Tata Trusts

Summary Background The aim of this systematic review was to synthesise evidence on the effectiveness and cost-effectiveness of interventions to support the recovery of people living with psychosis and their families in low-income and middle-income countries (LMICs). Methods We searched nine databases for articles published from January 2001 to January 2024 without language restrictions. Studies were eligible if they enrolled people living with psychosis or family members, and tested a psychoeducational, psychological, social, economic or service intervention or delivery or implementation strategy aimed at improving outcomes of people with psychosis. Eligible studies were required to compare outcomes with an alternative condition, using any prospective evaluation study design in a LMIC setting. We extracted summary data from published papers and appraised risk of bias using the Effective Public Health Practice Project tool. We prioritised the reporting of recovery-orientated outcomes including social inclusion, personal recovery, reduced stigma and discrimination and human rights protections. We conceptualised the person living with psychosis in their context (individual, family, organisation and community) based on the socio-ecological model of disability and highlighted studies intervening and measuring outcomes across multiple socio-ecological levels. Protocol registration: PROSPERO (CRD42022330298). Findings A total of 310 individual studies including data from 34,435 participants in 37 countries were included. Aggregate data from a further five meta-analyses, comprising data from 130 individual studies were also included. The majority of studies (77%) were conducted in upper middle-income countries. There was a dominance of studies evaluating impacts of interventions on individual-level mental health and functioning and a paucity of studies measuring the recovery-orientated outcomes prioritised by people living with psychosis. There were modest effects for comprehensive interventions involving family, psychosocial rehabilitation and care close to home provided by trained specialists however their scalability in resource-limited settings is unclear. Over half the studies were considered to have a high risk of bias. Interpretation There is a need for studies that evaluate scalable interventions supporting recovery with comprehensive and contextualised outcome measures and for greater investment in strengthening capacity to conduct rigorous psychosis research across LMICs. Funding None. Research in context Evidence before this study Recent World Health Organization (WHO) guidance on human rights-based, recovery-orientated community mental health care featured markedly few case studies of good practice for people with psychosis in low-income and middle-income countries (LMICs). Systematic reviews of interventions for psychosis in LMICs have been narrow in focus and reporting outcomes, and limited to English language publications. Added value of this study This systematic review is the most comprehensive synthesis to date of psychosis interventions in LMICs. Inclusion is not restricted by publication language. We highlight studies reporting recovery-oriented outcomes prioritised by people living with psychosis and impacts of interventions across levels of the socio-ecological model of disability. While being particularly relevant to LMICs, our findings also contribute a useful perspective for high income settings. Implications of all the available evidence Most interventions were targeted at the individual and focused on mental health and functioning outcomes, with few evaluations of impact on social inclusion and other valued outcomes. There is some evidence in support of specialist-delivered comprehensive interventions involving family, psychosocial rehabilitation and care close to home, but effect sizes were small-to-modest, and many intervention types and delivery agents have not been adequately tested, especially in LICs and rural settings. There is a clear need to develop comprehensive and contextualised measures for recovery-orientated outcomes and to invest in strengthening capacity to conduct rigorous research on interventions for psychosis in LMICs.

Quinone compounds are versatile molecules with significant biological importance and have therapeutic potential in medicine. This chapter provides a comprehensive overview of quinones, beginning with their definition, historical background, and chemical structure. It explores their diverse roles in biological systems, including their involvement in cellular respiration, enzymatic reactions as cofactors, and their function as endogenous compounds. Mechanistically, quinones employ their effects through redox properties, electron transfer processes, and interactions with cellular components such as proteins, lipids, and DNA. Therapeutically, quinones are pragmatic for their anti-cancer, antimicrobial, antiinflammatory, and antioxidant properties. Key drugs like doxorubicin and mitomycin C exemplify their efficacy in cancer treatment, while other quinones serve as antimicrobial agents against bacteria, fungi, and viruses. Challenges in drug development, including toxicity and stability issues, are addressed alongside strategies to mitigate these concerns. Case studies and clinical trial data underscore the clinical relevance of quinone-based therapies. Looking forward, future research opportunities include exploring novel quinone derivatives, integrating quinones in combination therapies, and advancing drug delivery systems to enhance their efficacy and safety profiles. The chapter concludes by emphasizing the significant role of quinone compounds in modern medicine and outlining potential breakthroughs that may further expand their therapeutic applications.

