The economic impact of visceral leishmaniasis on households in Bangladesh

OBJECTIVES: To explore current patterns of diagnosis and treatment, quantify household economic impact and identify household strategies to cover the costs of visceral leishmaniasis (VL) care in rural Bangladesh. METHOD: Structured interviews with 113 VL patients from 87 households documenting all provider visits and expenditures for health care for VL, and the ways in which the expenditures were covered. RESULTS: Patients paid a median of 7 visits to six different providers before beginning VL treatment. All visited the subdistrict government hospital at least once. While health care, including antileishmanial drug therapy, is officially available free of charge at government facilities, 79% of patients reported making informal payments for provider access, diagnostics and drug administration; only 14% of patients received their full drug course from this source. For the 58% of patients who purchased the full treatment course, drug cost constituted 34% of direct expenditure. Median direct expenditure for one VL patient was US$87 and median income lost was $40; median total expenditure was 1.2 times annual per capita income of our study population. Households employed multiple coping strategies to cover expenditures, most commonly sale or rental of assets (62%) and taking out loans (64%). CONCLUSIONS: Visceral leishmaniasis treatment causes a major economic burden in affected families. Control strategies for VL should facilitate timely, affordable diagnosis and treatment of patients to decrease the infection reservoir and to alleviate the economic burden of VL on households.     

Automated screening for distress: A perspective for the future

Distress is a complex condition, which affects a significant percentage of cancer patients and may lead to depression, anxiety, sadness, suicide and other forms of psychological morbidity. Compelling evidence supports screening for distress as a means of facilitating early intervention and subsequent improvements in psychological well‐being and overall quality of life. Nevertheless, despite the existence of evidence‐based and easily administered screening tools, for example, the Distress Thermometer, routine screening for distress is yet to achieve widespread implementation. Efforts are intensifying to utilise innovative, cost‐effective methods now available through emerging technologies in the informatics and computational arenas.     

Psoriasis in children: an insight

Onset of psoriasis in childhood is quite common. Chronicity, inflammation and hyperproliferation are the cardinal features by which the condition establishes its uniqueness. Clearance of disease may be farfetched in most patients and relapse is frequent. Early recognition and management of psoriasis in children and adolescents is vital in therapy in children.     

A comparison of cardiac strain among drillers of two different age groups in underground manual coal mines in India

Cardiac strain was evaluated in terms of working heart rate (WHR), relative cardiac cost (RCC), net cardiac cost (NCC) and other recovery indices among six younger (mean age 34.2 +/- 2.7 yr) and sixteen older (mean age 48.9 +/- 5.4 yr) drillers working in a manual underground coal mine over two spells of work. The mean WHR was within the range of 117-132 beats / min with corresponding mean relative cardiac cost between 44-48% of heart rate reserve for the younger group and 53-55% for their older counterparts. The mean NCC was above 50 beats/min for both age groups. It was seen that the workers surpassed the recommended limits of cardiac strain indices. The intensity of workload indicates the job to be "heavy" to "extremely heavy" in accordance with the heaviness scales based on WHR, NCC and recovery heart rates. Heat stress prevailing in the workplace in terms of effective temperature (ET) and wet bulb globe temperature (WBGT), was above the recommended limits as per the guidelines proposed by WHO and ACGIH. High physiological demands of the job which requires predominate static muscular exertions coupled with high heat stress were found to hinder the recovery process and may prove deleterious particularly for the older workers. Therefore, in the present context, the need of ergonomic interventions for job organization and quick reparation of environmental condition are strongly indicted.     

Static and Resonant Properties and Magnetic Phase Diagram of LiMn2TeO6

Physical properties of the mixed-valent tellurate of lithium and manganese, LiMn₂TeO₆, were investigated in measurements of ac and dc magnetic susceptibility χ, magnetization M, specific heat C_p, electron spin resonance (ESR), and nuclear magnetic resonance (NMR) in the temperature range 2–300 K under magnetic field up to 9 T. The title compound orders magnetically in two steps at T₁ = 20 K and T₂ = 13 K. The intermediate phase at T₂ < T < T₁ is fully suppressed by magnetic field µ₀H of about 4 T. Besides magnetic phases transitions firmly established in static measurements, relaxation-type phenomena were observed well above magnetic ordering temperature in resonant measurements.     

Rapid survey of wasting and stunting in children: What’s new,what’s old and what’s the buzz?

Nationwide Rapid Survey on Children (RSoC), conducted by the Ministry of Women and Child Development and UNICEF in 2013-14 showed a marked improvement in the status of the child malnutrition over the third National Family Health Survey (NFHS-3) that was conducted in 2005-06. Despite some impressive gains in the anthropometric indicators of malnutrition, the absolute levels remain high, and of concern. Despite these gains, the feeding indicators remain stagnant. The programmatic responses need to adopt a multi-sectoral comprehensive approach with regular and comprehensive nutrition surveillance and recognize the epidemiological diversity.