FABRICATION AND IN VITRO CHARACTERIZATION OF A NOVEL NANOSUSPENSION OF TELMISARTAN: A POORLY SOLUBLE DRUG PREPARED BY ANTISOLVENT PRECIPITATION TECHNIQUE USING 33 FACTORIAL DESIGN

Objective: The motivation behind the current examination was to build the solvency and dissolution rate of an antihypertensive drug telmisartan by the planning of nanosuspension by precipitation method at the research facility scale. We researched the nanoparticle manufacture of telmisartan employing a 33 factorial experimental configuration considering the impacts of nanosuspension on the physical, morphological, and dissolution properties of telmisartan. Methods: To get ready, nanosuspension particles of an ineffectively dissolvable drug are moreover of a drug solution to the anti-solvent leads to abrupt supersaturation and precipitation the making of nanoparticles. The nanosuspension particles of a poorly soluble drug loaded with urea and surfactants (sodium lauryl sulfate (SLS), poloxamer 188, Tween 80) have been prepared by a precipitation method. The nanosuspension particles were characterized for particle size, zeta potential, Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), in vitro drug release, and release kinetics. Results: The readily optimized batch nanosuspension particles evaluated and exhibited the particle size (750 nm), zeta potential (-24.33 mV), differential scanning calorimetry (DSC) drug exhibited a change in crystalline form to amorphous, in vitro dissolution (F12 was higher 95% within 5 min) and drug release kinetics. The formulation parameter of surfactant concentration is optimized. Conclusion: The formulation of the nanosuspension approach has been shown to substantial improvement in the dissolution rate, thereby enhancing the oral bioavailability with the future development of this technology

Survey of factors contributing to the happiness of older persons: A cross-sectional study of associated worries, anxiety, and depression

© 2023 Odisha Journal of Psychiatry. Published by Wolters Kluwer - Medknow. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://journals.lww.com/odjp/fulltext/2023/01000/survey_of_factors_contributing_to_the_happiness_of.4.aspxBACKGROUND: Old age is associated with a greater prevalence of worry, anxiety, and depression when compared to the younger age groups. Age-specific stressors and comorbidities accumulate and negatively impact the well-being of older adults. AIMS/OBJECTIVES: In this context, we intended to study the factors influencing the happiness of older adults. METHODS: It was a survey through a questionnaire of older adults attending a public health conference on old age-related issues. We inquired about what makes them happy, their worries, and physical and mental health issues. We also assessed their depression through the Patient Health Questionnaire (PHQ-9), anxiety through the General Anxiety Disorder 7 (GAD-7) scale, and quality of life (QoL) using a scale of 0 being worst to 10 being best. RESULTS: Factors that brought happiness to older adults were family and friends (25.7%), social activities (28.6%), traveling and sightseeing (11.4%), reading and writing (11.4%), meeting people (8.6%), and having time for self (8.6%). Besides these, 22.9% reported they enjoy working. A clinical level of anxiety (GAD-7 score of 10 or more) was present in 17.2% and depression (PHQ-9 score of 10 or more) in 28.6% of older adults. The anxiety and depression scores were positively correlated (P < 0.001) in the sample studied. There were no differences between genders related to concerns, health, finance, relationships, memory, needs for help, QoL, and severity of anxiety or depression. CONCLUSIONS: Older adults could identify various factors linked to their happiness, despite various concerns and mental health issues. The information might help family, informal, and professional caregivers to support activities that contribute to the well-being and happiness of older adults

Economic evaluation of participatory women's groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India

An estimated 2.4 million newborn infants died in 2020, 80% of them in sub-Saharan Africa and South Asia. To achieve the Sustainable Development Target for neonatal mortality reduction, countries with high mortality need to implement evidence-based, cost-effective interventions at scale. Our study aimed to estimate the cost, cost-effectiveness, and benefit-cost ratio of a participatory women's groups intervention scaled up by the public health system in Jharkhand, eastern India. The intervention was evaluated through a pragmatic cluster non-randomised controlled trial in six districts. We estimated the cost of the intervention at scale from a provider perspective, with a 42-month time horizon for 20 districts. We estimated costs using a combination of top-down and bottom-up approaches. All costs were adjusted for inflation, discounted at 3% per year, and converted to 2020 International Dollars (INT$). Incremental cost-effectiveness ratios (ICERs) were estimated using extrapolated effect sizes for the impact of the intervention in 20 districts, in terms of cost per neonatal deaths averted and cost per life year saved. We assessed the impact of uncertainty on results through one-way and probabilistic sensitivity analyses. We also estimated benefit-cost ratio using a benefit transfer approach. Total intervention costs for 20 districts were INT$ 15,017,396. The intervention covered an estimated 1.6 million livebirths across 20 districts, translating to INT$9.4 per livebirth covered. ICERs were estimated at INT$ 1,272 per neonatal death averted or INT$41 per life year saved. Net benefit estimates ranged from INT$ 1,046 million to INT$ 3,254 million, and benefit-cost ratios from 71 to 218. Our study suggests that participatory women's groups scaled up by the Indian public health system were highly cost-effective in improving neonatal survival and had a very favourable return on investment. The intervention can be scaled up in similar settings within India and other countries

