Foundation for Research in Community Health

Despite the presence of early warning systems and scoring systems, the basic vital parameter monitoring of laboring woman can become burdensome, owing to low doctor-patient ratio and skillset gap among healthcare providers, a solution to which is to have systems which can perform simultaneous maternal and fetal monitoring. The device is intelligent and AI-poweredclinical decision support system for clinicians to care for mothers during the course of pregnancy. This combines the digital, wireless, and connected fetal Doppler, the tocodynamometer, a multipara monitor - (Blood pressure, heart rate, SPO2, temperature, and ECG), and an interfacing screen for clinician interactions. The unique feature of the device is that it can trigger alarm systems when any of these parameters vary beyond the limits of normal or even in correlation. The clinician can interpret such information and make appropriate decisions. The provision of a single composite device measuring maternal and fetal monitoring is an apt technological support for optimal partogram monitoring. By giving a snapshot summary of the data points, the healthcare provider can seamlessly take informed decisions, rather than engage in time consuming data collection. Remote monitoring capability is an added advantage. The device has the potential to ably assist obstetricians and midwives in their day-to-day monitoring of pregnantwoman and save time and make informed decisions.

Feminism is about all forms of challenging social, economic and political power taken by a dominant group. Applying a feminist lens to scientific research brings many advantages, such as broadening theoretical perspectives, encouraging collaboration with — and inclusion of — marginalized groups, and widening the scope of research methods. We aim for this perspective piece to provide an access point for why researchers should incorporate feminist approaches in psychological science, what feminist approaches could look like and how researchers can start incorporating them into their own work. In answering the why, what and how of feminist practices, we strive to make working in a feminist way more legible and accessible, with the ultimate aim of cultivating a more comprehensive understanding of human psychology from diverse perspectives. Based on the lived experiences from an anecdotal survey as part of a SIPS hackathon, which revealed a lack of clear conceptual understanding of feminist approaches and feminism, and on our unique viewpoints as eight feminist ECRs working in different domains of psychological science, we propose constructive approaches for integrating feminist values and practices into psychological science. We highlight what possible barriers exist to incorporating feminist practices into one’s own work and how future research can embrace feminist practices. We also provide a short glossary explaining terminology that can support the communication of feminist research as well as a curated checklist of feminist practices to start out with. This perspective piece warmly invites—and promotes—researchers from all backgrounds and experience levels to engage in and contribute to the exploration of feminist values and practices within the realm of psychological science.