Background: Diffusion models have been used for over half a century to predict the spread of innovations, products, and services in target strata. However, the applicability and relevance of diffusion models for the new age app-based consumer services have not been researched, especially in developing markets like India. Purpose: This paper identifies gaps in the two founding theories on diffusion– Rogers' Diffusion of Innovation Model and Bass' Diffusion Model concerning app-based consumer services in India, and attempts to deploy these theories on the diffusion of new-age applications. Methods: The paper critically examines the diffusion theories to extract implementation gaps in the new-age platform applications. Further, it works towards proposing a reduced form equation by including a dampener in the traditional diffusion model equation offered by Bass, which can represent the diffusion curve for app-based services and thus explain the diffusion better. Findings: A set of enablers and disablers is identified through this research, influencing the diffusion of new-age applications. Including these elements explains diffusion from the source and medium points of view. Conclusion: Enhanced understanding of the diffusion of service applications among the population shall help app-driven businesses efficiently build products that are well accepted and adopted by the target population. Keywords: Diffusion, Innovation, Diffusion of Innovation, Service Apps, On-demand Application JEL Codes: O33, M31, L86, D83

Tooth extractions can introduce bacteria into the bloodstream, leading to transient bacteremia. Diabetic individuals are more susceptible due to impaired immunity, delayed healing, and reduced infection clearance. While systemic bacteremia is well-studied, localized bacteremia from the alveolar socket remains underexplored. This study compares post-extraction bacteremia in diabetic and non-diabetic patients to improve infection risk assessment and preventive care. 1. Compare alveolar socket bacteremia in diabetic and non-diabetic patients. 2. Assess bacteremia prevalence and severity in both groups. 3. Evaluate the impact of diabetes on post-extraction bacteremia. 4. Identify predominant bacterial species and their clinical relevance. 5. Examine associations between bacteremia, glycemic control, healing response, and infection risk. Sixty patients (30 diabetics, 30 non-diabetics) aged 30-70 from low-to-medium socioeconomic backgrounds were studied. Males predominated among diabetics, females among non-diabetics. Post-extraction socket blood was collected, cultured on blood agar, and incubated at 37°C for 24 hours. Bacterial identification was performed using microscopic examination and confirmatory assays. Statistical analysis ( p ≤ 0.05) showed diabetics had higher Streptococcus (56.6%), Enterococcus (26.6%), Klebsiella (3.3%), and Candida (3.3%), while non-diabetics had Enterococcus (40%), Streptococcus (30%), Moraxella (16.6%), and Escherichia coli (3.3%). Staphylococcus and Pneumococcus were exclusive to diabetics. Localized bacteremia may indicate systemic health risks. Further research is needed to establish clinical correlations, refine treatment protocols, and improve early intervention strategies.

Introduction:Cancer is becoming a leading cause of death and disability across the globe and India too has a high burden of disease with poor outcomes. The national cancer screening program has been rolled out since 2010 but has not yielded the desired results so far. The objective of the present review is to perform an analysis of the strengths and weaknesses of the cancer screening component of the National Program - Non Communicable Disease (NP-NCD) program based on a scoping review of policies, organization, and status of implementation of the program at the primary and secondary levels and also on observations from field experience of the program managers and other health professionals from selected states in India. Methods: A A mixed methodology was used to document the status of the implementation of the ongoing cancer screening program in India. The methodology included a literature review, observation of the frontline health professionals and an in-depth discussion with those in managerial capacity at the health facilities or the screening program. Results:Cancer screening is a complex public health initiative requiring a highly organized framework for effective implementation. Although India has implemented a comprehensive Non-Communicable Disease (NCD) screening program since 2010, the results have been minimal. The latest National Family Health Survey (NHFS 2019-21) reported that among the female population aged 30 to 49 years, only 1.9% and 0.9% were ever screened for cervical cancer and breast cancer respectively. The proportion of 30-49 year-old males reported to be ever screened for oral cancer was only 1.2%. Tamil Nadu and Kerala showed significantly better screening participation compared to other states in the country. Conclusion:Cancer screening is a complex public health initiative requiring a highly organized framework for effective implementation. The Ayushman Bharat comprehensive primary healthcare service package and plan to deliver cancer screening through the Health and Wellness centers (AB-HWCs) is a good opportunity to revamp the program.

