Challenges and measures to improve interviewers’ bias in large-scale demographic surveys in India: Some suggestions based on analysis of NFHS-4 data

With increasing demand for more data at local level, the health surveys have expanded both their coverage and areas of inquiry. To cater to this demand, the sample size in National Family Health Surveys (NFHS) increased significantly and thereby raised concerns regarding quality. The present paper attempts to investigate the presence of interviewers\u27 bias in the birth history data in 4th round of NFHS in four states—Haryana, Odisha, Tamil Nadu and Maharashtra. The paper suggests a practical procedure that can be used to promote judicious supervision to minimize the non-sampling errors in future rounds of NFHS or other large-scale demographic surveys. Findings show that the outlier-based approach adopted in the paper helps in detecting the presence of interviewers’ bias in the enumeration of total children ever born as well as those born during 5 years prior to the survey – two critical variables in demographic surveys. Among the four study states, the extent of the bias was highest in Tamil Nadu. In fact, in Haryana, the data was found to be free of any bias in the recording of the occurrence of births in 5 years preceding the survey. It is suggested that it should be feasible to employ the outlier-based approach early when fieldwork is in progress, along with usual practice of generating field check tables. This approach would have the potential to not only streamline the supervision but also help salvage the data from any biasing effects. The biasing effects, if any and found early during fieldwork can be rectified by suitably arranging the necessary revisits to the respondents

Is contraceptive prevalence declining in India? An appraisal based on NFHS-4

This study investigates the quality of the National Family Health Survey-4 data on contraceptive use by estimating investigator-induced bias. An outlier-bound approach was used to detect investigator bias, and contraceptive use was re-estimated adjusting for the bias in six study states. The findings suggest investigator bias at two levels: over-reporting of women as “never users” of contraception and a tendency to report sterilised women as current non-users and as cases of hysterectomy. Re-estimation of contraceptive use confirmed a declining trend in contraceptive prevalence in four study states. While the effect of the bias was moderate at the state level, it can potentially distort district-level estimates to a great extent

Do current measurement approaches underestimate levels of unwanted childbearing? Evidence from rural India

The validity of estimates of unintended childbearing has often been questioned, especially given their almost exclusive reliance on responses to survey questions that ask women to recall their intentions about past pregnancies. An opportunity to compare prospective and retrospective descriptions of intendedness was provided by a follow-up survey in four Indian states in 2002-2003 of rural woman originally interviewed in the 1998-99 National Family Health Survey-2. The results demonstrate a pronounced tendency for births prospectively classified as unwanted to be retrospectively described as having been wanted or mistimed. The main reason seems to be either that mothers adapt to the reality of a new birth or are reluctant to describe an existing child as having initially been unwanted. Our findings suggest that retrospective accounts of the wantedness of a birth, such as those obtained by current Demographic and Health Surveys, may lead to significant underestimates of true levels of unwanted childbearing

Domestic violence, contraceptive use, and unwanted pregnancy in rural India

This study examines the relationship between male-to-female physical domestic violence and unwanted pregnancy among women in three economically and culturally diverse areas of India. A central methodological focus of the study is the examination of retrospective and prospective measures of pregnancy unwantedness, contrasting their usefulness for specifying levels of unwanted pregnancy and its relationship with domestic violence. Data from India\u27s 1998-99 National Family Health Survey and a 2002-03 follow-up survey for which women in four states were reinterviewed are analyzed, and the factors associated with the intersurvey adoption of contraception and the experience of an unwanted pregnancy are examined. Women who experience physical violence from their husbands are significantly less likely to adopt contraception and more likely to experience an unwanted pregnancy. A prospectively measured indicator of unwanted pregnancy identifies a higher prevalence of unwanted pregnancies than do the traditionally employed retrospective measures and is more successful in establishing a relationship between unwanted pregnancies and domestic violence. The results demonstrate a clear relationship between a woman\u27s experience of physical violence from her husband and her ability to achieve her fertility intentions. The need to improve the measurement of pregnancy intendedness is clear, and a move toward using prospective measures as the standard is necessary

COVID-19 and gut immunomodulation

The disease coronavirus disease 2019 (COVID-19) is a severe respiratory illness that has emerged as a devastating health problem worldwide. The disease outcome is heterogeneous, and severity is likely dependent on the immunity of infected individuals and comorbidities. Although symptoms of the disease are primarily associated with respiratory problems, additional infection or failure of other vital organs are being reported. Emerging reports suggest a quite common co-existence of gastrointestinal (GI) tract symptoms in addition to respiratory symptoms in many COVID-19 patients, and some patients show just the GI symptoms. The possible cause of the GI symptoms could be due to direct infection of the epithelial cells of the gut, which is supported by the fact that (1) The intestinal epithelium expresses a high level of angiotensin-converting enzyme-2 and transmembrane protease serine 2 protein that are required for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry into the cells; (2) About half of the severe COVID-19 patients show viral RNA in their feces and various parts of the GI tract; and (3) SARS-CoV-2 can directly infect gut epithelial cells in vitro (gut epithelial cells and organoids) and in vivo (rhesus monkey). The GI tract seems to be a site of active innate and adaptive immune responses to SARS-CoV-2 as clinically, stool samples of COVID-19 patients possess proinflammatory cytokines (interleukin 8), calprotectin (neutrophils activity), and immunoglobulin A antibodies. In addition to direct immune activation by the virus, impairment of GI epithelium integrity can evoke immune response under the influence of systemic cytokines, hypoxia, and changes in gut microbiota (dysbiosis) due to infection of the respiratory system, which is confirmed by the observation that not all of the GI symptomatic patients are viral RNA positive. This review comprehensively summarizes the possible GI immunomodulation by SARS-CoV-2 that could lead to GI symptoms, their association with disease severity, and potential therapeutic interventions

