"There Is No Link Between Resource Allocation and Use of Local Data": A Qualitative Study of District-Based Health Decision-Making in West Bengal, India.

BACKGROUND: Effective coordination among multiple departments, including data-sharing, is needed for sound decision-making for health services. India has a district planning process involving departments for local resource-allocation based on shared data. This study assesses the decision-making process at the district level, with a focus on the extent of local data-use for resource allocation for maternal and child health. METHODS: Direct observations of key decision-making meetings and qualitative interviews with key informants were conducted in two districts in the State of West Bengal, India. Content analysis of the data maintained within the district health system was done to understand the types of data available and sharing mechanisms. This information was triangulated thematically based on WHO health system blocks. RESULTS: There was no structured decision-making process and only limited inter-departmental data-sharing. Data on all 21 issues discussed in the district decision-making meetings observed were available within the information systems. Yet indicators for only nine issues-such as institutional delivery and immunisation services were discussed. Discussions about infrastructure and supplies were not supported by data, and planning targets were not linked to health outcomes. CONCLUSION: Existing local data is highly under-used for decision-making at the district level. There is strong potential for better interaction between departments and better use of data for priority-setting, planning and follow-up

Systematic Review of Physical Activity, Sedentary Behaviour and Sleep Among Adults Living with Chronic Respiratory Disease in Low- and Middle-Income Countries.

ABSTRACT: Physical activity (PA), sedentary behaviour (SB) and sleep are important lifestyle behaviours associated with chronic respiratory disease (CRD) morbidity and mortality. These behaviours need to be understood in low- and middle-income countries (LMIC) to develop appropriate interventions. PURPOSE: Where and how have free-living PA, SB and sleep data been collected for adults living with CRD in LMIC? What are the free-living PA, SB and sleep levels of adults living with CRD? PATIENTS AND METHODS: The literature on free-living PA, SB and sleep of people living with CRD in LMIC was systematically reviewed in five relevant scientific databases. The review included empirical studies conducted in LMIC, reported in any language. Reviewers screened the articles and extracted data on prevalence, levels and measurement approach of PA, SB and sleep using a standardised form. Quality of reporting was assessed using bespoke criteria. RESULTS: Of 89 articles, most were conducted in Brazil (n=43). PA was the commonest behaviour measured (n=66). Questionnaires (n=52) were more commonly used to measure physical behaviours than device-based (n=37) methods. International Physical Activity Questionnaire was the commonest for measuring PA/SB (n=11). For sleep, most studies used Pittsburgh Sleep Quality Index (n=18). The most common ways of reporting were steps per day (n=21), energy expenditure (n=21), sedentary time (n=16), standing time (n=13), sitting time (n=11), lying time (n=10) and overall sleep quality (n=32). Studies revealed low PA levels [steps per day (range 2669–7490steps/day)], sedentary lifestyles [sitting time (range 283–418min/day); standing time (range 139–270min/day); lying time (range 76–119min/day)] and poor sleep quality (range 33–100%) among adults with CRD in LMIC. CONCLUSION: Data support low PA levels, sedentary lifestyles and poor sleep among people in LMIC living with CRDs. More studies are needed in more diverse populations and would benefit from a harmonised approach to data collection for international comparisons

Scenario of adolescent sexual and reproductive health with opportunities for information communication and technology use in selected South Asian countries

