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AdvertisementContinue reading the main storySupported byContinue reading the main storyThe 2021 Well purchase zithromax Holiday Gift GuideShare the gift of healthy living. Here’s a list of some of our favorite things, from the staff and contributors of Well.Send any friend a storyAs a subscriber, you have 10 gift articles to give each month. Anyone can read what purchase zithromax you share.Nov.

4, 2021For the 2021 Well Holiday Gift Guide, we’re sharing 21 of our favorite things that can make life just a little better.What makes the Well holiday guide so special?. These are gift ideas that the editors, writers and purchase zithromax contributors themselves have purchased (or received), used often and really love. Some are practical, a few are whimsical, but they all help us live well every day.You’ll find tasty treats, practical items for the home, gifts to ease stress and help you sleep, fitness gear, cozy indulgences and presents to inspire family time.

We’re publishing the gift guide a little earlier this year too, to help you avoid supply and shipping delays before the holidays.2021 Well Holiday Gift GuideCooking &. FoodMind & purchase zithromax. StressFitness &.

OutdoorsHome & purchase zithromax. FamilyBedtime &. ComfortCooking &.

FoodA reusable storage bagDitch the single-use sandwich and zippered storage bags (they’re terrible for the environment and hard to recycle) and give Stasher bags, a silicone bag that can be reused, refrigerated, frozen, boiled, microwaved, heated in the oven and cleaned in the dishwasher — again and again purchase zithromax. This sturdy bag has the same press-and-seal closure as disposable bags and comes in a variety of colors. I tried the starter kit, but some purchase zithromax of the bags are on the small side.

I prefer the sandwich, quart, half-gallon and standing bags for storing things like vegetables, tortillas, cheese and leftovers. I also use Stasher bags to keep my passport and treatment card safe and as a travel kit for makeup and toiletries. €” Tara Parker-Pope, columnist, WellCost purchase zithromax.

$37 and upAn overnight oats kitEveryone loves a gift from the kitchen, especially one that’s as delicious and good for you as this homemade overnight oats kit. Start with a 16-ounce Mason jar, and use this purchase zithromax recipe from NYT Cooking’s Genevieve Ko. You’ll fill about half the jar with a mixture of old-fashioned oats, dried fruits, seeds and salt.

(I use oats, dried apricots, pistachios, flax seeds and chia seeds.) Include a gift bag with extra packets of nuts, peanut butter, brown sugar or maple syrup, along with instructions. (Just stir in 1 cup regular or nondairy milk, cover and chill overnight, then top with nuts or other extras right before eating.) “I eat overnight purchase zithromax oats every weekday morning. I’m a huge fan.

I make it three days in advance sometimes, and it’s still super purchase zithromax yummy.” — Dani Blum, senior news assistant, WellCost. About $5Lemon-infused olive oilThe pretty packaging of il Boschetto lemon-infused extra virgin olive oil makes this a great host gift or a delicious present for the foodie on your shopping list. (We love il Boschetto, but you can find other lemon-infused olive oil at Italian specialty shops or try making your own.) “It’s delicious on salads, fish and pasta, drizzled over fresh mozzarella or crusty bread, or mashed with avocado for the best avocado toast you’ve ever tasted.” — Toby Bilanow, deputy editor, WellCost.

$30A spicy holiday teaTea always makes a great holiday gift, but Harney & purchase zithromax. Sons Hot Cinnamon Spice tea is extra special and comes in loose tea, sachets and tea bags. €œIt’s unlike any tea I’ve ever purchase zithromax had.

It wakes you up in the morning, but also replaces a dessert after dinner. Coffee drinkers like its bold flavors, and tea drinkers purchase zithromax are always surprised by how they’ve never tasted anything like it.” — Karen Barrow, deputy editor, StorylinesCost. $10 to $20Mind &.

StressA hands-free neck and shoulder massagerWorking on a laptop all day can take a toll on posture and cause you pain. For relief, try purchase zithromax the Alljoy Shiatsu Neck &. Shoulder Massager.

€œOn days when my neck and shoulders are all purchase zithromax knotted up, this massager works wonders. I don’t have to beg my kids or husband for a massage, and I can sit and watch something on my iPad while it kneads my muscles, almost as well as a trained masseuse.” — Apoorva Mandavilli, reporter, ScienceCost. $50The perfect journalExpressive writing has been linked with a number of health benefits, including lower stress and depression, fewer doctor appointments and even improving your memory.

€œI am a lifelong journaler, and purchase zithromax have crates of old ones dating back to first grade. I travel with my journal so I’m always on the hunt for ones that are sturdy but not too bulky. Decomposition books have become my favorites purchase zithromax.

They have lovely illustrations, come in a variety of colors, and the intricate drawings on the cover and the inside are perfect for doodling and coloring.” — Lori Leibovich, editor, WellCost. $8A stress-busting coloring bookColoring isn’t just for kids anymore. It can be purchase zithromax a stress-relieving distraction for grown-ups too.

Shop at an independent bookstore or online to find The Mindfulness Coloring Book, the Dr. Seuss Coloring Book or The Unofficial Bridgerton purchase zithromax Coloring Book. €œColoring with pencils is so easy, and also you can dig in hard and rub the pencil back and forth, which is probably better than biting your nails or picking at your cuticles.” — Dr.

Randi Hutter-Epstein, contributorCost. $5 to $15A soothing bubble bathA long hot bath before bedtime has been shown to help you fall asleep faster, purchase zithromax and taking baths may even be good for your heart. Dr.

Teal’s products, like foaming bubble bath with Epsom salts and lavender, can purchase zithromax make bath time feel more indulgent. (Epsom refers to the springs in England where the salts are found.) “My mom gave me this bubble bath, and it kept me warm and relaxed on many winter nights.” — Sarah Williamson, art director, WellCost. $5 to $10Fitness &.

OutdoorsSock-of-the-month clubA monthly sock delivery from Stance Socks just might motivate someone purchase zithromax to move a little more. You can give a 3-, 6- or 12-month gift subscription. €œThe best thing about purchase zithromax this present is that you get to select your own pair of socks each month.

You can build up a year’s worth of great socks that inspire you and make you want to get out the door and go!. € — Dr. Jordan Metzl, purchase zithromax contributorCost.

$57 and upA hydration vest for runners and cyclistsStaying hydrated on long runs and bike rides can be challenging. Water bottles are purchase zithromax heavy to carry. Waist belts are uncomfortable and can slip down.

Hydration backpacks purchase zithromax are bulky. The Osprey Dyna 6 1.5 liter hydration vest (sized for women) or the Osprey Duro (sized for men) solves everything. €œHydration vests are trim, lightweight, fit well across the chest, don’t slosh as you move, and can hold a phone, some Gu, an energy bar, a rain shell, and other essentials for long runs and bike rides.

I bought mine as a gift for myself last winter, when I was training for some trail races, and have purchase zithromax talked several friends into buying one, too.” — Gretchen Reynolds, Phys Ed columnistCost. $110A wildlife trail cameraWildlife cameras can reveal a hidden world in your backyard. Wirecutter (which is owned by The purchase zithromax New York Times) recommends one from Wildgame Innovations, or consider the Browning trail camera, which has a video option.

€œChecking the camera is a big deal in our house. Much of the fun is in finding new places to put it. Where do the purchase zithromax animals like to walk?.

Male deer are quite vain and like to have their pictures taken.” — Erik Vance, staff editor, WellCost. $100 to $179A lightweight water bottleIf you’re still looking for the perfect water bottle, consider the purchase zithromax GSI Microlite 500 Flip thermos/water bottle, which holds about 17 ounces of liquid. There is also a larger version that holds nearly 24 ounces.