Economic evaluation of participatory women's groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India

An estimated 2.4 million newborn infants died in 2020, 80% of them in sub-Saharan Africa and South Asia. To achieve the Sustainable Development Target for neonatal mortality reduction, countries with high mortality need to implement evidence-based, cost-effective interventions at scale. Our study aimed to estimate the cost, cost-effectiveness, and benefit-cost ratio of a participatory women's groups intervention scaled up by the public health system in Jharkhand, eastern India. The intervention was evaluated through a pragmatic cluster non-randomised controlled trial in six districts. We estimated the cost of the intervention at scale from a provider perspective, with a 42-month time horizon for 20 districts. We estimated costs using a combination of top-down and bottom-up approaches. All costs were adjusted for inflation, discounted at 3% per year, and converted to 2020 International Dollars (INT$). Incremental cost-effectiveness ratios (ICERs) were estimated using extrapolated effect sizes for the impact of the intervention in 20 districts, in terms of cost per neonatal deaths averted and cost per life year saved. We assessed the impact of uncertainty on results through one-way and probabilistic sensitivity analyses. We also estimated benefit-cost ratio using a benefit transfer approach. Total intervention costs for 20 districts were INT$ 15,017,396. The intervention covered an estimated 1.6 million livebirths across 20 districts, translating to INT$9.4 per livebirth covered. ICERs were estimated at INT$ 1,272 per neonatal death averted or INT$41 per life year saved. Net benefit estimates ranged from INT$ 1,046 million to INT$ 3,254 million, and benefit-cost ratios from 71 to 218. Our study suggests that participatory women's groups scaled up by the Indian public health system were highly cost-effective in improving neonatal survival and had a very favourable return on investment. The intervention can be scaled up in similar settings within India and other countries.</p

Eff ect of participatory women’s groups facilitated by Accredited Social Health Activists on birth outcomes in rural eastern India: a cluster-randomised controlled trial

Background A quarter of the world’s neonatal deaths and 15% of maternal deaths happen in India. Few community-based strategies to improve maternal and newborn health have been tested through the country’s government-approved Accredited Social Health Activists (ASHAs). We aimed to test the eff ect of participatory women’s groups facilitated by ASHAs on birth outcomes, including neonatal mortality. Methods In this cluster-randomised controlled trial of a community intervention to improve maternal and newborn health, we randomly assigned (1:1) geographical clusters in rural Jharkhand and Odisha, eastern India to intervention (participatory women’s groups) or control (no women’s groups). Study participants were women of reproductive age (15–49 years) who gave birth between Sept 1, 2009, and Dec 31, 2012. In the intervention group, ASHAs supported women’s groups through a participatory learning and action meeting cycle. Groups discussed and prioritised maternal and newborn health problems, identifi ed strategies to address them, implemented the strategies, and assessed their progress. We identifi ed births, stillbirths, and neonatal deaths, and interviewed mothers 6 weeks after delivery. The primary outcome was neonatal mortality over a 2 year follow up. Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN31567106. Findings Between September, 2009, and December, 2012, we randomly assigned 30 clusters (estimated population 156 519) to intervention (15 clusters, estimated population n=82 702) or control (15 clusters, n=73 817). During the follow-up period (Jan 1, 2011, to Dec 31, 2012), we identifi ed 3700 births in the intervention group and 3519 in the control group. One intervention cluster was lost to follow up. The neonatal mortality rate during this period was 30 per 1000 livebirths in the intervention group and 44 per 1000 livebirths in the control group (odds ratio [OR] 0.69, 95% CI 0·53–0·89). Interpretation ASHAs can successfully reduce neonatal mortality through participatory meetings with women’s groups. This is a scalable community-based approach to improving neonatal survival in rural, underserved areas of India

Exploring the Equity Impact of a Maternal and Newborn Health Intervention: A Qualitative Study of Participatory Women's Groups in Rural South Asia and Africa

A consensus is developing on interventions to improve newborn survival, but little is known about how to reduce socioeconomic inequalities in newborn mortality in low- and middle-income countries. Participatory learning and action (PLA) through women's groups can improve newborn survival and home care practices equitably across socioeconomic strata, as shown in cluster randomised controlled trials. We conducted a qualitative study to understand the mechanisms that led to the equitable impact of the PLA approach across socioeconomic strata in four trial sites in India, Nepal, Bangladesh, and Malawi