This article was published in Health Science Journal [© 2015 Technological Educational Institute of Athens] and the definite version is available at: https://goo.gl/9bTTyZIntroduction: Regardless of being involved in early sexual activity, significant number of South Asian adolescents gets restricted in making informed decisions on sexual and reproductive practices due to diverse seclusion norms. Since adolescents have been identified as the earliest users of new technologies like mobile phones, computers and the Internet, these tools can be harnessed to deliver sexuality education to overcome the trajectory of engaging in risky sexual behavior. Regardless of numerous efforts, Information and communication technology (ICTs) in response to the health concerns still a challenge. Aim: A systematic review was conducted to ascertain and describe the scenario and ICT use opportunities in Adolescent Sexual and Reproductive Health program information. Methodology: Peer-reviewed published studies, government and non-government documents, and survey reports between 1990 and 2013 on adolescent sexual and reproductive health in the selected South Asian countries were systematically reviewed right from their formation till latest amendment. Eligibility criteria were literature published in English, targeting male and female adolescents, aged 10-19 years irrespective of their marital status. Results: In depth review of 86 publicly available documents comprising policy papers and guidelines of selected countries along with journal articles, survey reports found 27 documents matching our selection criteria. All such documents were assessed and relevant information was extracted by research team. In contrast to the general population, data on adolescent access to and use of ICT in practicing sexual and reproductive health services are minimal, and criteria and definitions that would aid data analysis and comparison across countries are lacking. Conclusion: ICT platforms should be applied to scale-up policies and programmes that promote the sexual and reproductive health of adolescents due to their low cost, increased access to remote populations, better efficiency and improved flexibility for programming.Publishe

India's policy and programmatic response to mental health of young people: A narrative review

India's response to meet the mental health needs of 252 million young people between 15 and 24 years is guided by the Mental Healthcare Act 2017 (MHCA), which advocates a rights-based approach to receiving mental healthcare, the National Mental Health Policy 2014, and the National Mental Health Program operational since 1982. We undertook a comprehensive narrative review of policies, programs, and legislations across five ministries of the Government of India—Health and Family Welfare, Education, Women and Child Development, Youth Affairs and Sports, and Social Justice and Empowerment—over the last ten years to map their approach and identify enablers and barriers for promoting youth mental health in India. Our work builds on the previous reviews on children and adolescents’ mental health in India and captures the rapidly advancing policy landscape amidst the new challenges and opportunities presented by the COVID-19 pandemic, especially the increasing acceptability of digital health interventions including tele-consultations. We note that all the five ministries recognized mental health as an important aspect of overall development and well-being of young people. However, their approach is fragmented and a comprehensive approach to youth mental health is missing in the Indian context. Having said that, many enablers for integration of preventive, promotive, and curative mental health interventions exist especially as mental health is increasingly being recognized as an integral part of the comprehensive primary healthcare. However, much needs to be done in terms of strategic planning for screening, early detection and treatment, and developing strong referral systems between community, schools and mental healthcare services. Effective implementation of MHCA, sustainable intersectoral integration of mental health across youth-oriented services, empowerment of young people, and judicious use of digital technology hold the key to reimagining the approach to advance young people's mental health in India

Extraction of rutin from tagetes erecta (Marigold) and preparation of peroral nano-suspension for effective antitussive/expectorant therapy

The present study narrates the extraction of rutin from Tagetes erecta (Marigold) via maceration followed by ultrasonication. The extracted rutin was further fabricated into nanoparticles by high-pressure homogenization (HPH) and assessed by HPLC, DSC, XRD, TEM, and FTIR spectroscopy. The optimized batch of nanoparticles obtained using 32 central composite design (CCD) which exhibited particle size 209±14 nm, PDI 0.234±0.06, and 92±1.3% entrapment efficiency. The lyophilized rutin nanoparticles were further converted into nano-suspension. Interestingly, the rutin nano-suspension exhibited a similar antitussive effect in vivo as that by standard treatment pentoxyverine and reduced the coughing times within 2 min. Also, the phlegm showed high UV absorbance, implying its better expectorant activity than the standard and control. The rutin nano-suspension was highly stable and shelf life was found to be ∼29.1 months. The present study, for the first time, paves a way for the use of rutin nano-suspension to overcome chest congestion, shortening of breath, and in the management of cough

Heart rate variability during head‐up tilt shows inter‐individual differences among healthy individuals of extreme Prakriti types

