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Introduction: While detecting active TB is central to public health efforts, modelling indicates that reducing latent TB through preventive therapy is crucial. Current regimens mitigate risk but are lengthy and have side effects, necessitating support for uninterrupted treatment. This paper presents the development and evaluation of a digital health platform designed to enhance adherence among LTBI patients. Methods: A Quasi-experimental study was conducted among LTBI patients in Delhi. A total of 163 participants were allocated to intervention (n=82) and control (n=81) groups. Participants were followed up for 6 months post recruitment. Effectiveness of mobile application was evaluated through quantitative tools. Results: Intervention group participants showed slightly higher treatment completion rates (65.91%), in comparison to participants in control group (63%). The analysis demonstrated no co-relation of gender, age, education and employment with treatment completion rates in intervention group. While text and video-based interventions have shown success, there remains a need for more user-centric digital health interventions in this area, given the limited number of studies to date. Conclusion: The mobile health applications can be useful for LTBI care. However, there is a need of involving users during development so that continued interest of users can be ensured.

Background: Cervical cancer remains a significant global health concern, with well-established risk factors. Population-based electronic surveillance tools offer a promising avenue for identifying risk factors associated with cervical cancer development way before it becomes an actual concern for a woman. The objective of this study is to understand and to support the app- based decision-making tool for identifying risk factors of cervical cancer for the women between 30-60 years of age. Method: The study will be conducted in the selected Sampoorna Non-Communicable Diseases (NCD) clinics at Lucknow, Uttar Pradesh (UP). A rigorous review of database was conducted to summarize the evidence on informatics available for early identification of cervical cancer app. An app-based decision- making tool will be developed to identify and detect the high- risk population developing cervical cancer. The app then will be shared with health workers at Sampoorna clinics and will be capacitated for using it to collect real time data. Conclusion: The utilization of a population-based electronic surveillance tool will facilitate the identification of various risk factors contributing to cervical cancer development. The methodology process will help to comprehend the analysis providing the insights. This approach has the potential to enhance targeted interventions, public health policies, and personalized screening programs to mitigate the burden of cervical cancer. The objective of this paper is to understand and to support the design of dashboards for creating transparency and accountability.

Introduction: There has been a gradual increase in the burden of COPD on patients, caretakers, and the health system. Digital health interventions for the self-management of COPD help patients to learn and practice the skills necessary to manage their COPD better. Method: We searched PubMed (NCBI), Scopus (Elsevier), Web of Science (Clarivate), and Cochrane Central Register of Controlled Trials (Wiley) databases from January 1, 2005 to September 30, 2022 and included English language articles that enrolled clinically diagnosed COPD patients of any age with the implementation of digital health intervention for COPD. Result: We identified 3216 records, of which 61 studies were assessed at the full-text screening stage, and 32 met the inclusion criteria. The interventions include patient monitoring, COPD education, physical activity or exercise, pulmonary rehabilitation, inhaler use techniques, breathing exercises, medication management, and counseling. Mobile-based interventions were the preferred mode of delivery of interventions. COPD-related outcomes were measured regarding COPD exacerbations, admissions or readmissions, exercise capacity, lung function, and inhaler use technique. Conclusion: Most studies were conducted in developed countries, but there needs to be more literature on low-to-middle-income countries. The findings of this systematic review would support the development of a smartphone-enabled home-based self-management informatics platform in India.

Introduction: Digital health interventions are gradually being incorporated into the management of tuberculosis to ensure treatment adherence, but only a small number of trials focusing on latent tuberculosis infection (LTBI) care have tested and evaluated them. It is anticipated that 170 million persons with LTBI may eventually develop active TB; thus, treatment of LTBI patients is an important aspect, along with ensuring treatment adherence. Digital platforms can be beneficial to ensure treatment adherence in LTBI patients, as various studies have shown the positive impact of digital interventions in improving patients’ treatment adherence and treatment outcome. This study aims to explore the various available digital interventions worldwide for treatment adherence in LTBI patients and develop an informatics platform for enhancing treatment adherence in LTBI patients. Methods: This will be a quasi-experimental study divided into three phases. In the first phase, a scoping review method will be used to conduct a systematic literature review using the PRISMA tool to report on various digital interventions focused on treatment adherence in LTBI patients. In the second phase, a text message-based digital platform will be developed, and in the third phase of the study, an evaluation of the digital platform will be done using qualitative and quantitative questionnaires. The study will be conducted using a mixed-methods approach between January 2023 and December 2023. The sample size will be 162 participants, of whom 81 will be assigned to an intervention group and 81 will receive the usual care from the respective chest clinic as a control group. Results: A descriptive analysis of demographic variables and other variables will be done. Continuous variables will be described as mean ± standard deviation (M ± SD), medians (inter-quartile ranges) (M (IQR)), and medians (5th percentile to 95th percentile) (P5-P95). A two-sample independent T-test, the chi-square test, and the Mann-Whitney test will be used for comparisons between groups. Treatment success between control and intervention will be compared through a chi-square test. Conclusions: The key finding of the study will be an understanding of the efficiency of digital platforms for improving treatment adherence in latent TB patients in India.