€œI can’t say enough good things about it. It’s so easy to clean and doesn’t have annoying small purchase zithromax parts or straws. It’s super lightweight yet can keep liquids cold or hot.

The push-button purchase zithromax lid is great for a germaphobe like me who doesn’t want an exposed drinking spout.” — Christina Caron, reporter, WellCost:$30Cozy winter leggingsDon’t let cold weather stop you from exercising. Try the Baleaf fleece-lined leggings. (The company also makes fleece-lined bottoms for men.) “The winter exercise must-have for me is fleece-lined leggings.

I got these as a gift and purchase zithromax thought they would be too hot or possibly bulky, but it felt like I was wearing comfy sweatpants. Bonus points because they come in petite for short ladies and are very affordable.” — Farah Miller, editorial director, WellCost. $30 to purchase zithromax $35Home &.

FamilyNontoxic cleaning productsMany of us have been cleaning more during the zithromax and, as a result, have noticed the harsh nature of common household chemicals. €œI’ve tried every healthy home cleaning product I can get my hands on and haven’t been impressed when they all failed the bathroom mold-removal test. But Branch purchase zithromax Basics passed with flying colors!.

This starter kit has replaced 90 percent of my toxic cleaners. I’m buying these for my purchase zithromax mom and friends. It’s really good for people who are sensitive to chemicals in regular products.” — Jaspal Riyait, art director, WellCost.

$69The best dog collarMy dog’s old collar had frayed and was a pain to remove during grooming. In search of a better collar, I found purchase zithromax If It Barks custom collars. These sturdy attractive collars come in a range of sizes and colors and have a variety of customization options.

For my purchase zithromax dog, Maddie, I chose the feminine and floral “Be Mine Bouquet” pattern, with a sturdy hybrid buckle that can be customized with my dog’s name, phone and address. It’s the best dog collar ever, and it looks adorable on her. €” Tara Parker-Pope, columnist, WellCost.

$29 and upThe gift of timeMost of us can’t afford a personal assistant, but new online virtual assistant services like Time etc and Fancy purchase zithromax Hands can help with those time-sucking tasks like calling the utility company, planning a vacation, dealing with email or knocking items off a to-do list. For in-person handyman and home tasks, consider a Task Rabbit gift card. Or you can purchase zithromax gift yourself to a friend or family member.

€œA few years ago a relative offered me the gift of his services. I pointed to several file cabinets and told him to throw out the contents — decades of work files — and not let me look at what was landing in the recycling.” — Jane Brody, Personal Health purchase zithromax columnistCost. $30 and upA personalized children’s bookMake your child the star of their own bedtime story or turn a parent into a super hero with a Wonderbly custom book.

Personalization options vary by title. You’ll find evergreen books about friendship, adventure, classroom capers, grandparents and purchase zithromax bedtime. (Winter holiday-themed books are limited to Christmas.) “You can choose from several stories, designs and soft or hard cover.

My husband was touched and pretty surprised when purchase zithromax he saw it was customized. It’s a fun, unique gift.” — Melonyce McAfee, senior staff editor, WellCost. $35 and upBedtime &.

ComfortA cashmere warming bottleModern luxury meets old-fashioned purchase zithromax practicality in this cashmere-covered hot-water warming bottle, which you can find from Naked Cashmere or Britain’s Pink and Ginger. €œI bought this hot-water bottle after a trip to Ireland, where they seem ubiquitous. I use it for aches, purchase zithromax cramps and general coziness.

When the temperature dips I tuck it under the covers before I get into bed for a warm treat when I climb in.” — Tiffanie Graham, photo editor, WellCost. $45 to $95A better reading lightThe Mighty Bright is a bendable, rechargeable light that clips onto your book and can be dimmed so it won’t disturb others in the room. €œMy mother-in-law recommended this reading light, and it has changed purchase zithromax the sleep game for me and my older daughter.

We both have trouble falling asleep and need relaxing activities to do that don’t involve screens. Now we can read books to help wind down without waking purchase zithromax anybody up.” — Jessica Grose, Parenting columnistCost. $30An electric blanketElectric blankets don’t get as much attention as trendy weighted blankets and plush throws, but they’re often a more affordable source of cozy comfort.

Pro tip. A larger blanket may inspire children and teens to cuddle with you purchase zithromax. Wirecutter recommends the Sunbeam Velvet Plush Heated Blanket.

€œWe watch a little television in the evenings to wind down, and it feels so good to get under a heated blanket.” — Lisa Damour, Adolescence purchase zithromax columnistCost. $99 to $179A sleek white-noise machineFor the restless sleeper in your life, Wirecutter recommends the LectroFan Evo, a white-noise machine that can mask traffic sounds, barking dogs and loud parties with soothing whirring, buzzing and humming sounds. The LectroFan also has two ocean-sound settings.

€œThe anxiety of the purchase zithromax zithromax wreaked havoc on my sleep. My white-noise machine is a lifesaver. It uses a range of frequencies and masks purchase zithromax the worst city noises.

It also has a sleek and modern design and is compact and easy to travel with.” — Julia Calderone, senior staff editor, WellCost. $45AdvertisementContinue reading the main storyAdvertisementContinue reading the main storySupported byContinue reading the main storyThe Ketamine CureThe once-taboo drug has been repurposed to treat depression and is even available for delivery. But how safe purchase zithromax is it?.

Send any friend a storyAs a subscriber, you have 10 gift articles to give each month. Anyone can purchase zithromax read what you share.Credit...Erica Gannett for The New York TimesNov. 4, 2021Updated 12:56 p.m.

ETChris Gathman, 40, has lived with chronic depression, a condition that runs in his family, for most purchase zithromax of his life. He’s used a combination of antidepressants and cognitive behavioral therapy to treat his symptoms, with limited success. In 2018, he sunk into an even deeper depression that began impacting his ability to socialize and complete daily tasks.“I knew I needed to do something,” said Mr.

Gathman, who lives in purchase zithromax Miami. So when his primary care physician suggested ketamine — an anesthetic that has improved symptoms of depression in early studies — he reached out to a clinic nearby.“I woke up the next day and felt completely normal,” he said about his first IV infusion, administered at Ketamine Health Centers. €œI didn’t feel purchase zithromax depressed at all.” Mr.

Gathman then persuaded his parents to seek out the therapy at the same clinic for their depression, and they both reported immediate relief as well.Ketamine — an anesthetic first popular with the 1970s counterculture movement and then as a club drug known as “Special K” — has recently emerged as a promising mental health treatment. Unlike conventional antidepressants, which work by increasing serotonin levels, ketamine appears to impact a neurotransmitter called glutamate, which is thought to play a role in regulating mood.In early trials, patients suffering from a wide range of drug-resistant mood disorders — including major depressive disorder, bipolar disorder, obsessive compulsive disorder and social anxiety disorder — have seen symptoms improve, often immediately.Thanks to these success stories, hundreds of new ketamine providers have popped up across the country. Typically patients take ketamine through an IV, nasal spray or tablet once or twice a week for six to eight weeks (though some may need purchase zithromax to take it longer).

Sessions last between one and two hours and can cause feelings of dissociation, or feeling disconnected from reality, and euphoria.Mr. Gathman, for instance, said purchase zithromax the treatment made him “sleepy” and provoked an “out of body” experience. He described these sensations as “pleasant” — though he struggled with his balance and a sense of being “dazed” for several hours following each session.

