Socialization, legitimation and the transfer of biomedical knowledge to low- and middle-income countries: analyzing the case of emergency medicine in India

BACKGROUND: Medical specialization is a key feature of biomedicine, and is a growing, but weakly understood aspect of health systems in many low- and middle-income countries (LMICs), including India. Emergency medicine is an example of a medical specialty that has been promoted in India by several high-income country stakeholders, including the Indian diaspora, through transnational and institutional partnerships. Despite the rapid evolution of emergency medicine in comparison to other specialties, this specialty has seen fragmentation in the stakeholder network and divergent training and policy objectives. Few empirical studies have examined the influence of stakeholders from high-income countries broadly, or of diasporas specifically, in transferring knowledge of medical specialization to LMICs. Using the concepts of socialization and legitimation, our goal is to examine the transfer of medical knowledge from high-income countries to LMICs through domestic, diasporic and foreign stakeholders, and the perceived impact of this knowledge on shaping health priorities in India. METHODS: This analysis was conducted as part of a broader study on the development of emergency medicine in India. We designed a qualitative case study focused on the early 1990s until 2015, analyzing data from in-depth interviewing (n = 87), document review (n = 248), and non-participant observation of conferences and meetings (n = 6). RESULTS: From the early 1990s, domestic stakeholders with exposure to emergency medicine in high-income countries began to establish Emergency Departments and initiate specialist training in the field. Their efforts were amplified by the active legitimation of emergency medicine by diasporic and foreign stakeholders, who formed transnational partnerships with domestic stakeholders and organized conferences, training programs and other activities to promote the field in India. However, despite a broad commitment to expanding specialist training, the network of domestic, diasporic and foreign stakeholders was highly fragmented, resulting in myriad unstandardized postgraduate training programs and duplicative policy agendas. Further, the focus in this time period was largely on training specialists, resulting in more emphasis on a medicalized, tertiary-level form of care. CONCLUSIONS: This analysis reveals the complexities of the roles and dynamics of domestic, diasporic and foreign stakeholders in the evolution of emergency medicine in India. More research and critical analyses are required to explore the transfer of medical knowledge, such as other medical specialties, models of clinical care, and medical technologies, from high-income countries to India

Out-of-Pocket Expenditure in Hypertension Related Care in India: Estimates from National Sample Survey 2017-18

Background: Studies estimating treatment cost associated with hypertension care in the Indian context are limited and show considerable variations. Objective: To estimate the extent of out-of-pocket expenditure (OOPE) for hypertension care at the population level and its financial impact on households in India. Methods: We analysed the data of the 75th round of the of NSSO survey (India) on the social consumption of health care conducted in 2017-18.  OOPE was assessed after deducting the amount reimbursed by insurance from the total medical expenditure per episode of hypertension-related hospitalisation and outpatient visit during the survey period. OOPE for hypertension care was considered catastrophic if exceeding 10% of the household’s monthly per capita expenditure. The determinants of catastrophic health expenditures were examined using a multivariate logistic regression analysis.   Results:  A total of 1,351 and 6,379 individuals reported hypertension-related hospitalization and outpatient care, respectively, in the survey. The overall hypertension-related hospitalization rate was 54 per 100,000 persons.  OOPE associated with hypertension-related hospitalisation were on an average INR 3,491 (SD 6,176) and INR 24,565 (SD 37,343) in public hospitals and private hospitals, respectively. The OOPE for hypertension related to outpatient visit was INR 277 (SD 571) in public facilities but was in the range of INR 457 (SD 556) – INR 695 (SD 1,431) based on the type of private hospitals/clinics. OOPE on medicines constituted on an average 43% (95% CI: 32-52%) and 66% (95% CI: 54-64%) of public sector hospitalisation and outpatient care respectively. The risk of catastrophic expenditure due to hypertension care was 41% among the poorest households. Conclusion: Direct expenses on drugs and diagnostic tests contribute significantly to OOPE. The on-going public health efforts towards controlling hypertension need to ensure better access to essential hypertensive drugs and diagnostic tests in public facilities

Direct costs for nonsurgical management of Chronic Pancreatitis in a tertiary care teaching hospital

<p><b>Background:</b> Chronic pancreatitis (CP) is a leading cause of hospitalization among gastrointestinal diseases resulting in considerable financial burden to patients. However the direct costs for nonsurgical management in CP remains unexplored.</p> <p><b>Methods:</b> A cross sectional study was carried out (2011–14) in the Department of Gastroenterology, Kasturba Hospital, Manipal, India. Demographic and clinical data on laboratory investigations, interventions and follow up were obtained from the medical records department. Item costs were derived from the hospital electronic billing section. Cost was expressed as median annual cost per patient.</p> <p><b>Results:</b> 65 (male 48; 73.8%) patients were included. Their median age was 31 (range 12–68) years. The annual median (IQR) total cost per patient was INR 88,892 (70,550.5–116,004); [USD 1410(1119–1841); € 1155(916–1507)], comprising of INR 61,089 (39,102.5–90,360.5) [USD 970 (621–1434); € 793(508–1174)] for outpatient management and INR 32,450 (11,016–46,958) [USD 515 (175–745); €421(143–610)] for hospitalization. 69.5% of the treatment cost was attributed to outpatient treatment. Drugs contributed to 54%, hospitalization incurred 30.5%, investigations 12% and professional fees (3.5%) of the total cost. Pancreatic enzyme replacement therapy (PERT) cost contributed to three-quarters of drug therapy. Use of rabeprazole as against pantoprazole reduced the overall annual cost of therapy by 4%.</p> <p><b>Conclusions:</b> This study depicts the first nonsurgical management of accrued direct costs associated with CP due to expensive medications. Due to the high cost for PERT, its usefulness needs proper validation by cost benefit analysis.</p

Biogenic Nanoparticle Synthesis Using Marine Alga Schizochytrium sp.

International Conference on Medical and Biological Engineering in Bosnia and Herzegovina (CMBEBIH) -- MAY 16-18, 2019 -- Banja Luka, BOSNIA & HERCEGWOS: 000491311000033Nanotechnology is one of the most promising science and technology discipline that targets to bring new solutions for many applications in biotechnology, biomedical, energy and cosmetic industry by improving particles and devices scale of nanometers. Various sized and shaped nanoparticles can be synthesized by several methods. Up to now, scientists prefer physical and chemical fabrication of nanoparticles. But, these methods contain use of toxic, expensive and non-environmentalist solvents, reducing and stabilising agents. For a sustainable science, there is a necessity development of more eco-friendly, cost-effective and trustable alternative processes. in this context, using biological sources as reaction agent, have a strong potential. Plants, bacteria, fungi are essential biological sources for transformation of metals to nanoparticles. Many researchers focus on fungi and bacteriological potential in nanofabrication whereas algae are highly intriguing biological systems in nanotechnological approach. Some of cyanobacteria and algae have previously been used to synthesize intracellular or extracellular metal nanoparticles. Most of the research concentrate especially on gold and silver nanoparticle production from algae. in this work; bioreduction of silver, zinc and iron metals have been investigated using culture supernatant of marine algae Schizochytrium sp. For characterization of nanoparticles, UV visible spectroscopy, zeta sizer were used. Nanoparticle size was determined by zeta sizer and particles' surface plasmon resonance band detected by UV-Visible Spectroscopy.Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [117M052]This research was supported by the Scientific and Technological Research Council of Turkey (TUBITAK) with 117M052 Project Number