Background: The burden of chronic obstructive pulmonary disease to patients, their caretakers, and health system is gradually increasing and is associated with the morbidity, mortality, disability adjusted life years and higher costs. Self-management of COPD is a vital strategy for its management. This study aims to develop, implement, and evaluate an informatics platform for the home-based self-management of Chronic Obstructive Pulmonary Disease. Method: A systematic review will be conducted to synthesize and appraise the evidence on self-management informatics tool or platform for COPD. An evidence-based COPD self-management application will be developed and implemented to 35 COPD patients at identified hospitals of New Delhi using prospective non-randomized study. A mixed methods study will be conducted to evaluate the effectiveness of this informatics platform at selected hospitals of Delhi. Outcomes will be measured in terms of self-management for COPD related exacerbations, number of health care facility admissions for COPD and hospitalization days, adherence to the informatics platform, number of exacerbations requiring hospital visits, health related quality of life. Conclusion: The development and evaluation of home-based self-management of informatics platform for COPD would be an innovative strategy for the COPD patients in India.

Colorectal cancer (CRC) is a major clinical and public health burden. Screening has been shown to be effective in preventing CRC. In 2021, less than 72% of adult Americans had received CRC screening based on the most recent guidelines. This study examined the relationship between social support and screening colonoscopy or sigmoidoscopy uptake among U.S. adults and the socioeconomic factors that impact the relationship. We conducted a cross-sectional study using the 2021 National Health Interview Survey (NHIS) data for 20,008 U.S. adults to assess the weighted rates of screening colonoscopy or sigmoidoscopy among individuals with strong, some, and weak social support. Adjusted binary logistic regression models were utilized to obtain the weighted odds of receiving a screening colonoscopy or sigmoidoscopy among adults with different levels of social support and socioeconomic status. About 58.0% of adults who reported having colonoscopy or sigmoidoscopy had strong social support, compared to 52.0% who had some or weak social support. In addition, compared to adults with weak social support, the weighted adjusted odds of having colonoscopy or sigmoidoscopy were 1.0 (95% C.I. = 0.994, 0.997; p < 0.001) and 1.3 (95% C.I. = 1.260, 1.263; p < 0.001) for adults with some and strong social support, respectively. Socioeconomic differences were observed in the odds of colonoscopy or sigmoidoscopy uptake based on having strong social support. Having strong social support is an important factor in increasing colonoscopy or sigmoidoscopy screening uptake. Policies and interventions that enhance social support among adults for screening colonoscopy or sigmoidoscopy are warranted.

Wedelia chinensis is a folk medicine used in many Asian countries to treat various ailments. Earlier investigations reported that the petroleum ether extract of the plant has potential biological activity, but the compounds responsible for activity are not yet completely known. Therefore, the current work was designed to isolate and characterize the compounds from the petroleum ether extract and to study their bioactivities. Four compounds including two diterepenes (-) kaur-16α-hydroxy-19-oic acid (1) and (-) kaur-16-en-19-oic acid (2), and two steroids β-sitosterol (3), and cholesta-5,23-dien-3-ol (4) were isolated and characterized. Among the compounds, the diterpenes were found to have more biological activities than the steroidal compounds. Compound 1 showed the highest cytotoxicity with LC50 of 12.42 ± 0.87 μg/mL. Likewise, it possesses good antioxidant activity in terms of reducing power. On the contrary, compound 2 exerted the highest antiacetylcholinesterase and antibutyrylcholinesterase activity. Both the diterpenes showed almost similar antibacterial and antifungal activity. The identification of diterpenoid and steroid compounds with multifunctional activities suggests that W. chinensis may serve as an important source of bioactive compounds which should be further investigated in animal model for therapeutic potential in the treatment of different chronic diseases.