The ketamine boom has increased access to thousands who may benefit, but some scientists and doctors worry the drug is not yet ready for widespread use.Chris Gatham struggled with chronic depression for decades before finding relief through intravenous ketamine treatments. €œI woke up the next day and felt completely normal,” he said.Credit...Gesi Schilling for The New York Times“I understand the purchase zithromax rush for ketamine, in both private and public clinics,” said Dr. Carolyn Rodriguez, director of the Translational Therapeutics Lab at Stanford University, who conducted an early small trial of ketamine to treat obsessive compulsive disorder and saw an impressive and immediate decrease in symptoms.

But given the lack of long-term data, potential for troubling side purchase zithromax effects and possibility for abuse, “I believe that ketamine is not yet ready for safe general use,” she said.Ketamine on DemandKetamine’s success in early trials has surprised and excited researchers who study mood disorders, a field where drugs like Prozac and Zoloft, paired with talk therapy, have been the main treatment options for decades. But, as with Mr. Gathman, interventions don’t work for up to 30 percent of those suffering from major depression.Moreover, it can take up to two months to determine whether these interventions have any effect at all — a dangerously long time for those suffering from suicidal thoughts and other mood disorders, said Dr.

Joshua Berman, the medical director for interventional psychiatry at Columbia University, who helps lead the development purchase zithromax of the department’s ketamine program. Ketamine’s effects, on the other hand, are often immediate.Though relatively new in the field of mental health, ketamine has been used in hospitals and on battlefields as an anesthetic since 1970. While the drug’s clearance by the Food and Drug Administration does not yet extend most ketamine treatments to mood disorders, any physician can prescribe it off-label to patients whom they believe might benefit — allowing purchase zithromax the commercial ketamine business to flourish.Chris Walden, the co-founder of Ketamine Media, a public relations firm that works with ketamine providers, said that ketamine clinics have grown from a few dozen to “many hundreds” in the United States but couldn’t give exact numbers.Some of these providers are associated with academic institutions conducting clinical trials.

Others operate out of private boutique-like clinics such as Nushama, which was recently opened on Park Avenue in New York City by designer Jay Godfrey.And some patients skip the clinic entirely. Mindbloom, which launched in late 2018, is an at-home delivery service that sends ketamine lozenges directly to the homes of patients. The company — among the fastest growing of several purchase zithromax at-home ketamine delivery services, like My Ketamine Home and TrippSitter — pairs its clients with psychiatric clinicians certified to prescribe drugs, who determine if the drug is appropriate for them.

Then other employees, called “psychedelic guides,” meet with patients virtually before and after sessions to process the experience. There are no purchase zithromax formal requirements to becoming a psychedelic guide, but most have completed training in fields such as mental health, life coaching or crisis management.Dylan Beynon, Mindbloom’s chief executive and founder, said over 80 percent of his clients suffering from depression or anxiety experience significant improvement after four sessions — and that just 5 percent of patients experience side effects, which were mostly mild.By shipping directly to clients, the company has lowered the cost of ketamine therapy — which averages $400 to $800 per session at many in-person clinics — to $120 to $190 per session, said Mr. Beynon.

Given that ketamine is rarely covered by insurance, this is still prohibitively expensive for many.Still, many experts do not believe patients should be self-administering ketamine — which can produce powerful dissociative sensations and even a seemingly catatonic state — outside of a clinical setting. Other side effects — like increased blood pressure, paranoia and suicidal thoughts — are rare purchase zithromax and typically only appear at very high doses.Dr. Leonardo Vando, Mindbloom’s medical director, claimed that out of tens of thousands of doses administered, the company has only observed mild side effects, like nausea.Dr.

Gerard Sanacora, director of the Yale Depression Research Program and the Yale-New Haven Hospital purchase zithromax Interventional Psychiatry Service, agreed that serious side effects are rare but has seen patients experience chest pains and worried about exacerbating heart conditions. €œIf you treat enough people, something is going to go wrong,” he said.“With a drug like ketamine that can affect heart rate and blood pressure, it’s especially important to get a well-documented cardiac history, laboratory screening assessments, and to be monitored during the infusions,” said Dr. Rodriguez.

Screening candidates in this way led her to discover an undiagnosed heart condition in one patient. €œIt would not have been a good idea to give ketamine to that person.”Mindbloom's at-home kit, nicknamed the Bloombox, contains ketamine tablets you can take at home, along with sleeping mask and journal.Credit...Erica Gannett for The New York TimesA Promising Yet Unregulated IndustryMany ketamine providers, including Mindbloom, require clients to meet with a psychiatric clinician to ensure they are a good fit for the therapy. Mr.

Beynon said his company, which conducts these screenings remotely, turns away roughly 35 percent of those that apply — including people whose symptoms aren’t severe enough to warrant it or are too severe for at-home treatment. He declined to provide documentation to support this claim.However, this level of screening is not required by law and some patients just find a prescribing doctor online who will issue the drug through a private pharmacy with no other oversight.The potential for abuse is reason to be cautious about ketamine’s use outside of a carefully controlled clinical setting, said Dr. Rodriguez — particularly in clinics that may be providing higher doses than what has been studied.

€œThere is potentially this opioid effect, this rush, that taps into brain regions that may be susceptible to addiction,” she said.Ketamine’s impacts can also be transient, Dr. Berman said, meaning some patients may need to keep taking it — but most research has not looked at the long-term effects of ketamine therapy.There is one exception. In 2019 the Food and Drug Administration approved esketamine, a ketamine nasal spray, for the treatment of drug-resistant depression and suicidality.

This approval was given only after large, randomized, placebo-controlled trials, said Dr. Sanacora. This research also led to the creation of strict guidelines for use of the product — like conducting the therapy in a certified doctor’s office or clinic and monitoring a patient for two hours after treatment.“I am not sure why the same evaluation and management guidance isn’t being used for other forms of the treatment,” Dr.

Sanacora said.Dr. Rodriguez said she believed ketamine providers should be relying on a 2017 Consensus Statement issued by an American Psychiatric Association task force, of which both she and Dr. Sanacora are members.

The statement includes best practices for screening potential patients and for administering the drug — some of which would be difficult outside of a well-equipped clinical setting.Waiting For DataMost experts agree much more research about ketamine’s effectiveness in mental health is needed, and dozens of trials are currently underway globally.However, there are real barriers to new large-scale trials like those conducted with esketamine, said Dr. Berman, since pharmaceutical companies are unlikely to pay for research into a drug that can already be prescribed off label. €œThe nasal spray was new technology so there was a greater incentive for the private sector to invest in large trials,” he said.In the absence of this research, Dr.

Sanacora and others have suggested the creation of a registry — similar to the Risk Evaluation and Mitigation Strategy program, which the F.D.A. Requires for certain medications with serious safety concerns — to help gather data on side effects and how the drug is being administered.Some researchers believe this type of data, once gathered, could be used to develop better standards in the industry — and could even expand ketamine’s use, rather than restrict it.For instance, though ketamine has mostly been studied in drug-resistant patients, some believe it could prove to be an effective first-line treatment option for severe depression, said Dr. Berman, since its impacts are often felt immediately.

While more data is collected, Dr. Rodriguez said that plenty of patients are truly suffering. €œThey’re in such deep, deep pain,” she said.

€œAs long as patients understand the limits of current research and are able to make an informed decision with their clinical care team, shouldn’t they be allowed to weigh potential side effects against the deep pain that they’re in?. €David Dodge is a freelance writer focusing on health, wellness, parenting, travel and the L.G.B.T.Q. Community.AdvertisementContinue reading the main story.

