Enhancing care for urban poor living with chronic conditions : role of local health systems

Five-year research in a poor urban neighborhood in South India reveals a high burden of chronic conditions where the majority rely on private health facilities for care. Poverty hinders people from accessing health services and those who seek care get further impoverished. Socially defined roles and positions limit women and elderly in managing care. Fragmented services imply patients having to visit more than one facility for a single episode of care. The limited use of medical records and lack of referral systems hinder continuity of care. Poor regulation of the private sector, lack of platforms for community engagement and corruption mark ineffective governance of the mixed local health system. The government sector fails to provide adequate care, whereas the private sector strives to maximize profits. Care for the poor is at best seen as charity. Our study unravels the complex nature of the local health system wherein implementing positive change requires careful consideration of local dynamics and opportunities

Moral Rationalism and Independent rationality as a source of Sharī ͑a in Shī ͑ī uṣūl al-fiqh; In search of an ͑Adliyya reading of Sharī ͑a

Within Shī ͑ī works of Sharī ͑a legal theory (uṣūl al-fiqh) there is a theoretical space for reason as an independent source of normativity alongside the Qur’ān and the Prophetic tradition. This space stems from a meta-ethical moral rationalism considered fundamental to Shī ͑ī theology. The position holds that unmediated reason is capable of understanding the morally praiseworthy and the morally blameworthy independently of revelation. Describing themselves as ͑Adliyya (literally the people of Justice) this meta-ethical position allows the Shī ͑a to attribute a substantive rational conception of justice to God, both in terms of His actions and His regulative instructions (aḥkām). Despite the Shīʿī adoption of this meta-ethical position, and the jurisprudential space held for independent rationality that implies rational morality must be a condition for the validity of any Sharī ͑a precept attributed to a Just God, independent judgements of rational morality play little or no role in the actual inference of Sharī ͑a norms within mainstream contemporary Shī ͑ī thought. As part of a search for an ʿAdliyya reading of Sharī ͑a, this study examines the theoretical reason for why this moral rationalism plays no substantive role in the actual inference of Sharī ͑a precpets through a close examination of the notion of independent rationality as a source in modern Shī ͑ī uṣūl al-fiqh. The obstacles preventing the ͑Adliyya moral rationalism from impacting the reading of fiqh in modern Shī ͑ī thought are shown to be purely epistemic. In line with the ‘emic’ approach adopted through the study, these epistemic obstcales are revistsed with the view of identifying scope for allowing a reading of Sharī ͑a that is consistent with the fundamental theological moral rationalism of Shī ͑ī thought. It is argued that judgements of rational morality, even when not definitively certain, can not be ignored in the face of the apparent meaning of texts that are themselves also not certain. A move towards an ͑Adliyya reading of Sharī ͑a demands that the strength of independent rational evidences be reconciled against the strength of any other apparently conflicting evidences such that independent judgements of rational morality act as a substantive condition for the validity of precpets attributed to a Just and moral God

An Integrated Approach for Jammer Detection using Software Defined Radio

AbstractDue to shared nature of wireless communication any malicious user can easily monitored communication between two devices and emits false message to block communication. Nowadays increased use of software defined radio (SDR) technology makes any types of jammer device using same hardware with little modification in software. A jammer transmits radio signal to block legitimate communication either overlapping signal with more power or reducing signal to noise ratio. In this paper we have survey different jammer detection methods for efficient detection of jammers presence in system. Existing jammer detection methods like packet delivery ratio (PDR), packet send ratio (PSR), bad packet ratio (BPR) and signal to noise ratio (SNR) can effectively detects jammer, here we have proposed novel method for jammer detection using communication parameter used in SDR like synchronization indicator, iteration and adaptive signal to jammer plus noise ratio (ASNJR). This system uses that parameter which is readily available in system so computation has been reduced and ASNJR also has been adaptively updated with and without presence of jammer. Experimental result show that this system based on SDR effectively detects presence of jammer

Preoperative Bladder Urine Culture as a Predictor of Intraoperative Stone Culture Results: Clinical Implications and Relationship to Stone Composition

Purpose We examine the relationship between urine and stone cultures in a large cohort of patients undergoing percutaneous stone removal and compare the findings in infectious vs metabolic calculi. Materials and Methods A total of 776 patients treated with percutaneous nephrolithotomy who had preoperative urine cultures and intraoperative stone cultures were included in the study. Statistical analysis used chi-square or logistic fit analysis as appropriate. Results Preoperative urine culture was positive in 352 patients (45.4%) and stone cultures were positive in 300 patients (38.7%). There were 75 patients (9.7%) with negative preoperative cultures who had positive stone cultures, and in patients with both cultures positive the organisms differed in 103 (13.3%). Gram-positive organisms predominated in preoperative urine and stone cultures. Conclusions Preoperative urine cultures in patients undergoing percutaneous nephrolithotomy are unreliable as there is a discordance with intraoperative stone cultures in almost a quarter of cases. There has been a notable shift toward gram-positive organisms in this cohort of patients

Religious Authority beyond Domination and Discipline: Epistemic Authority and Its Vernacular Uses in the Shi‘i Diaspora

