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Engaging with discourse on lifestyle modification

Lifestyle modifications through a range of health care practices are considered central to the management, control and prevention of chronic non-communicable diseases. While there is a critical perspective on the epistemologies of such global health discourses in existing literature, empirical evidence on how people engage with such prescriptive lifestyle modifications in different cultural contexts is very limited. The paper in this context draws on illness narratives of heart patients to discuss about the anxiety and uncertainty expressed by patients and others about notions of what constitutes ‘healthy’ and ‘risky’. It specifically unpacks the global-local dynamics in the construction of risk and healthy lifestyle and examines the contexts in which such global discourses are embodied, resisted or negotiated in different cultural contexts. The paper also examines how global health discourses travel to local sites through popular press. The paper draws on evidence collected through analyzing two Indian national English dailies and in-depth interviews with heart patients and their family members in Delhi, India in 2007-2008.

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Response: caught between two world views

As a trained allopathic practitioner myself, two decades ago I found myself in similar circumstances (1) and appreciate the dilemma of the young doctors. Since this analysis is after the event, it must be read as a tentative explanation of the confusion we often create for ourselves.

Historical influences on a doctor’s professional behaviour

The beginnings of this story must go back to the time when we clinical practitioners, along with the rest of the scientific community, adopted positivism as the way that knowledge was constructed. A positivist approach emphasises “facts” as perceived by the five senses as the basis of empirical evidence. When these facts are shared by a community of “objective observers”, the common ground becomes the basis of “truth” or “real” knowledge. In fact, the positivists would say this is the only truth, proven and set in stone. Interpretation does not play a role here, as the shared observation is considered to be true (1).

However, this knowledge is still from a particular point of view, however closely shared. Western science, in its claim to be objective, separated the observer from the observed and was willy-nilly given pride of place in the hierarchy of knowledge. Medicine, claiming to be a science, needed to be free of “subjective values” (1). This is one limb of a doctor’s training; the attitude imbibed from it has repercussions which we shall see as we proceed.

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What next for measles control for Karnataka,India?

Worldwide, measles still kills 400 people every day, more than 90% of them being under-fives. Three out of four deaths happen in India, India’s progress in measles control is a major determining factor in global control of measles. Prevention of measles deaths is key to achieve millennium development goal 4; that is to reduce under-five mortality by two thirds by 2015. There is limited literature available on measles epidemiology in India. No measles surveillance was done before 2006. Built on an existing flaccid paralysis surveillance system, a measles surveillance programme was launched in four southern states of India in 2006, among them Karnataka. The objectives of this work is to describe the epidemiology of measles in Karnataka and to identify ways to improve measles control in the state.



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Can health insurance improve access to quality care for the Indian poor?

Recently, the Indian government launched health insurance schemes for the poor both to protect them from highhealth spending and to improve access to high-quality health services. This article aims to review the potentials of healthinsurance interventions in order to improve access to quality care in India based on experiences of community health insurance schemes.
Data sources
PubMed, Ovid MEDLINE (R), All EBM Reviews, CSA Sociological Abstracts, CSA Social Service Abstracts,EconLit, Science Direct, the ISI Web of Knowledge, Social Science Research Network and databases of research centers were searched up to September 2010. An Internet search was executed.
Study selection.
One thousand hundred and thirty-three papers were assessed for inclusion and exclusion criteria. Twenty-five papers were selected providing information on eight schemes.
Data extraction.
A realist review was performed using Hirschman’s exit-voice theory: mechanisms to improve exit strategies (financial assets and infrastructure) and strengthen patient’s long voice route (quality management) and short voice route (patient pressure).
Results of data synthesis.
All schemes use a mix of measures to improve exit strategies and the long voice route. Most mechanisms are not effective in reality. Schemes that focus on the patients’ bargaining position at the patient-provider interface
seem to improve access to quality care.
Top-down health insurance interventions with focus on exit strategies will not work out fully in the Indian context. Government must actively facilitate the potential of CHI schemes to emancipate the target group so that they may transform from mere passive beneficiaries into active participants in their health.

Keywords: health insurance, quality improvement, access to care, community health insurance, realist review, India

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Factors Influencing Receipt of Iron Supplementation by Young Children and their Mothers in Rural India

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Articles in BMC journals are listed in PubMed and archived at PubMed Central.

National policies recommending routine iron supplementation. Understanding factors associated with receipt of iron in the field could help optimise implementation of anaemia control policies. Thus, we undertook 1) a cross-sectional study to evaluate iron supplementation to children (and mothers) in rural Karnataka, India, and 2) an analysis of all-India rural data from the National Family Health Study 2005-6 (NFHS-3)

ISSN 1471-2458

Article type : Research article

Submission date : 31 January 2011

Acceptance date : 3 August 2011
Publication date : 3 August 2011

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Human disease hinders anti-poaching efforts in Indian nature reserves

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Where hunting pressure is high, anti-poaching efforts are often crucial for protecting native wildlife populations in nature reserves. However, many reserves suffer from inadequate support and provisioning of staff, especially in developing nations. In Pakke Tiger Reserve in northeastern India, we found that malarial infection is a serious hindrance for front-line patrolling staff that limits the time they can spend in the field. We assessed the consequences of malaria both for local people and park staff in the general region and its indirect effects on wildlife protection. To accomplish this we compiled data from annual epidemiological records of malaria, the number of malaria cases and associated mortality, financial costs, and loss of time spent patrolling. Over a 4-year period (2006–2009), the majority (71%) of forest department staff in Pakke Tiger Reserve suffered from malaria. Malaria treatments cost park managers nearly 3% of their total budget and caused a net loss of 44,160 man hours of anti-poaching effort. The government forest and health departments involved in the employment and health of park staff have separate missions and responsibilities, yet our findings show that a multi-disciplinary approach to conservation is essential to avoid overall systemic failure.


► We examined the effects of malaria on anti-poaching staff and its consequences for park protection. ► We focussed particularly on protected areas in northeastern India that suffer from significant wildlife poaching. ► Malaria had a measurable impact on the health of forest department staff, park budgets, and anti-poaching efforts. ► Simple, short-term measures, such as the distribution of insecticide-treated nets, reduced infection rates among park staff. ► An ultimate solution is to improve health services and ensure better coordination between forest and health services.

Article type Research article

Authors : Velho N, Srinivasan U, Prashanth NS & Laurance WF

Journal: Biological Conservation

Submission date : 18 March 2011

Acceptance date : 4 June 2011

Publication date : 15 July 2011

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