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Credit. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb.

Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition.

In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition. The other authors on this paper were Ginette A.

Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an . These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow.

Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear. To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients with different tumor types.

Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

It’s one of those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a zithromax, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs.

€œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says. Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

Credit http://raindogmarketing.com/kamagra-online-uk-next-day-delivery/ purchase zithromax. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this purchase zithromax population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb.

Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, purchase zithromax a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in patients purchase zithromax with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition.

In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race purchase zithromax matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says purchase zithromax.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also purchase zithromax for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition. The other authors on this paper were Ginette purchase zithromax A.

Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational purchase zithromax burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by purchase zithromax Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New England Journal of purchase zithromax Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an . These medicines have had remarkable success in treating some types of cancers that historically purchase zithromax have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden of certain tumor types has previously been proposed as an purchase zithromax explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow.

Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear purchase zithromax. To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on purchase zithromax the mutational burden of thousands of tumor samples from patients with different tumor types.

Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer purchase zithromax. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

It’s one of those things that doesn’t purchase zithromax sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to purchase zithromax checkpoint inhibitors. However, he explains, this cancer type is often caused by a zithromax, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide purchase zithromax clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs.

€œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says. Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

What side effects may I notice from Zithromax?

Side effects that you should report to your prescriber or health care professional as soon as possible:

• dark yellow or brown urine;
• difficulty breathing; severe or watery diarrhea;
• skin rash, itching;
• irregular heartbeat, palpitations, or chest pain;
• vomiting;
• yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

• diarrhea;
• dizziness, drowsiness;
• hearing loss;
• headache;
• increased sensitivity to the sun;
• nausea;
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This list may not describe all possible side effects.

Biaxin vs zithromax

How to cite this biaxin vs zithromax article:Singh OP take a look at the site here. Psychiatry research in India. Closing the biaxin vs zithromax research gap. Indian J Psychiatry 2020;62:615-6Research is an important aspect of the growth and development of medical science. Research in India in general and medical research in particular is always being criticized for lack of biaxin vs zithromax innovation and originality required for the delivery of health services suitable to Indian conditions.

Even the Indian Council of Medical Research (ICMR) which is a centrally funded frontier organization for conducting medical research couldn't avert criticism. It has been criticized heavily for not producing quality research papers which are pioneering, ground breaking, or pragmatic solutions for health issues plaguing India. In the words of a leading daily, The ICMR could not even list one practical application of its hundreds of research papers published in various biaxin vs zithromax national and international research journals which helped cure any disease, or diagnose it with better accuracy or in less time, or even one new basic, applied or clinical research or innovation that opened a new frontier of scientific knowledge.[1]This clearly indicates that the health research output of ICMR is not up to the mark and is not commensurate with the magnitude of the disease burden in India. According to the 12th Plan Report, the country contributes to a fifth of the world's share of diseases. The research conducted elsewhere may not be generalized to the Indian population owing to differences in biology, health-care systems, health practices, culture, biaxin vs zithromax and socioeconomic standards.

Questions which are pertinent and specific to the Indian context may not be answered and will remain understudied. One of the vital elements in improving this situation is the need for relevant research base that would equip policymakers to take informed health policy decisions.The Parliamentary Standing Committee on Health and Family Welfare in the 100th report on Demand for Grants (2017–2018) of the Department of Health Research observed that “the biomedical research output needs to be augmented substantially to cater to the health challenges faced by the country.”[1]Among the various reasons, lack of fund, infrastructure, and resources is the prime cause which is glaringly evident from the inadequate budget allocation for biomedical research. While ICMR has a budget of 232 million dollars per year on health research, it biaxin vs zithromax is zilch in comparison to the annual budget expenditure of the National Institute of Health, USA, on biomedical research which is 32 billion dollars.The lacuna of quality research is not merely due to lack of funds. There are other important issues which need to be considered and sorted out to end the status quo. Some of the factors which need our immediate attention are:Lack of research training and teachingImproper allocation of research facilitiesLack of information about research work happening globallyLack of promotion, motivation, commitment, and passion in the field of researchClinicians being overburdened with patientsLack of collaboration between medical colleges and established research institutesLack of continuity of research in successive batches of postgraduate (PG) students, leading to wastage of previous research and resourcesDifficulty in the application of basic biomedical research into pragmatic intervention solutions due to lack of interdisciplinary technological support/collaboration between basic scientists, clinicians, and technological experts.Majority of the biomedical research in India are conducted in medical biaxin vs zithromax institutions.

The majority of these are done as thesis submission for fulfillment of the requirement of PG degree. From 2015 onward, publication of papers had been made an obligatory requirement for promotion of faculty to biaxin vs zithromax higher posts. Although it offered a unique opportunity for training of residents and stimulus for research, it failed to translate into production of quality research work as thesis was limited by time and it had to be done with other clinical and academic duties.While the top four medical colleges, namely AIIMS, New Delhi. PGIMER, Chandigarh. CMC, Vellore biaxin vs zithromax.

And SGIMS, Lucknow are among the top ten medical institutions in terms of publication in peer-reviewed journals, around 332 (57.3%) medical colleges have no research paper published in a decade between 2004 and 2014.[2]The research in psychiatry is realistically dominated by major research institutes which are doing commendable work, but there is a substantial lack of contemporary research originating from other centers. Dr. Chittaranjan Andrade (NIMHANS, Bengaluru) and Dr. K Jacob (CMC, Vellore) recently figured in the list of top 2% psychiatry researchers in the world from India in psychiatry.[3] Most of the research conducted in the field of psychiatry are limited to caregivers' burden, pathways of care, and other topics which can be done in limited resources available to psychiatry departments. While all these areas of work are important in providing proper care and treatment, there is overabundance of research in these areas.The Government of India is aggressively looking forward to enhancing the quality of research and is embarking on an ambitious project of purchasing all major journals and providing free access to universities across the country.

The India Genome Project started in January, 2020, is a good example of collaboration. While all these actions are laudable, a lot more needs to be done. Following are some measures which will reduce the gap:Research proposals at the level of protocol can be guided and mentored by institutes. Academic committees of different zones and journals can help in this endeavorBreaking the cubicles by establishing a collaboration between medical colleges and various institutes. While there is a lack of resources available in individual departments, there are universities and institutes with excellent infrastructure.

They are not aware of the requirements of the field of psychiatry and research questions. Creation of an alliance will enhance the quality of research work. Some of such institutes include Centre for Neuroscience, Indian Institute of Science, Bengaluru. CSIR-Institute of Genomics and Integrative Biology, New Delhi. And National Institute of Biomedical Genomics, KalyaniInitiation and establishment of interactive and stable relationships between basic scientists and clinical and technological experts will enhance the quality of research work and will lead to translation of basic biomedical research into real-time applications.

For example, work on artificial intelligence for mental health. Development of Apps by IITs. Genome India Project by the Government of India, genomic institutes, and social science and economic institutes working in the field of various aspects of mental healthUtilization of underutilized, well-equipped biotechnological labs of nonmedical colleges for furthering biomedical researchMedical colleges should collaborate with various universities which have labs providing testing facilities such as spectroscopy, fluoroscopy, gamma camera, scintigraphy, positron emission tomography, single photon emission computed tomography, and photoacoustic imagingCreating an interactive, interdepartmental, intradepartmental, and interinstitutional partnershipBy developing a healthy and ethical partnership with industries for research and development of new drugs and interventions.Walking the talk – the psychiatric fraternity needs to be proactive and rather than lamenting about the lack of resource, we should rise to the occasion and come out with innovative and original research proposals. With the implementation of collaborative approach, we can not only enhance and improve the quality of our research but to an extent also mitigate the effects of resource crunch and come up as a leader in the field of biomedical research. References 1.2.Nagoba B, Davane M.