Enhydra fluctuans, a popular vegetable in Bangladesh, is used in folk medicine to treat diseases of the nervous system. The objective of this study was to investigate the phytochemical profile and cholinesterase inhibitory and antioxidant potential of the extracts of E. fluctuans. Among the four tested extracts, the chloroform extract was found to exert the highest inhibition against both the acetylcholinesterase and butyrylcholinesterase enzymes with the IC50 (concentration required for 50% inhibition) values of 83.90 μg/mL and 48.14 μg/mL, respectively. Likewise, the chloroform extract showed the highest radical scavenging activity and reducing power. In DPPH radical scavenging assay, the IC50 value was found to be 113.27 μg/mL, and in reducing power assay, the absorbance was found to be 1.916 at a concentration of 50 μg/mL. Phytochemical analyses revealed that the chloroform extract contained 19.16 mg gallic acid equivalent (GAE)/g extract of phenolics and 41.84 mg catechin equivalent (CE)/g extract of flavonoids, which appeared to be the highest among the extracts. A significant correlation was observed between phenolic content and butyrylcholinesterase inhibition and antioxidant activity, while a moderate correlation was seen between flavonoid content and cholinesterase inhibition and antioxidant activity. These findings suggest that E. fluctuans is a natural source of cholinesterase inhibitors and antioxidants, which could be utilized as functional foods for Alzheimer’s disease management.

Neurotoxicity is a serious health problem of patients chronically exposed to arsenic. There is no specific treatment of this problem. Oxidative stress has been implicated in the pathological process of neurotoxicity. Polyphenolics have proven antioxidant activity, thereby offering protection against oxidative stress. In this study, we have isolated the polyphenolics from Acacia nilotica and investigated its effect against arsenic-induced neurotoxicity and oxidative stress in mice. Acacia nilotica polyphenolics prepared from column chromatography of the crude methanol extract using diaion resin contained a phenolic content of 452.185 ± 7.879 mg gallic acid equivalent/gm of sample and flavonoid content of 200.075 ± 0.755 mg catechin equivalent/gm of sample. The polyphenolics exhibited potent antioxidant activity with respect to free radical scavenging ability, total antioxidant activity and inhibition of lipid peroxidation. Administration of arsenic in mice showed a reduction of acetylcholinesterase activity in the brain which was counteracted by Acacia nilotica polyphenolics. Similarly, elevation of lipid peroxidation and depletion of glutathione in the brain of mice was effectively restored to normal level by Acacia nilotica polyphenolics. Gallic acid methyl ester, catechin and catechin-7-gallate were identified in the polyphenolics as the major active compounds. These results suggest that Acacia nilotica polyphenolics due to its strong antioxidant potential might be effective in the management of arsenic induced neurotoxicity.

Introduction: During the COVID-19 pandemic, Indonesia faced shortages of medical supplies and healthcare workers. With a limited supply of healthcare workers, we examined the possibility of bringing final-year nursing students into COVID-19 patient care., Methods: We conducted a cross-sectional survey among final-year nursing students to assess their willingness and readiness to work with patients with COVID-19 in Indonesia. We recruited 1,028 final-year nursing students in East Java, Indonesia, during October 7-20, 2021. Data were collected using an online questionnaire designed for this study using Google Forms. Response data were extracted from Google Forms to MS Excel 2016 for analysis. We performed univariate analysis for descriptive statistics, followed by multivariate analysis using binary logistic regression to analyze the effect of independent variables on study outcomes., Results: The characteristics of the study participants showed that most respondents were female (97.1%) and of Javanese ethnicity (75.3%). More than 90% of participants reported no chronic diseases (96.2%) and were vaccinated (81.4%). Most participants were willing to work (84.3%) and ready to work (94.4%) with patients with COVID-19. Adjusted analysis showed that sex, type of institution, ethnicity, household condition, and history of chronic diseases were independent determinants of willingness to work with patients with COVID-19. Male and private university students were significantly more willing to work with patients with COVID-19., Conclusions: Nursing students were willing to work with patients with COVID-19 during the pandemic; however, a longitudinal study is recommended for trend analysis., (© 2023 The Authors.)

Background: Hepatocellular carcinoma (HCC) is one of the fastest growing causes of cancer-related death in the USA. Studies that investigated the impact of HCC therapeutic delays are limited to single centers, and no large-scale database research has been conducted. This study investigated the association of surgical delay and survival in HCC patients., Methods: Patients underwent local tumor destruction and hepatic resection for stages I-III HCC were identified from the 2004 to 2013 Commission on Cancer's National Cancer Database. Surgical delay was defined as > 60 days from the date of diagnosis to surgery. Generalized linear-mixed model assessed the demographic and clinical factors associated with delay, and frailty Cox proportional hazard analysis examined the prognostic factors for overall survival., Results: A total of 12,102 HCC patients met the eligibility criteria. Median wait time to surgery was 50 days (interquartile range, 29-86), and 4987 patients (41.2%) had surgical delay. Delayed patients demonstrated better 5-year survival for local tumor destruction (29.1 vs. 27.6%; P = .001) and resection (44.1 vs. 41.0%; P = .007). Risk-adjusted model indicated that delayed patients had a 7% decreased risk of death (HR, 0.93; 95% CI, 0.87-0.99; P = .027). Similar findings were also observed using other wait time cutoffs at 50, 70, 80, 90, and 100 days., Conclusions: A plausible explanation of this finding may be case prioritization, in which patients with more severe and advanced disease who were at higher risk of death received earlier surgery, while patients with less-aggressive tumors were operated on later and received more comprehensive preoperative evaluation.

