine ownership in rural India. Doing so could bolster progress towards Sustainable Development Goal (SDG) 6.

Background: Worldwide coronary artery disease is the leading cause of death and reduction in Disability Adjusted Life Years. Only a few studies of the association of epicardial adipose tissue (EAT) with the complexity of CAD have been there, therefore, this study was planned to calculate the anterior EAT thickness by 2D echocardiography, and to determine the severity of coronary lesion by syntax score (SS) on coronary angiogram. Methodology: This hospital-based observational study was carried out with total 100 patients with a diagnosis of CSAP got admitted in the department from August 2022 to July 2023 at a tertiary care facility. Patients of >18 years of age, who gave informed consent, diagnosed with CSAP undergoing coronary angiography were included in our study. The concentrations of triglycerides (TGs), total cholesterol, HDL, VLDL was measured, and LDL was lab tested, and the Syntax score was calculated. Data analysis was done using SPSS version 23.0. Results: In our study, the mean age of patients was 54.34±14.87 years, with male to female ratio was 3.5:1. Dyslipidemia was the most common risk factor. High syntax score was seen in 42 cases, followed by intermediate in 31 and low score in 27 cases. Mean EAT score was more in cases with higher syntax score and this score was statistically significant (p<0.05). Patients with abnormal waist circumference have significantly higher syntax score (p<0.05). Cutoff of EAT was 6.15 using ROC, and for this cutoff sensitivity and specificity was 87.5% and 100% respectively. Conclusion: When comparing patients with an SS of =33 to those with an SS of <33, the EAT thickness in the former group was considerably larger. The 6.15 mm EAT threshold value was found to be predictive of severe CAD. A noteworthy association was seen between EAT and both WC and lipid profile. [ABSTRACT FROM AUTHOR]

Background: LV diastolic dysfunction contributes to signs and symptoms of heart failure and LV diastolic dysfunction is associated with increased mortality rates in patients chronic heart failure independent of systolic function after acute myocardial infarction. This study was planned to calculate the mean change in LV diastolic function at 3 months and 1 year after MI from baseline. Materials and Methods: This hospital-based retrospective observational study was carried out in a tertiary care facility at Jaipur. Data of total 75 patients of acute MI who got admitted from 1st April 2022 to 30th September 2022 was collected retrospectively. Baseline and follow up data of clinical evaluation of all patients visits at 3 and 12 months along with Two-Dimensional Echocardiography for assessment of Diastolic Dysfunction was obtained from the records and analysed. Result: The mean age of cases was 63±11 years. Male to female ratio was 2.9:1. Patients with normal, impaired relaxation, or restrictive LV diastolic Doppler filling were categorized in 38.7%, 40%, and 21.3% respectively. In patients with normal filling pattern early and late mitral peak flow velocity, E/A ratio, and mitral E-wave deceleration time were without significant changes during 12 months of follow-up. In patients with impaired relaxation E/A ratio, mitral E deceleration time, isovolumetric relaxation time, and peak pulmonary venous systolic and diastolic flow velocity were unchanged during follow-up. Conclusion: Patients exhibiting early diastolic dysfunction symptoms develop LV dilatation and in-hospital congestive heart failure. Patients who developed this LV filling abnormality or who had a prolonged restrictive LV filling pattern were linked to higher NYHA class scores and hospital readmissions for heart failure during follow-up. [ABSTRACT FROM AUTHOR]

Percutaneous transluminal angioplasty (PTA) and stenting have emerged as viable alternatives to surgical approaches for managing chronic total occlusion (CTO) of the subclavian artery (SA). This case series presents five instances of successful percutaneous interventions in patients with SA-CTO lesions, demonstrating technical feasibility, effectiveness, and reliability. The endovascular approach offers a minimally invasive option with outcomes comparable to traditional surgical methods, reducing the risks associated with anesthesia and postoperative morbidity. While literature supports percutaneous interventions in acute and subtotal occlusions, data on SA-CTO lesions remain limited. The reported cases emphasize the need for prospective trials to evaluate the efficacy of percutaneous interventions in managing SA-CTO lesions, highlighting their potential as a safe and effective alternative. [ABSTRACT FROM AUTHOR]

Introduction- Heart failure (HF) is one of the most elusive syndromes in cardiology with high morbidity and mortality. Aim- To study Get with the guidelines heart failure Score (GWTG-HF) among patients of acute decompensated heart failure, correlate it with outcome of survival or death till 4 week of illness, compare its performance with APACHE 2 score and to Compare its results with NT PROBNP in predicting mortality amongst patient of south east Asian ethnicity. Methods- Prospective observational study at medical wards and ICUs in the Department of Cardiology, SMS medical college on 300 patients of acute decompensated heart failure, as per Framingham criteria were analyzed and each patient underwent a complete clinical evaluation along with calculation of GWTG HF and APACHE 2 score. All the patients had NT pro BNP test within 48 hours of admission. Patient were then followed till 4 weeks of illness for outcome of survival or death, whichever occurred earlier. GWTG HF score of the patient was then compared with APACHE 2 score and it was correlated with the outcome of patients and NT pro BNP levels. Results- The GWTG-HF score could predict the outcome of survival and death in ADHF patients of south east Asian ethnicity. When compared, APACHE 2 score performed better than GWTG-HF score in predicting outcome. However, GWTG-HF score was easily calculated at the bedside and was easy to use. GWTG-HF score correlated with NT- pro BNP levels with rising score having higher NT pro BNP levels. Conclusion: In resource limited settings like those in the ASAIN countries the usage of a risk prediction score can help the physicians for accurate referral and timely intervention amongst the sickest patients of heart failure. [ABSTRACT FROM AUTHOR]