A prospective key informant surveillance system to measure maternal mortality – findings from indigenous populations in Jharkhand and Orissa, India

In places with poor vital registration, measurement of maternal mortality and monitoring the impact of interventions on maternal mortality is difficult and seldom undertaken. Mortality ratios are often estimated and policy decisions made without robust evidence. This paper presents a prospective key informant system to measure maternal mortality and the initial findings from the system

Economic evaluation of nutrition-sensitive agricultural interventions to increase maternal and child dietary diversity and nutritional status in rural Odisha, India

BACKGROUND: Economic evaluations of nutrition-sensitive agriculture (NSA) interventions are scarce, limiting assessment of their potential affordability and scalability. OBJECTIVE: We conducted cost-consequence analyses of three participatory video-based interventions of fortnightly women's group meetings using: 1) NSA videos; 2) NSA and nutrition-specific videos; or 3) NSA videos with a nutrition-specific Participatory Learning and Action (PLA) cycle. METHODS: Interventions were tested in a 32-month, four-arm cluster-randomized controlled trial, UPAVAN, in Keonjhar district, Odisha, India. Impacts were evaluated in children aged 0-23 months and their mothers. We estimated program costs using data collected prospectively from expenditure records of implementing and technical partners, and societal costs using expenditure assessment of households with a child aged 0-23 months and key informant interviews. Costs were adjusted for inflation, discounted, and converted to 2019 US${\$}$. RESULTS: Total program costs of each intervention ranged from US${\$}$272,121 to US${\$}$386,907. Program costs per pregnant woman or mother of a child aged 0-23 months were US${\$}$62 for NSA videos, US${\$}$84 for NSA and nutrition-specific videos, and US${\$}$78 for NSA videos with PLA (societal costs: US${\$}$125, US${\$}$143, and US${\$}$122 respectively). Substantial shares of total costs constituted developing and delivering the videos and PLA (52-69%) and quality assurance (25-41%). Relative to control, children's minimum dietary diversity was higher in the intervention incorporating nutrition-specific videos (adjusted relative risk [95% CI] 1.19 [1.03, 1.37]) and PLA (1.27 [1.11, 1.46]). Relative to control, mothers' minimum dietary diversity was higher in NSA video (1.21 [1.01, 1.45]), and NSA with PLA (1.30 [1.10, 1.53]) interventions. CONCLUSION: NSA videos with PLA can increase both maternal and child dietary diversity and has the lowest cost per unit increase in diet diversity. Building on investments made in developing UPAVAN, cost-efficiency at scale could be increased with less intensive monitoring, reduced start-up costs, and integration within existing government programs.Trial registration: ISRCTN65922679

The Equity Impact of Community Women's Groups to Reduce Neonatal Mortality: A Meta-analysis of Four Cluster Randomized Trials

Socioeconomic inequalities in neonatal mortality are substantial in many developing countries. Little is known about how to address this problem. Trials in Asia and Africa have shown strong impacts on neonatal mortality of a participatory learning and action intervention with women’s groups. Whether this intervention also reduces mortality inequalities remains unknown. We describe the equity impact of this women’s groups intervention on the neonatal mortality rate (NMR) across socioeconomic strata. We conducted a meta-analysis of all four participatory women’s group interventions that were shown to be highly effective in cluster randomized trials in India, Nepal, Bangladesh and Malawi. We estimated intervention effects on NMR and health behaviours for lower and higher socioeconomic strata using random effects logistic regression analysis. Differences in effect between strata were tested. Analysis of 69120 live births and 2505 neonatal deaths shows that the intervention strongly reduced the NMR in lower (50–63% reduction depending on the measure of socioeconomic position used) and higher (35–44%) socioeconomic strata. The intervention did not show evidence of ‘elite-capture’: among the most marginalized populations, the NMR in intervention areas was 63% lower [95% confidence interval (CI) 48–74%] than in control areas, compared with 35% (95% CI: 15–50%) lower among the less marginalized in the last trial year (P-value for difference between most/less marginalized: 0.009). The intervention strongly improved home care practices, with no systematic socioeconomic differences in effect. Participatory women’s groups with high population coverage benefit the survival chances of newborns from all socioeconomic strata, and perhaps especially those born into the most deprived households

Effect of participatory women's groups facilitated by Accredited Social Health Activists on birth outcomes in rural eastern India: A cluster-randomised controlled trial

Background: A quarter of the world's neonatal deaths and 15% of maternal deaths happen in India. Few community-based strategies to improve maternal and newborn health have been tested through the country's government-approved Accredited Social Health Activists (ASHAs). We aimed to test the effect of participatory women's groups facilitated by ASHAs on birth outcomes, including neonatal mortality. Methods: In this cluster-randomised controlled trial of a community interve