Current status of medical research in India. Where are we?. Walawalkar Int Med J 2017;4:66-71. 3.Ioannidis JP, Boyack KW, Baas J. Updated science-wide author databases of standardized citation indicators.

PLoS Biol 2020;18:e3000918. Correspondence Address:Dr. Om Prakash SinghAA 304, Ashabari Apartments, O/31, Baishnabghata, Patuli Township, Kolkata - 700 094, West Bengal IndiaSource of Support. None, Conflict of Interest. NoneDOI.

10.4103/indianjpsychiatry.indianjpsychiatry_1362_2Abstract Background. The burden of mental illness among the scheduled tribe (ST) population in India is not known clearly.Aim. The aim was to identify and appraise mental health research studies on ST population in India and collate such data to inform future research.Materials and Methods. Studies published between January 1980 and December 2018 on STs by following exclusion and inclusion criteria were selected for analysis. PubMed, PsychINFO, Embase, Sociofile, Cinhal, and Google Scholar were systematically searched to identify relevant studies.

Quality of the included studies was assessed using an appraisal tool to assess the quality of cross-sectional studies and Critical Appraisal Checklist developed by Critical Appraisal Skills Programme. Studies were summarized and reported descriptively.Results. Thirty-two relevant studies were found and included in the review. Studies were categorized into the following three thematic areas. Alcohol and substance use disorders, common mental disorders and sociocultural aspects, and access to mental health-care services.

Sociocultural factors play a major role in understanding and determining mental disorders.Conclusion. This study is the first of its kind to review research on mental health among the STs. Mental health research conducted among STs in India is limited and is mostly of low-to-moderate quality. Determinants of poor mental health and interventions for addressing them need to be studied on an urgent basis.Keywords. India, mental health, scheduled tribesHow to cite this article:Devarapalli S V, Kallakuri S, Salam A, Maulik PK.

Mental health research on scheduled tribes in India. Indian J Psychiatry 2020;62:617-30 Introduction Mental health is a highly neglected area particularly in low and middle-income countries (LMIC). Data from community-based studies showed that about 10% of people suffer from common mental disorders (CMDs) such as depression, anxiety, and somatic complaints.[1] A systematic review of epidemiological studies between 1960 and 2009 in India reported that about 20% of the adult population in the community are affected by psychiatric disorders in the community, ranging from 9.5 to 103/1000 population, with differences in case definitions, and methods of data collection, accounting for most of the variation in estimates.[2]The scheduled tribes (ST) population is a marginalized community and live in relative social isolation with poorer health indices compared to similar nontribal populations.[3] There are an estimated 90 million STs or Adivasis in India.[4] They constitute 8.6% of the total Indian population. The distribution varies across the states and union territories of India, with the highest percentage in Lakshadweep (94.8%) followed by Mizoram (94.4%). In northeastern states, they constitute 65% or more of the total population.[5] The ST communities are identified as culturally or ethnographically unique by the Indian Constitution.

They are populations with poorer health indicators and fewer health-care facilities compared to non-ST rural populations, even when within the same state, and often live in demarcated geographical areas known as ST areas.[4]As per the National Family Health Survey, 2015–2016, the health indicators such as infant mortality rate (IMR) is 44.4, under five mortality rate (U5MR) is 57.2, and anemia in women is 59.8 for STs – one of the most disadvantaged socioeconomic groups in India, which are worse compared to other populations where IMR is 40.7, U5MR is 49.7, and anemia in women among others is 53.0 in the same areas.[6] Little research is available on the health of ST population. Tribal mental health is an ignored and neglected area in the field of health-care services. Further, little data are available about the burden of mental disorders among the tribal communities. Health research on tribal populations is poor, globally.[7] Irrespective of the data available, it is clear that they have worse health indicators and less access to health facilities.[8] Even less is known about the burden of mental disorders in ST population. It is also found that the traditional livelihood system of the STs came into conflict with the forces of modernization, resulting not only in the loss of customary rights over the livelihood resources but also in subordination and further, developing low self-esteem, causing great psychological stress.[4] This community has poor health infrastructure and even less mental health resources, and the situation is worse when compared to other communities living in similar areas.[9],[10]Only 15%–25% of those affected with mental disorders in LMICs receive any treatment for their mental illness,[11] resulting in a large “treatment gap.”[12] Treatment gaps are more in rural populations,[13] especially in ST communities in India, which have particularly poor infrastructure and resources for health-care delivery in general, and almost no capacity for providing mental health care.[14]The aim of this systematic review was to explore the extent and nature of mental health research on ST population in India and to identify gaps and inform future research.

Materials and Methods Search strategyWe searched major databases (PubMed, PsychINFO, Embase, Sociofile, Cinhal, and Google Scholar) and made hand searches from January 1980 to December 2018 to identify relevant literature. Hand search refers to searching through medical journals which are not indexed in the major electronic databases such as Embase, for instance, searching for Indian journals in IndMed database as most of these journals are not available in major databases. Physical search refers to searching the journals that were not available online or were not available online during the study years. We used relevant Medical Subject Heading and key terms in our search strategy, as follows. €œMental health,” “Mental disorders,” “Mental illness,” “Psychiatry,” “Scheduled Tribe” OR “Tribe” OR “Tribal Population” OR “Indigenous population,” “India,” “Psych*” (Psychiatric, psychological, psychosis).Inclusion criteriaStudies published between January 1980 and December 2018 were included.

Studies on mental disorders were included only when they focused on ST population. Both qualitative and quantitative studies on mental disorders of ST population only were included in the analysis.Exclusion criteriaStudies without any primary data and which are merely overviews and commentaries and those not focused on ST population were excluded from the analysis.Data management and analysisTwo researchers (SD and SK) initially screened the title and abstract of each record to identify relevant papers and subsequently screened full text of those relevant papers. Any disagreements between the researchers were resolved by discussion or by consulting with an adjudicator (PKM). From each study, data were extracted on objectives, study design, study population, study duration, interventions (if applicable), outcomes, and results. Quality of the included studies was assessed, independently by three researchers (SD, SK, and AS), using Critical Appraisal Checklist developed by Critical Appraisal Skills Programme (CASP).[15] After a thorough qualitative assessment, all quantitative data were generated and tabulated.

A narrative description of the studies is provided in [Table 1] using some broad categories. Results Search resultsOur search retrieved 2306 records (which included hand-searched articles), of which after removing duplicates, title and abstracts of 2278 records were screened. Of these, 178 studies were deemed as potentially relevant and were reviewed in detail. Finally, we excluded 146 irrelevant studies and 32 studies were included in the review [Figure 1].Quality of the included studiesSummary of quality assessment of the included studies is reported in [Table 2]. Overall, nine studies were of poor quality, twenty were of moderate quality, and three studies were of high quality.

The CASP shows that out of the 32 studies, the sample size of 21 studies was not representative, sample size of 7 studies was not justified, risk factors were not identified in 28 studies, methods used were not sufficiently described to repeat them in 24 studies, and nonresponse reasons were not addressed in 24 studies. The most common reasons for studies to be of poor-quality included sample size not justified. Sample is not representative. Nonresponse not addressed. Risk factors not measured correctly.