SummaryBackgroundAdult undernourishment remains pervasive throughout India, and often results from food deprivation, which refers to the inadequate consumption of foods with caloric and nutrient significance. Therefore, understanding the extent to which food groups are missing from an individual's diet is essential to understanding the extent to which they are undernourished.MethodsWe used data from two National Family Health Surveys conducted in 2016 and 2021 for this cross-sectional analysis. The study population consisted of women and pregnant women between the ages of 15–49, and men between the ages of 15–54. We examined shifts in the percentage of people not consuming dairy, pulses/beans/legumes, dark leafy green vegetables, fruits, eggs, and fish and meat among women, pregnant women, and men between the two time points. We also examined these patterns by household wealth and education, two important markers of socioeconomic status.FindingsOverall, we found that fewer women, pregnant women, and men were not eating each of the six food groups in 2021 than in 2016. Additionally, the gap in food group consumption between women, pregnant women, and men in the lowest and highest socioeconomic groups shrank between 2016 and 2021. Yet, food group deprivation remained most prevalent among those in the lowest socioeconomic groups. The two exceptions for this were for eggs and meat/fish. Nevertheless, the majority of India's poorest and least educated adults are not consuming high-quality protein sources, including dairy, the consumption of which is far more common among wealthier and more educated Indian adults.InterpretationOur results show that fewer adults were not consuming important food groups in 2021 than in 2016. However, many of India's poorest and least educated adults are still not consuming high-quality sources of protein or fruits, two food groups that are essential for good health. While adults might be getting protein and nutrients from pulses, legumes, beans, and other vegetables, efforts are needed to improve affordability of, and access to, high-quality sources of protein and fruits.FundingThis work was supported by the 10.13039/100000865Bill & Melinda Gates Foundation, INV- 002992.

The importance of social networks in setting-up and running a business is well established in the literature. Experts on informality have concluded that with the development of a country, the informal sector will increasingly turn formal. However, evidence from this study indicates otherwise. This study looks at Surat in India which is one of the largest textile producing cities internationally. The industrial district has numerous informal establishments that form a part of the crucial ecosystem, working in cohesion with the more established ‘formal’ firms. The study examines the roles that social networks play in sustaining the textile industry. The research infers that social networks are crucial to run a business in the Surat textile market as all transactions take place through informal contracts, which are grounded on trust-based ‘references’, thereby making a strong network structure a key requirement.

To estimate the clinical outcome of humanistic nursing intervention after cochlear implantation in pediatric patients with congenital deafness.Methods: Pediatric participants who suffered from congenital deafness were included.A total of 85 participants were assigned to a control subgroup (n=42), which adopted routine nursing intervention, and an observation subgroup (n=43), which adopted humanistic nursing intervention.Cochlear implantation was performed in both subgroups.The language and auditory rehabilitation, quality of life, and the incidence of complications were evaluated.Results: After nursing, there was a notable distinction between the observation subgroup and control subgroup in the language and hearing levels, the scores of SIR, CAP, and MAIS.As for the quality of life, it was corroborated by a notable distinction of the scores for two subgroups in somatic, physiological, social, and psychological functions.In terms of the incidence of complications, it was notably lower incidence for the observation subgroup (2.32%) versus the control subgroup (14.28%).Conclusion: The application of humanistic nursing in pediatric patients with congenital deafness undergoing cochlear implantation is beneficial to promote the rehabilitation of language and hearing, improve the quality of life and, reduce the incidence of postoperative complications.

Lozenges are solid dosage forms that include one or more medications that are supposed to dissolve or disintegrate slowly in the mouth, or medicated candies that dissolve slowly in the mouth to lubricate and soothe sensitive throat tissue. The objective of the present study was formulation and evaluation of Medicated Soft Lozenges of Montelukast sodium by using PEG 1500 as a lozenges base while Dextrose as a sweetener. The drug excipients interaction study was done by FTIR, the compatibility of Montelukast sodium with PEG 1500 and Dextrose the studies of FTIR showed that all above characteristic peaks of Montelukast sodium were observed near about their respective values so it has been concluded that there is no incompatibility between excipients and pure drug. Formulations were prepared by melting and moulding technique. The Medicated Soft lozenges of Montelukast sodium were evaluated for physical appearance, thickness, weight variation, hardness, friability test, drug content, disintegration time, in- vitro drug release and stability study. All prepared batches showed good in- vitro dissolution studies. The best result from lozenges batches was from F2 which gives Thickness of 5.12 mm, Weight variation of 0.24 mg, Hardness of 6.5 kg/cm-1, Friability of 0.695%, Drug content of 98.32%, Disintegration time of 30 min and In- vitro drug release of 80%. The main selection criteria for the best formulation was in-vitro drug release of the formulations equal to the in-vitro drug release of the pure drug which is not less than 70%, which complies with the IP standards and hardness of the formulation batches. Hence it can be concluded that Medicated Soft Lozenges of Montelukast sodium can be successfully formulated by melting and mould technique