Cancer health disparities may exist based on the facility type. We aimed to determine the association between the academic status of centers and outcomes of patients with acute myeloid leukemia (AML). Using the National Cancer Data Base, we compared 1-month mortality and long-term overall survival (OS) of 60 738 patients with AML, who received first course treatment between 2003 and 2011 at academic or nonacademic centers (community cancer program, comprehensive community cancer program, and others). Multivariate analysis was done using logistic regression for one-month mortality and Cox regression with backward elimination approach for OS. Patients treated at academic centers differed from those at nonacademic centers in that they were younger with a median age of 62 versus 70 years (P < .0001), more often an ethnic minority (P < .0001), had lower education level (P = .005), lower co-morbidity score (P < .0001), a different income (P < .0001), and insurance profile (P < .0001), and more often received chemotherapy (P < .0001) and transplant (P < .0001). Receipt of care at nonacademic centers was associated with worse 1-month mortality (29% vs. 16%, P < .0001) and 5-year OS (15% vs. 25%; P < .0001). After adjusting for prognostic covariates, the 1-month mortality (odds ratio, 1.52; 95% confidence interval, CI 1.46-1.59; P < .0001) and OS were significantly worse in nonacademic centers, compared to academic centers. Our large database study suggests that the receipt of initial therapy at academic centers is associated with lower 1-month mortality and higher long-term OS. Investigation of the underlying reasons may allow reducing this disparity., (© 2017 Wiley Periodicals, Inc.)

Introduction: Outcomes following surgery are better than following radiation therapy (RT), for stage I NSCLC. Whether this is due to selection of healthier patients for surgery is unclear. This study was undertaken to compare outcomes between surgical patients and patients who were surgical candidates but did not receive surgery., Methods: Data of patients with stage I NSCLC between 1988 and 2007, included in the SEER database were analyzed. Overall survival (OS) was examined by treatment type (surgery only, radiation only, surgery and radiation, and no treatment). OS was compared between RT patients who refused surgery and those not fit for surgery. Cox proportional hazards model was used to compare outcomes by treatment type., Results: Data from 8579 patients with stage I NSCLC during 1988-2007 were analyzed. Use of RT alone increased during the study period. An increasing proportion of patients with stage I lung cancer chose to have no treatment. On multivariate analysis, OS was better among patients who had surgery. There was a 56% improvement in survival among patients who had surgery compared to fit patients who refused surgery (HR 0.437, 95% CI 0.301-0.632). Patients who refused surgery had a better OS than those who were not fit for surgery (log-rank p = 0.01). Patients who received RT alone or no treatment had a significant improvement in five-year OS during the latter part of the study period (1998-2002 vs. 1988-1992)., Conclusions: In medically fit patients, outcomes following surgery are better than those following conventional radiation. Hence surgery should be chosen over conventional radiation, whenever possible. Outcomes following RT show an improvement over time reflecting improvement in radiation techniques., (Published by Elsevier Ireland Ltd.)

Objectives: The objectives of this study were to identify the risk factors for measles and low vaccination rates, to evaluate the performance of surveillance, and to calculate vaccine effectiveness and failure in Iraq for the years 2005 to 2010., Methods: Logistic regression was used on measles surveillance data from Iraq obtained during the period 1 January 2005 to 31 December 2010; adjusted odds ratios were calculated. The performance of surveillance was evaluated according to World Health Organization (WHO) guidelines., Results: Of 18,746 suspected cases, a measles diagnosis was made for 81.4%. Children aged 1-5 years were the most affected (>48%). The odds of measles were significantly higher in the central and southern provinces than in the northern provinces. Those vaccinated with at least one dose of measles-containing vaccine had a 3.7-times lower risk of contracting measles than those who were not vaccinated. Lower odds of vaccination were noted for adults aged 18 years and older and those living in central and southern provinces, as well as those living outside the capital city of a province. Three WHO performance indicators were lower than the recommended cut-off levels. A vaccine failure rate of 66.1% and effectiveness of 90.03% were estimated., Conclusions: Measles continues to be an important cause of morbidity in Iraq. Improvements in vaccine coverage, proper vaccine handling, and prompt reporting of suspected cases are all necessary to eliminate measles from Iraq., (Copyright © 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)