EXECUTIVE SUMMARY Oral cancer is the term described as cancers occurring in the mouthparts that include lips, cheeks, sinuses, tongue, hard and soft palate, or the base of the mouth extending up to the oropharynx. Globally, oral cancer ranks 17th among all types of cancer in terms of both incidence and mortality. India has the largest number of oral cancer cases in the world, and this constitutes more than one-third of the total global burden. In India, oral cancer ranks as the second most common cancer, and is the number one cancer among males. In India, around 130,000 new cases and >75,000 deaths were reported only in the year 2020, with an expected doubling of incidence by 2040. This burden of oral cancer is further complicated by the late-stage diagnosis and low survival rates. In India, the majority of oral cancer cases are reported in the advanced stages, and hence, the chances of cure are very low. This report provides an insight into oral cancer as a public health problem in India, along with etiology and strategies to diagnose, treat, and prevent it while providing recommendations to improve upon the availability and delivery of treatment for oral cancer. The predominant risk factor for developing oral cancer is tobacco consumption. The continual use of tobacco in both smoking and smokeless forms is a major contributor to tumor development in the oral cavity. Other risk factors such as alcohol, diet and nutrition, oral thrush, dental problems, chronic irritation from sharp teeth or ill-fitting dentures, and human papillomavirus (HPV) infection also contribute to the burden. Further, social, cultural, and psychological factors too play an important role in developing oral cancer. Oral potentially malignant disorders (OPMDs) are a diverse group of conditions that are the precursors of oral cancer. It is important to recognize that a patient diagnosed with an OPMD has an increased risk of developing oral cancer compared to a person with a healthy mucosa. Lesions such as Erythroplakia, Erythroleukoplakia, Leukoplakia, Proliferative verrucous leukoplakia, Submucous fibrosis, Palatal lesions associated with reverse smoking, oral lichenoid lesions, oral lichen planus, smokeless tobacco keratosis, and more are the common OPMDs seen in the country. Oral cancer screenings, which are conducted to identify any clinical premalignant phase (accessible to visual inspection), are usually done on a mass scale and shows a decreased burden of advanced oral cancer incident cases and deaths as compared to no screening. Among the screening strategies, it is suggested that high-risk screening is cost-effective compared to mass screening at periodic intervals. Oral cancer screening methods vary across healthcare settings, each with its advantages and limitations. While visual inspection remains a fundamental tool, adjunctive technologies are sometimes used in dental clinics; community outreach programs and telemedicine extend accessibility to screening. The Ministry of Health and Family Welfare, Government of India, has prepared a universal and objective operational framework for cancer screening and management that aims to promote, coordinate, and conduct research to better understand, detect, diagnose, and treat cancer. The framework makes it mandatory to perform screening of oral, cervix, and breast cancer for males and females above the age of 30. Concerning oral cancer treatment, several modalities are available; however, the cure depends on the cancer stage when diagnosed and the delay in starting treatment. Primary surgery is the preferred modality of treatment for a vast majority of operable oral cancers. Radiotherapy is an alternate for early-stage oral cancers with comparable control rates to surgery. Typically, the primary treatment for oral cancer is surgery. The primary goal of surgical resection is to ensure complete removal of the tumor tissue. However, the potential negative impacts on appearance and functionality due to the extent of the disease and the necessary surgical removal stress the importance of using less invasive surgical methods. The National Cancer Grid Management Guidelines for early-stage cancer recommends surgical local excision with a minimum of 1 cm gross margin, accompanied by appropriate neck dissection and suitable reconstruction. For advanced stages, surgery is preferred, along with adjuvant radiotherapy or chemotherapy. Oral cancer in its entirety imposes a significant fiscal burden on a national, institutional, family, and individual level. Funding of cancer care in India is a complex mixture of state and government accountabilities, with the government shouldering most of the responsibility. Oral cancer as such, has not been given a separate budget in India, but it is covered under various facilities of the government, schemes, and programs for cancer. This report entails the Task Force Committee recommendation for screening, diagnosis, prevention, and management of oral cancer, along with research, policy, and advocacy recommendations to address this immense public health problem in the country.

Developmental adversities early in life are associated with later psychopathology. Clustering may be a useful approach to group multiple diverse risks together and study their relation with psychopathology. To generate risk clusters of children, adolescents, and young adults, based on adverse environmental exposure and developmental characteristics, and to examine the association of risk clusters with manifest psychopathology. Participants (n = 8300) between 6 and 23 years were recruited from seven sites in India. We administered questionnaires to elicit history of previous exposure to adverse childhood environments, family history of psychiatric disorders in first-degree relatives, and a range of antenatal and postnatal adversities. We used these variables to generate risk clusters. Mini-International Neuropsychiatric Interview-5 was administered to evaluate manifest psychopathology. Two-step cluster analysis revealed two clusters designated as high-risk cluster (HRC) and low-risk cluster (LRC), comprising 4197 (50.5%) and 4103 (49.5%) participants, respectively. HRC had higher frequencies of family history of mental illness, antenatal and neonatal risk factors, developmental delays, history of migration, and exposure to adverse childhood experiences than LRC. There were significantly higher risks of any psychiatric disorder [Relative Risk (RR) = 2.0, 95% CI 1.8-2.3], externalizing (RR = 4.8, 95% CI 3.6-6.4) and internalizing disorders (RR = 2.6, 95% CI 2.2-2.9), and suicidality (2.3, 95% CI 1.8-2.8) in HRC. Social-environmental and developmental factors could classify Indian children, adolescents and young adults into homogeneous clusters at high or low risk of psychopathology. These biopsychosocial determinants of mental health may have practice, policy and research implications for people in low- and middle-income countries.