And methods used were not sufficiently described to repeat them. Studies under the moderate quality did not have a representative sample. Non-responders categories was not addressed. Risk factors were not measured correctly. And methods used were not sufficiently described to allow the study to be replicated by other researchers.The included studies covered three broad categories.

Alcohol and substance use disorders, CMD (depression, anxiety, stress, and suicide risk), socio-cultural aspects, and access to mental health services.Alcohol and substance use disordersFive studies reviewed the consumption of alcohol and opioid. In an ethnographic study conducted in three western districts in Rajasthan, 200 opium users were interviewed. Opium consumption was common among both younger and older males during nonharvest seasons. The common causes for using opium were relief of anxiety related to crop failure due to drought, stress, to get a high, be part of peers, and for increased sexual performance.[16]In a study conducted in Arunachal Pradesh involving a population of more than 5000 individuals, alcohol use was present in 30% and opium use in about 5% adults.[17] Contrary to that study, in Rajasthan, the prevalence of opium use was more in women and socioeconomic factors such as occupation, education, and marital status were associated with opium use.[16] The prevalence of opium use increased with age in both sexes, decreased with increasing education level, and increased with employment. It was observed that wages were used to buy opium.

In the entire region of Chamlang district of Arunachal Pradesh, female substance users were almost half of the males among ST population.[17] Types of substance used were tobacco, alcohol, and opium. Among tobacco users, oral tobacco use was higher than smoking. The prevalence of tobacco use was higher among males, but the prevalence of alcohol use was higher in females, probably due to increased access to homemade rice brew generally prepared by women. This study is unique in terms of finding a strong association with religion and culture with substance use.[18]Alcohol consumption among Paniyas of Wayanad district in Kerala is perceived as a male activity, with many younger people consuming it than earlier. A study concluded that alcohol consumption among them was less of a “choice” than a result of their conditions operating through different mechanisms.

In the past, drinking was traditionally common among elderly males, however the consumption pattern has changed as a significant number of younger men are now drinking. Drinking was clustered within families as fathers and sons drank together. Alcohol is easily accessible as government itself provides opportunities. Some employers would provide alcohol as an incentive to attract Paniya men to work for them.[19]In a study from Jharkhand, several ST community members cited reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement, as a reason for consuming alcohol. Societal acceptance of drinking alcohol and peer pressure, as well as high emotional problems, appeared to be the major etiology leading to higher prevalence of substance dependence in tribal communities.[20] Another study found high life time alcohol use prevalence, and the reasons mentioned were increased poverty, illiteracy, increased stress, and peer pressure.[21] A household survey from Chamlang district of Arunachal Pradesh revealed that there was a strong association between opium use and age, occupation, marital status, religion, and ethnicity among both the sexes of STs, particularly among Singhpho and Khamti.[15] The average age of onset of tobacco use was found to be 16.4 years for smoked and 17.5 years for smokeless forms in one study.[22]Common mental disorders and socio-cultural aspectsSuicide was more common among Idu Mishmi in Roing and Anini districts of Arunachal Pradesh state (14.2%) compared to the urban population in general (0.4%–4.2%).

Suicides were associated with depression, anxiety, alcoholism, and eating disorders. Of all the factors, depression was significantly high in people who attempted suicide.[24] About 5% out of 5007 people from thirty villages comprising ST suffered from CMDs in a study from West Godavari district in rural Andhra Pradesh. CMDs were defined as moderate/severe depression and/or anxiety, stress, and increased suicidal risk. Women had a higher prevalence of depression, but this may be due to the cultural norms, as men are less likely to express symptoms of depression or anxiety, which leads to underreporting. Marital status, education, and age were prominently associated with CMD.[14] In another study, gender, illiteracy, infant mortality in the household, having <3 adults living in the household, large family size with >four children, morbidity, and having two or more life events in the last year were associated with increased prevalence of CMD.[24] Urban and rural ST from the same community of Bhutias of Sikkim were examined, and it was found that the urban population experienced higher perceived stress compared to their rural counterparts.[25] Age, current use of alcohol, poor educational status, marital status, social groups, and comorbidities were the main determinants of tobacco use and nicotine dependence in a study from the Andaman and Nicobar Islands.[22] A study conducted among adolescents in the schools of rural areas of Ranchi district in Jharkhand revealed that about 5% children from the ST communities had emotional symptoms, 9.6% children had conduct problems, 4.2% had hyperactivity, and 1.4% had significant peer problems.[27] A study conducted among the female school teachers in Jharkhand examined the effects of stress, marital status, and ethnicity upon the mental health of school teachers.

The study found that among the three factors namely stress, marital status, and ethnicity, ethnicity was found to affect mental health of the school teachers most. It found a positive relationship between mental health and socioeconomic status, with an inverse relationship showing that as income increased, the prevalence of depression decreased.[28] A study among Ao-Nagas in Nagaland found that 74.6% of the population attributed mental health problems to psycho-social factors and a considerable proportion chose a psychiatrist or psychologist to overcome the problem. However, 15.4% attributed mental disorders to evil spirits. About 47% preferred to seek treatment with a psychiatrist and 25% preferred prayers. Nearly 10.6% wanted to seek the help of both the psychiatrist and prayer group and 4.4% preferred traditional healers.[28],[29] The prevalence of Down syndrome among the ST in Chikhalia in Barwani district of Madhya Pradesh was higher than that reported in overall India.

Three-fourth of the children were the first-born child. None of the parents of children with Down syndrome had consanguineous marriage or a history of Down syndrome, intellectual disability, or any other neurological disorder such as cerebral palsy and epilepsy in preceding generations. It is known that tribal population is highly impoverished and disadvantaged in several ways and suffer proportionately higher burden of nutritional and genetic disorders, which are potential factors for Down syndrome.[30]Access to mental health-care servicesIn a study in Ranchi district of Jharkhand, it was found that most people consulted faith healers rather than qualified medical practitioners. There are few mental health services in the regions.[31] Among ST population, there was less reliance and belief in modern medicine, and it was also not easily accessible, thus the health-care systems must be more holistic and take care of cultural and local health practices.[32]The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health project was implemented in thirty ST villages in West Godavari District of Andhra Pradesh. The key objectives were to use task sharing, training of primary health workers, implementing evidence-based clinical decision support tools on a mobile platform, and providing mental health services to rural population.

The study included 238 adults suffering from CMD. During the intervention period, 12.6% visited the primary health-care doctors compared to only 0.8% who had sought any care for their mental disorders prior to the intervention. The study also found a significant reduction in the depression and anxiety scores at the end of intervention and improvements in stigma perceptions related to mental health.[14] A study in Gudalur and Pandalur Taluks of Nilgiri district from Tamil Nadu used low cost task shifting by providing community education and identifying and referring individuals with psychiatric problems as effective strategies for treating mental disorders in ST communities. Through the program, the health workers established a network within the village, which in turn helped the patients to interact with them freely. Consenting patients volunteered at the educational sessions to discuss their experience about the effectiveness of their treatment.