Abstract Autonomic modulation is critical during various physiological activities, including orthostatic stimuli and primarily evaluated by heart rate variability (HRV). Orthostatic stress affects people differently suggesting the possibility of identification of predisposed groups to autonomic dysfunction‐related disorders in a healthy state. One way to understand this kind of variability is by using Ayurvedic approach that classifies healthy individuals into Prakriti types based on clinical phenotypes. To this end, we explored the differential response to orthostatic stress in different Prakriti types using HRV. HRV was measured in 379 subjects(Vata = 97, Pitta = 68, Kapha = 68, and Mixed Prakriti = 146) from two geographical regions(Vadu and Delhi NCR) for 5 min supine (baseline), 3 min head‐up‐tilt (HUT) at 60°, and 5 min resupine. We observed that Kapha group had lower baseline HRV than other two groups, although not statistically significant. The relative change (%Δ1&2) in various HRV parameters in response to HUT was although minimal in Kapha group. Kapha also had significantly lower change in HR, LF (nu), HF (nu), and LF/HF than Pitta in response to HUT. The relative change (%Δ1) in HR and parasympathetic parameters (RMSSD, HF, SD1) was significantly greater in the Vata than in the Kapha. Thus, the low baseline and lower response to HUT in Kapha and the maximum drop in parasympathetic activity of Vata may indicate a predisposition to early autonomic dysfunction and associated conditions. It emphasizes the critical role of Prakriti‐based phenotyping in stratifying the differential responses of cardiac autonomic modulation in various postures among healthy individuals across different populations

Whole Exome Sequencing in Healthy Individuals of Extreme Constitution Types Reveals Differential Disease Risk: A Novel Approach towards Predictive Medicine

Precision medicine aims to move from traditional reactive medicine to a system where risk groups can be identified before the disease occurs. However, phenotypic heterogeneity amongst the diseased and healthy poses a major challenge for identification markers for risk stratification and early actionable interventions. In Ayurveda, individuals are phenotypically stratified into seven constitution types based on multisystem phenotypes termed “Prakriti”. It enables the prediction of health and disease trajectories and the selection of health interventions. We hypothesize that exome sequencing in healthy individuals of phenotypically homogeneous Prakriti types might enable the identification of functional variations associated with the constitution types. Exomes of 144 healthy Prakriti stratified individuals and controls from two genetically homogeneous cohorts (north and western India) revealed differential risk for diseases/traits like metabolic disorders, liver diseases, and body and hematological measurements amongst healthy individuals. These SNPs differ significantly from the Indo-European background control as well. Amongst these we highlight novel SNPs rs304447 (IFIT5) and rs941590 (SERPINA10) that could explain differential trajectories for immune response, bleeding or thrombosis. Our method demonstrates the requirement of a relatively smaller sample size for a well powered study. This study highlights the potential of integrating a unique phenotyping approach for the identification of predictive markers and the at-risk population amongst the healthy

Feature Selection.

<p>Venn diagram shows the overlap of features selected through LASSO, elastic net and random forests modelling. 31 variables were common between all the three methods.</p

Recapitulation of Ayurveda constitution types by machine learning of phenotypic traits

<div><p>In Ayurveda system of medicine individuals are classified into seven constitution types, “<i>Prakriti</i>”, for assessing disease susceptibility and drug responsiveness. <i>Prakriti</i> evaluation involves clinical examination including questions about physiological and behavioural traits. A need was felt to develop models for accurately predicting <i>Prakriti</i> classes that have been shown to exhibit molecular differences. The present study was carried out on data of phenotypic attributes in 147 healthy individuals of three extreme <i>Prakriti types</i>, from a genetically homogeneous population of Western India. Unsupervised and supervised machine learning approaches were used to infer inherent structure of the data, and for feature selection and building classification models for <i>Prakriti</i> respectively. These models were validated in a North Indian population. Unsupervised clustering led to emergence of three natural clusters corresponding to three extreme <i>Prakriti</i> classes. The supervised modelling approaches could classify individuals, with distinct <i>Prakriti</i> types, in the training and validation sets. This study is the first to demonstrate that <i>Prakriti</i> types are distinct verifiable clusters within a multidimensional space of multiple interrelated phenotypic traits. It also provides a computational framework for predicting <i>Prakriti</i> classes from phenotypic attributes. This approach may be useful in precision medicine for stratification of endophenotypes in healthy and diseased populations.</p></div