BackgroundThe Auxiliary nurse midwife (ANM) cadre was created to focus on maternal and child health. ANMs are respected members of their communities and established providers of maternal and child health care within the community and at the facility level. Over time, additional roles and responsibilities have been added. Despite the importance of ANMs in the primary healthcare system in India, studies that consider factors governing the performance of ANMs in their workplaces are limited. We aimed to study factors governing performance of ANMs in Pune district, India.MethodsSemi-structured interviews were conducted with 13 purposely selected key informants at facility, district, state, and national levels. Focus group discussions were conducted with 41 ANMs and 25 members of the community. Non-participatory observations with eight ANMs provided information to expand on and scrutinise findings that emerged from the other lines of inquiry. A realist lens was applied to identify ANMs’ performance as a result of “mechanisms” (training, supervision, accountability mechanisms) within the given “context” (regulatory system, infrastructure and resources, ANMs’ expanded scope of work, gender roles and norms).ResultsWeak enforcement of regulatory system led to poor standardisation of training quality among training institutions. Challenges in internal accountability mechanisms governing ANMs within the health system hierarchy made it difficult to ensure individual accountability. Training and supervision received were inadequate to address current responsibilities. The supervisory approach focused on comparing information in periodic reports against expected outputs. Clinical support in workplaces was insufficient, with very little problem identification and solving.ConclusionFocusing on the tasks of ANMs with technical inputs alone is insufficient to achieve the full potential of ANMs in a changing context. Systematic efforts tackling factors governing ANMs in their workplaces can produce a useful cadre, that can play an important role in achieving universal health coverage in India.

In the current study, ceftazidime- and ciprofloxacin-resistant—or dual drug-resistant (DDR)—E. coli were isolated from river Mula-Mutha, which flows through rural Pune district and Pune city. The DDR E. coli were further examined for antibiotic resistance to six additional antibiotics. The study also included detection of genes responsible for ceftazidime and ciprofloxacin resistance and vectors for horizontal gene transfer. Twenty-eight percent of the identified DDR E. coli were resistant to more than six antibiotics, with 12% being resistant to all eight antibiotics tested. Quinolone resistance was determined through the detection of qnrA, qnrB, qnrS and oqxA genes, whereas cephalosporin resistance was confirmed through detection of TEM, CTX-M-15, CTX-M-27 and SHV genes. Out of 219 DDR E. coli, 8.2% were qnrS positive and 0.4% were qnrB positive. Percentage of isolates positive for the TEM, CTX-M-15 and CTX-M-27 genes were 32%, 46% and 0.9%, respectively. None of the DDR E. coli tested carried the qnrA, SHV and oqxA genes. Percentage of DDR E. coli carrying Class 1 and 2 integrons (mobile genetic elements) were 47% and 8%, respectively. The results showed that antibiotic resistance genes (ARGs) and integrons were present in the E. coli isolated from the river at points adjoining and downstream of Pune city.

The majority of people in rural villages in Maharashtra, India, have access to improved drinking water sources. Nevertheless, the water quality at the point of consumption often does not satisfy the drinking water standard. In this study, we assess changes in water quality from its source to the point of consumption and explore the ties between water management practices and water quality. Water samples were collected at the water source and from 135 households’ drinking water storage tanks, and analyzed for fecal coliforms. In parallel, a survey was done to find out water treatment and storage interventions, sanitation and hygiene practices, and households’ perception of, and satisfaction with, drinking water quality. Our results show that even though 98% of the households in this study received their drinking water from an improved source, on average only 50% of sources, and even less during the monsoon, showed acceptable levels of fecal bacteria. Households’ engagement in treatment and storage interventions varied, but was considered crucial due to unreliable centralized chlorination at the village level. Further work is warranted to understand to what extent the different factors influence variations in water quality at the point of consumption and thus to determine what are the most effective interventions.

Guideline development gathered pace in India after the inception of National Rural Health Mission (NRHM) in 2005. However, there is a lack of adequate information about guideline development process, review, and update. This paper reports on the systematic appraisal of Indian guidelines related to maternity management (MM) and family planning (FP) using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, which was one of the components of a pilot research in 2012-13. Forty-four selected guidelines about MM and FP, identified through a consensus building workshop, were independently appraised by two appraisers with AGREE instrument having six different domains. Mean item scores, domain scores, and standardized scores were calculated by averaging the scores across the two appraisers. Most guidelines scored high in scope and purpose and clarity of presentation. However, they had little documentation about the development group member details, incorporation of patient views, evidence search method, method chosen for formulating recommendations, tools for application, potential barriers, cost implications, and information about the funding body. Nonclinical guidelines scored higher than clinical guidelines (P = 0.01) for MM in the domain applicability. Clinical FP guidelines scored higher than nonclinical guidelines in the domain of rigor of development (0.01). Despite being clinically sound, Indian guidelines score poorly due to weak documentation about their development process. It is recommended that the guideline development process be improved with systematic documentation for achieving standardization.