CRISPR-Cas9 : a promising genome editing therapeutic tool for Alzheimer’s disease : a narrative review

Alzheimer’s disease (AD) is a chronic and irreversible neurodegenerative disorder characterized by cognitive deficiency and development of amyloid-β (Aβ) plaques and neurofibrillary tangles, comprising hyperphosphorylated tau. The number of patients with AD is alarmingly increasing worldwide; currently, at least 50 million people are thought to be living with AD. The mutations or alterations in amyloid-β precursor protein (APP), presenilin-1 (PSEN1), or presenilin-2 (PSEN2) genes are known to be associated with the pathophysiology of AD. Effective medication for AD is still elusive and many gene-targeted clinical trials have failed to meet the expected efficiency standards. The genome editing tool clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9 has been emerging as a powerful technology to correct anomalous genetic functions and is now widely applied to the study of AD. This simple yet powerful tool for editing genes showed the huge potential to correct the unwanted mutations in AD-associated genes such as APP, PSEN1, and PSEN2. So, it has opened a new door for the development of empirical AD models, diagnostic approaches, and therapeutic lines in studying the complexity of the nervous system ranging from different cell types (in vitro) to animals (in vivo). This review was undertaken to study the related mechanisms and likely applications of CRISPR-Cas9 as an effective therapeutic tool in treating AD

Hot and malignant – a case of invasive papillary carcinoma in hyperthyroid patient with hot nodules

Introduction: Malignant thyroid nodules are clinically euthyroid and appear as cold nodules on scintigraphy. Malignancy in hyper-functioning thyroid nodule is rare. Case report: A 48-year-old male with painless swelling on the right side of his neck for the last 4 months complained of feeling hot all the time, sweating and unintentionally losing about 20 pounds. On physical examination, there was a 3-cm mobile, non-tender mass on the right supra-clavicular area biopsy of which was consistent with metastatic papillary carcinoma of thyroid. Neck imaging showed a cystic mass in the right supra-clavicular fossa region, bilateral neck adenopathy and multiple thyroid nodules. Subsequent thyroid radionuclide scans showed three hyper-functioning nodules, which were later demonstrated to be a follicular variant of papillary microcarcinoma. He was treated with total thyroidectomy followed by radioactive iodine thyroid ablation therapy. Conclusion: Physicians need to be aware and vigilant for the possibilities of malignancy in a hyper-functioning thyroid nodule when evaluating any thyroid nodule

Boron-carbon-nitrogen foam surfaces for thermal physisorption applications

A surface chemical treatment of highly porous carbon foams was adopted to synthesize boron-carbon-nitrogen (B-C-N) foams for thermal energy storage and release using an adsorption/desorption cycle with lightweight hydrocarbons. Microwave treatment in boric acid and urea was used to modify carbon foams with a B-C-N surface. Depending on the initial carbon foam state, B-C-N surface layers were produced with both amorphous and crystalline structures. The resultant B-C-N foams were characterized by TEM, XPS, XRD, FESEM and Raman measurements to quantify their stoichiometry, structure, and morphology. Adsorption enthalpy with methanol and thermal stability of foams was analyzed with DSC and TGA respectively. Thermal conductivity was measured by a transient laser flash technique. Results indicate that the crystalline graphitic carbon foam produces superior B-C-N surfaces compared to amorphous carbon foam. The crystalline B-C-N foams are found to provide the highest adsorption capacity, better thermal and oxidation stability. (c) 2012 Elsevier B.V. All rights reserved

Altered gut microbiome drives heightened pain sensitivity in a murine model of metastatic triple-negative breast cancer

The microbiota residing in the gut environment is essential for host homeostasis. Increasing evidence suggests that microbial perturbation (dysbiosis) regulates cancer initiation and progression at local and distant sites. Here, we have identified microbial dysbiosis with the depletion of commensal bacteria as a host-intrinsic factor associated with metastatic dissemination to the bone. Using a mouse model of triple-negative mammary cancer, we demonstrate that a pre-established disruption of microbial homeostasis using an antibiotic cocktail increases tumor growth, enhanced circulating tumor cells, and subsequent dissemination to the bone. We found that the presence of pathogenic bacteria and loss of commensal bacteria in an antibiotic-induced gut environment is associated with sustained inflammation. Increased secretion of G-CSF and MMP-9 in intestinal tissues, followed by increased neutrophil infiltration and severe systemic inflammation in tumor-bearing mice, indicates the direct consequence of a dysbiotic microbiome. Increased neutrophil infiltration to the bone metastatic niche facilitates extravasation and transendothelial migration of tumor cells. It provides a novel, pre-established, and favorable environment to form an immunosuppressive pre-metastatic niche. The presence of tumor cells in immunosuppressive metastatic tumor niche disrupts the balance between osteoblasts and osteoclasts, promotes osteoclast differentiation, and remodels the bone structure. Excessive bone resorption by osteoclasts causes bone degradation and ultimately causes extreme pain in a bone metastatic mouse model. In clinical settings, bone metastasis is associated with intractable severe pain that severely compromises the quality of life in these patients