Community awareness programs altered knowledge and attitudes toward mental illness in the community.[33] A study in Nilgiri district, Tamil Nadu, found that the community had been taking responsibility of the patients with the system by providing treatment closer to home without people having to travel long distances to access care. Expenses were reduced by subsidizing the costs of medicine and ensuring free hospital admissions and referrals to the people.[34] A study on the impact of gender, socioeconomic status, and age on mental health of female factory workers in Jharkhand found that the ST women were more likely to face stress and hardship in life due to diverse economic and household responsibilities, which, in turn, severely affected their mental health.[35] Prevalence of mental health morbidity in a study from the Sunderbans delta found a positive relation with psycho-social stressors and poor quality of life. The health system in that remote area was largely managed by “quack doctors” and faith healers. Poverty, illiteracy, and detachment from the larger community helped reinforce superstitious beliefs and made them seek both mental and physical health care from faith healers.[36] In a study among students, it was found that children had difficulties in adjusting to both ethnic and mainstream culture.[27] Low family income, inadequate housing, poor sanitation, and unhealthy and unhygienic living conditions were some environmental factors contributing to poor physical and mental growth of children. It was observed that children who did not have such risk factors maintained more intimate relations with the family members.

Children belonging to the disadvantaged environment expressed their verbal, emotional need, blame, and harm avoidances more freely than their counterparts belonging to less disadvantaged backgrounds. Although disadvantaged children had poor interfamilial interaction, they had better relations with the members outside family, such as peers, friends, and neighbors.[37] Another study in Jharkhand found that epilepsy was higher among ST patients compared to non-ST patients.[31] Most patients among the ST are irregular and dropout rates are higher among them than the non-ST patients. Urbanization per se exerted no adverse influence on the mental health of a tribal community, provided it allowed preservation of ethnic and cultural practices. Women in the ST communities were less vulnerable to mental illness than men. This might be a reflection of their increased responsibilities and enhanced gender roles that are characteristic of women in many ST communities.[38] Data obtained using culturally relevant scales revealed that relocated Sahariya suffer a lot of mental health problems, which are partially explained by livelihood and poverty-related factors.

The loss of homes and displacement compromise mental health, especially the positive emotional well-being related to happiness, life satisfaction, optimism for future, and spiritual contentment. These are often not overcome even with good relocation programs focused on material compensation and livelihood re-establishment.[39] Discussion This systematic review is to our knowledge the first on mental health of ST population in India. Few studies on the mental health of ST were available. All attempts including hand searching were made to recover both published peer-reviewed papers and reports available on the website. Though we searched gray literature, it may be possible that it does not capture all articles.

Given the heterogeneity of the papers, it was not possible to do a meta-analysis, so a narrative review was done.The quality of the studies was assessed by CASP. The assessment shows that the research conducted on mental health of STs needs to be carried out more effectively. The above mentioned gaps need to be filled in future research by considering the resources effectively while conducting the studies. Mental and substance use disorders contribute majorly to the health disparities. To address this, one needs to deliver evidence-based treatments, but it is important to understand how far these interventions for the indigenous populations can incorporate cultural practices, which are essential for the development of mental health services.[30] Evidence has shown a disproportionate burden of suicide among indigenous populations in national and regional studies, and a global and systematic investigation of this topic has not been undertaken to date.

Previous reviews of suicide epidemiology among indigenous populations have tended to be less comprehensive or not systematic, and have often focused on subpopulations such as youth, high-income countries, or regions such as Oceania or the Arctic.[46] The only studies in our review which provided data on suicide were in Idu Mishmi, an isolated tribal population of North-East India, and tribal communities from Sunderban delta.[24],[37] Some reasons for suicide in these populations could be the poor identification of existing mental disorders, increased alcohol use, extreme poverty leading to increased debt and hopelessness, and lack of stable employment opportunities.[24],[37] The traditional consumption pattern of alcohol has changed due to the reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement.[19],[20]Faith healers play a dominant role in treating mental disorders. There is less awareness about mental health and available mental health services and even if such knowledge is available, access is limited due to remoteness of many of these villages, and often it involves high out-of-pocket expenditure.[35] Practitioners of modern medicine can play a vital role in not only increasing awareness about mental health in the community, but also engaging with faith healers and traditional medicine practitioners to help increase their capacity to identify and manage CMDs that do not need medications and can be managed through simple “talk therapy.” Knowledge on symptoms of severe mental disorders can also help such faith healers and traditional medicine practitioners to refer cases to primary care doctors or mental health professionals.Remote settlements make it difficult for ST communities to seek mental health care. Access needs to be increased by using solutions that use training of primary health workers and nonphysician health workers, task sharing, and technology-enabled clinical decision support tools.[3] The SMART Mental Health project was delivered in the tribal areas of Andhra Pradesh using those principles and was found to be beneficial by all stakeholders.[14]Given the lack of knowledge about mental health problems among these communities, the government and nongovernmental organizations should collect and disseminate data on mental disorders among the ST communities. More research funding needs to be provided and key stakeholders should be involved in creating awareness both in the community and among policy makers to develop more projects for ST communities around mental health. Two recent meetings on tribal mental health – Round Table Meeting on Mental Health of ST Populations organized by the George Institute for Global Health, India, in 2017,[51] and the First National Conference on Tribal Mental Health organized by the Indian Psychiatric Society in Bhubaneswar in 2018 – have identified some key areas of research priority for mental health in ST communities.

A national-level policy on mental health of tribal communities or population is advocated which should be developed in consultation with key stakeholders. The Indian Psychiatric Society can play a role in coordinating research activities with support of the government which can ensure regular monitoring and dissemination of the research impact to the tribal communities. There is a need to understand how mental health symptoms are perceived in different ST communities and investigate the healing practices associated with distress/disaster/death/loss/disease. This could be done in the form of cross-sectional or cohort studies to generate proper evidence which could also include the information on prevalence, mental health morbidity, and any specific patterns associated with a specific disorder. Future research should estimate the prevalence of mental disorders in different age groups and gender, risk factors, and the influence of modernization.

Studies should develop a theoretical model to understand mental disorders and promote positive mental health within ST communities. Studies should also look at different ST communities as cultural differences exist across them, and there are also differences in socioeconomic status which impact on ability to access care.Research has shown that the impact and the benefits are amplified when research is driven by priorities that are identified by indigenous communities and involve their active participation. Their knowledge and perspectives are incorporated in processes and findings. Reporting of findings is meaningful to the communities. And indigenous groups and other key stakeholders are engaged from the outset.[47] Future research in India on ST communities should also adhere to these broad principles to ensure relevant and beneficial research, which have direct impact on the mental health of the ST communities.There is also a need to update literature related to mental health of ST population continuously.

Develop culturally appropriate validated instruments to measure mental morbidity relevant to ST population. And use qualitative research to investigate the perceptions and barriers for help-seeking behavior.[48] Conclusion The current review helps not only to collate the existing literature on the mental health of ST communities but also identify gaps in knowledge and provide some indications about the type of research that should be funded in future.Financial support and sponsorshipNil.Conflicts of interestThere are no conflicts of interest. References 1.Gururaj G, Girish N, Isaac MK. Mental. Neurological and Substance abuse disorders.

Strategies towards a systems approach. In. Burden of Disease in India. Equitable development – Healthy future New Delhi, India. National Commission on Macroeconomics and Health.

Ministry of Health and Family Welfare, Government of India. 2005. 2.Math SB, Srinivasaraju R. Indian Psychiatric epidemiological order zithromax without prescription studies. Learning from the past.

Indian J Psychiatry 2010;52:S95-103. 3.Tewari A, Kallakuri S, Devarapalli S, Jha V, Patel A, Maulik PK. Process evaluation of the systematic medical appraisal, referral and treatment (SMART) mental health project in rural India. BMC Psychiatry 2017;17:385. 4.Ministry of Tribal Affairs, Government of India.