“Religious authority” remains a ubiquitous but controversial term of comparative analysis. In Islamic studies, authority is generally personified in the form of the ulama and most often viewed through Weber’s lens of charismatic, legal-rational, and traditional types of legitimate domination. Our particular interest, Twelver Shi‘i Islam, seems a paradigmatic case, where the relationship between “the Ayatollahs” and state power has dominated academic discussion since Khomeini. Through ethnography of a Shi‘i diaspora community in the UK, we argue for a radical shift in perspective: away from forms of clerical power and towards non-specialist uses of clerical authority as expert opinion. Far from such “epistemic” authority being opposed to ordinary agency, here they are inextricably linked. Inspirational work in the anthropology of Islam has understood ordinary Muslim experiences of authority in non-liberal ways, as (Foucauldian) ethical discipline and self-care. We maintain the need to transcend not only domination but discipline too, refocusing the comparison between (Shi‘i) Islamic legal and liberal thought, in the form of Raz’s classic “service conception” of authority. Both stress the rationality of following authoritative opinion and its role as reason and justification for individual action. Our ethnography of ordinary practice then shows the sheer diversity of ways that such epistemic authority can be taken up, including, but not limited to, projects of personal piety and adversarial community politics. In our context, as surely also in others, domination and discipline should thus be seen as potential uses of “religious” epistemic authority, rather than as its privileged form

Special considerations for vitamin D in the South Asian population in the UK

The human requirement for vitamin D is achieved primarily through the synthesis of this pre-hormone in the skin during exposure to UVB radiation, with only a minor contribution from the diet year-round. Achieving optimal vitamin D status is therefore largely dependent upon adequate exposure of the skin to sunlight, however the length of exposure required varies with latitude and season, and is also dependent upon skin pigmentation with darker skin requiring greater exposure than fair skin due to the protective effects of melanin against ultraviolet B (UVB) radiation. In northern European latitudes, where UVB radiation between the months of October and March is of insufficient intensity for the synthesis of vitamin D via this route, vitamin D deficiency is a public health concern, particularly for South Asian diaspora and other dark skinned ethnic minority communities. The consequences of vitamin D deficiency include poor bone health, including rickets and osteomalacia. In addition there is increasing awareness of an important role for vitamin D in the development and progression of chronic diseases including type 2 diabetes which is prevalent in South Asian populations. The aim of this review is to examine some of the most recent reports of vitamin D status in South Asian diaspora communities, and to explore its impact on bone health. In addition, we will examine the putative association between type 2 diabetes and vitamin D deficiency in South Asian populations and the current guidelines for treatment of vitamin D deficiency of South Asians in primary care settings

No longer diseases of the wealthy : prevalence and health-seeking for self-reported chronic conditions among urban poor in Southern India

Background: The burden of chronic conditions is high in low-and middle-income countries and poses a significant challenge to already weak healthcare delivery systems in these countries. Studies investigating chronic conditions among the urban poor remain few and focused on specific chronic conditions rather than providing overall profile of chronic conditions in a given community, which is critical for planning and managing services within local health systems. We aimed to assess the prevalence and health-seeking behaviour for self-reported chronic conditions in a poor neighbourhood of a metropolitan city in India. Methods: We conducted a house-to-house survey covering 9299 households (44514 individuals) using a structured questionnaire. We relied on self-report by respondents to assess presence of any chronic conditions, including diabetes and hypertension. Multivariable logistic regression was used to analyse the prevalence and health-seeking behaviour for self-reported chronic conditions in general as well as for diabetes and hypertension in particular. The predictor variables included age, sex, income, religion, household poverty status, presence of comorbid chronic conditions, and tiers in the local health care system. Results: Overall, the prevalence of self-reported chronic conditions was 13.8% (95% CI = 13.4, 14.2) among adults, with hypertension (10%) and diabetes (6.4%) being the most commonly reported conditions. Older people and women were more likely to report chronic conditions. We found reversal of socioeconomic gradient with people living below the poverty line at significantly greater odds of reporting chronic conditions than people living above the poverty line (OR = 3, 95% CI = 1.5, 5.8). Private healthcare providers managed over 80% of patients. A majority of patients were managed at the clinic/health centre level (42.9%), followed by the referral hospital (38.9%) and the super-specialty hospital (18.2%) level. An increase in income was positively associated with the use of private facilities. However, elderly people, people below the poverty line, and those seeking care from hospitals were more likely to use government services. Conclusions: Our findings provide further evidence of the urgent need to improve care for chronic conditions for urban poor, with a preferential focus on improving service delivery in government health facilities

Constraints faced by urban poor in managing diabetes care: patients' perspectives from South India

Background: Four out of five adults with diabetes live in low- and middle-income countries (LMIC). India has the second highest number of diabetes patients in the world. Despite a huge burden, diabetes care remains suboptimal. While patients (and families) play an important role in managing chronic conditions, there is a dearth of studies in LMIC and virtually none in India capturing perspectives and experiences of patients in regard to diabetes care. Objective: The objective of this study was to better understand constraints faced by patients from urban slums in managing care for type 2 diabetes in India. Design: We conducted in-depth interviews, using a phenomenological approach, with 16 type 2- diabetes patients from a poor urban neighbourhood in South India. These patients were selected with the help of four community health workers (CHWs) and were interviewed by two trained researchers exploring patients’ experiences of living with and seeking care for diabetes. The sampling followed the principle of saturation. Data were initially coded using the NVivo software. Emerging themes were periodically discussed among the researchers and were refined over time through an iterative process using a mind-mapping tool. Results: Despite an abundance of healthcare facilities in the vicinity, diabetes patients faced several constraints in accessing healthcare such as financial hardship, negative attitudes and inadequate communication by healthcare providers and a fragmented healthcare service system offering inadequate care. Strongly defined gender-based family roles disadvantaged women by restricting their mobility and autonomy to access healthcare. The prevailing nuclear family structure and inter-generational conflicts limited support and care for elderly adults. Conclusions: There is a need to strengthen primary care services with a special focus on improving the availability and integration of health services for diabetes at the community level, enhancing patient centredness and continuity in delivery of care. Our findings also point to the need to provide social services in conjunction with health services aiming at improving status of women and elderly in families and society