The City Initiative for Newborn Health

This article describes the critical first steps taken to revitalize the vast public health system of Mumbai City through the active participation of personnel from within the system. It focuses on one of two components of an ambitious action-research project aimed at improving the survival and health of newborn infants and mothers living in slum communities in Mumbai

Conflict, Crisis, and Abuse in Dharavi, Mumbai: Experiences from Six Years at a Centre for Vulnerable Women and Children

Nayreen Daruwalla and colleagues describe the Centre for Vulnerable Women and Children, which serves clients coping with crisis and violence in the urban setting of Dharavi, Mumbai

Cluster-randomised controlled trial of community mobilisation in Mumbai slums to improve care during pregnancy, delivery, postpartum and for the newborn

Background: The United Nations Millennium Development Goals look to substantial improvements in child and maternal survival. Morbidity and mortality during pregnancy, delivery and the postnatal period are prime obstacles to achieving these goals. Given the increasing importance of urban health to global prospects, Mumbai's City Initiative for Newborn Health aims to improve maternal and neonatal health in vulnerable urban slum communities, through a combination of health service quality improvement and community participation. The protocol describes a trial of community intervention aimed at improving prevention, care seeking and outcomes.Objective: To test an intervention that supports local women as facilitators in mobilising communities for better health care. Community women's groups will build an understanding of their potential to improve maternal and infant health, and develop and implement strategies to do so.Design: Cluster-randomized controlled trial.Methods: The intervention will employ local community-based female facilitators to convene groups and help them to explore maternal and neonatal health issues. Groups will meet fortnightly through a seven-phase process of sharing experiences, discussion of the issues raised, discovery of potential community strengths, building of a vision for action, design and implementation of community strategies, and evaluation.The unit of allocation will be an urban slum cluster of 1000-1500 households. 48 clusters have been randomly selected after stratification by ward. 24 clusters have been randomly allocated to receive the community intervention. 24 clusters will act as control groups, but will benefit from health service quality improvement. Indicators of effect will be measured through a surveillance system implemented by the project. Key distal outcome indicators will be neonatal mortality and maternal and neonatal morbidity. Key proximate outcome indicators will be home care practices, uptake of antenatal, delivery and postnatal care, and care for maternal and neonatal illness.Data will be collected through a vital registration system for births and deaths in the 48 study clusters. Structured interviews with families will be conducted at about 6 weeks after index deliveries. We will also collect both quantitative and qualitative data to support a process evaluation.Trial registration: Current controlled trials ISRCTN9625679

Cross-cultural Validation of the 5-Factor Structure of Negative Symptoms in Schizophrenia.

Objective: Negative symptoms are currently viewed as having a 2-dimensional structure, with factors reflecting diminished expression (EXP) and motivation and pleasure (MAP). However, several factor-analytic studies suggest that the consensus around a 2-dimensional model is premature. The current study investigated and cross-culturally validated the factorial structure of BNSS-rated negative symptoms across a range of cultures and languages. Method: Participants included individuals diagnosed with a psychotic disorder who had been rated on the Brief Negative Symptom Scale (BNSS) from 5 cross-cultural samples, with a total N = 1691. First, exploratory factor analysis was used to extract up to 6 factors from the data. Next, confirmatory factor analysis evaluated the fit of 5 models: (1) a 1-factor model, 2) a 2-factor model with factors of MAP and EXP, 3) a 3-factor model with inner world, external, and alogia factors; 4) a 5-factor model with separate factors for blunted affect, alogia, anhedonia, avolition, and asociality, and 5) a hierarchical model with 2 second-order factors reflecting EXP and MAP, as well as 5 first-order factors reflecting the 5 aforementioned domains. Results: Models with 4 factors or less were mediocre fits to the data. The 5-factor, 6-factor, and the hierarchical second-order 5-factor models provided excellent fit with an edge to the 5-factor model. The 5-factor structure demonstrated invariance across study samples. Conclusions: Findings support the validity of the 5-factor structure of BNSS-rated negative symptoms across diverse cultures and languages. These findings have important implications for the diagnosis, assessment, and treatment of negative symptoms

Editorial - Publication and Promotion: Call for Breaking the Link

If I may take the liberty of rephrasing Shakespeare's words, `The spoken word is often buried with one's bones - it is the written word that lives long after'. This is particularly true in the field of academic medicine where a person's progress is mainly judged by the number of papers he has published. The key words here are `number of publications'. Very little if any emphasis is laid on the quality of these publications and on whether they have contributed in any way to the advancement of scientific knowledge

Editorial - Publication and Promotion: Call for Breaking the Link

If I may take the liberty of rephrasing Shakespeare's words, `The spoken word is often buried with one's bones - it is the written word that lives long after'. This is particularly true in the field of academic medicine where a person's progress is mainly judged by the number of papers he has published. The key words here are `number of publications'. Very little if any emphasis is laid on the quality of these publications and on whether they have contributed in any way to the advancement of scientific knowledge

Causes of Neonatal Mortality in India (Adapted from [1])

<p>Causes of Neonatal Mortality in India (Adapted from [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030339#pmed-0030339-b001" target="_blank">1</a>])</p

Magnitude of Urban Poverty Worldwide

<div><p>(Data sources: [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030339#pmed-0030339-b014" target="_blank">14</a>,<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030339#pmed-0030339-b015" target="_blank">15</a>])</p> <p>The unit for the y axis is millions.</p> <p>Popn, population; UN, United Nations.</p></div