Report of the High Level Committee on Socio-economic, Health and Educational Status of Tribal Communities of India. New Delhi. Government of India. 2014. 5.Office of the Registrar General and Census Commissioner, Census of India.

New Delhi. Office of the Registrar General and Census Commissioner. 2011. 6.International Institute for Population Sciences and ICF. National Family Health Survey (NFHS-4), 2015-16.

India, Mumbai. International Institute for Population Sciences. 2017. 7.World Health Organization. The World Health Report 2001-Mental Health.

New Understanding, New Hope. Geneva, Switzerland. World Health Organization. 2001. 8.Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, et al.

Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004;291:2581-90. 9.Ministry of Health and Family Welfare, Government of India and Ministry of Tribal Affairs, Report of the Expert Committee on Tribal Health. Tribal Health in India – Bridging the Gap and a Roadmap for the Future. New Delhi.

Government of India. 2013. 10.Government of India, Rural Health Statistics 2016-17. Ministry of Health and Family Welfare Statistics Division. 2017.

11.Ormel J, VonKorff M, Ustun TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA 1994;272:1741-8. 12.Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M, INDIGO Study Group.

Global pattern of experienced and anticipated discrimination against people with schizophrenia. A cross-sectional survey. Lancet 2009;373:408-15. 13.Armstrong G, Kermode M, Raja S, Suja S, Chandra P, Jorm AF. A mental health training program for community health workers in India.

Impact on knowledge and attitudes. Int J Ment Health Syst 2011;5:17. 14.Maulik PK, Kallakuri S, Devarapalli S, Vadlamani VS, Jha V, Patel A. Increasing use of mental health services in remote areas using mobile technology. A pre-post evaluation of the SMART Mental Health project in rural India.

J Global Health 2017;7:1-13. 15.16.Ganguly KK, Sharma HK, Krishnamachari KA. An ethnographic account of opium consumers of Rajasthan (India). Socio-medical perspective. Addiction 1995;90:9-12.

17.Chaturvedi HK, Mahanta J. Sociocultural diversity and substance use pattern in Arunachal Pradesh, India. Drug Alcohol Depend 2004;74:97-104. 18.Chaturvedi HK, Mahanta J, Bajpai RC, Pandey A. Correlates of opium use.

Retrospective analysis of a survey of tribal communities in Arunachal Pradesh, India. BMC Public Health 2013;13:325. 19.Mohindra KS, Narayana D, Anushreedha SS, Haddad S. Alcohol use and its consequences in South India. Views from a marginalised tribal population.

Drug Alcohol Depend 2011;117:70-3. 20.Sreeraj VS, Prasad S, Khess CR, Uvais NA. Reasons for substance use. A comparative study of alcohol use in tribals and non-tribals. Indian J Psychol Med 2012;34:242-6.

[PUBMED] [Full text] 21.Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders. Findings from the Global Burden of Disease Study 2010. Lancet 2013;382:1575-86. 22.Janakiram C, Joseph J, Vasudevan S, Taha F, DeepanKumar CV, Venkitachalam R.

Prevalence and dependancy of tobacco use in an indigenous population of Kerala, India. Oral Hygiene and Health 2016;4:1 23.Manimunda SP, Benegal V, Sugunan AP, Jeemon P, Balakrishna N, Thennarusu K, et al. Tobacco use and nicotine dependency in a cross-sectional representative sample of 18,018 individuals in Andaman and Nicobar Islands, India. BMC Public Health 2012;12:515. 24.Singh PK, Singh RK, Biswas A, Rao VR.

High rate of suicide attempt and associated psychological traits in an isolated tribal population of North-East India. J Affect Dis 2013;151:673-8. 25.Sushila J. Perception of Illness and Health Care among Bhils. A Study of Udaipur District in Southern Rajasthan.

2005. 26.Sobhanjan S, Mukhopadhyay B. Perceived psychosocial stress and cardiovascular risk. Observations among the Bhutias of Sikkim, India. Stress Health 2008;24:23-34.

27.Ali A, Eqbal S. Mental Health status of tribal school going adolescents. A study from rural community of Ranchi, Jharkhand. Telangana J Psychiatry 2016;2:38-41. 28.Diwan R.

Stress and mental health of tribal and non tribal female school teachers in Jharkhand, India. Int J Sci Res Publicat 2012;2:2250-3153. 29.Longkumer I, Borooah PI. Knowledge about attitudes toward mental disorders among Nagas in North East India. IOSR J Humanities Soc Sci 2013;15:41-7.

30.Lakhan R, Kishore MT. Down syndrome in tribal population in India. A field observation. J Neurosci Rural Pract 2016;7:40-3. [PUBMED] [Full text] 31.Nizamie HS, Akhtar S, Banerjee S, Goyal N.

Health care delivery model in epilepsy to reduce treatment gap. WHO study from a rural tribal population of India. Epilepsy Res Elsevier 2009;84:146-52. 32.Prabhakar H, Manoharan R. The Tribal Health Initiative model for healthcare delivery.

A clinical and epidemiological approach. Natl Med J India 2005;18:197-204. 33.Nimgaonkar AU, Menon SD. A task shifting mental health program for an impoverished rural Indian community. Asian J Psychiatr 2015;16:41-7.

34.Yalsangi M. Evaluation of a Community Mental Health Programme in a Tribal Area- South India. Achutha Menon Centre For Health Sciences Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Working Paper No 12. 2012. 35.Tripathy P, Nirmala N, Sarah B, Rajendra M, Josephine B, Shibanand R, et al.

Effect of a participatory intervention with women's groups on birth outcomes and maternal depression in Jharkhand and Orissa, India. A cluster-randomised controlled trial. Lancet 2010;375:1182-92. 36.Aparajita C, Anita KM, Arundhati R, Chetana P. Assessing Social-support network among the socio culturally disadvantaged children in India.

Early Child Develop Care 1996;121:37-47. 37.Chowdhury AN, Mondal R, Brahma A, Biswas MK. Eco-psychiatry and environmental conservation. Study from Sundarban Delta, India. Environ Health Insights 2008;2:61-76.

38.Jeffery GS, Chakrapani U. Eco-psychiatry and Environmental Conservation. Study from Sundarban Delta, India. Working Paper- Research Gate.net. September, 2016.

39.Ozer S, Acculturation, adaptation, and mental health among Ladakhi College Students a mixed methods study of an indigenous population. J Cross Cultl Psychol 2015;46:435-53. 40.Giri DK, Chaudhary S, Govinda M, Banerjee A, Mahto AK, Chakravorty PK. Utilization of psychiatric services by tribal population of Jharkhand through community outreach programme of RINPAS. Eastern J Psychiatry 2007;10:25-9.

41.Nandi DN, Banerjee G, Chowdhury AN, Banerjee T, Boral GC, Sen B. Urbanization and mental morbidity in certain tribal communities in West Bengal. Indian J Psychiatry 1992;34:334-9. [PUBMED] [Full text] 42.Hackett RJ, Sagdeo D, Creed FH. The physical and social associations of common mental disorder in a tribal population in South India.

Soc Psychiatry Psychiatr Epidemiol 2007;42:712-5. 43.Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A. Development of a cognitive screening instrument for tribal elderly population of Himalayan region in northern India. J Neurosci Rural Pract 2013;4:147-53. [PUBMED] [Full text] 44.Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A.

Identifying risk for dementia across populations. A study on the prevalence of dementia in tribal elderly population of Himalayan region in Northern India. Ann Indian Acad Neurol 2013;16:640-4. [PUBMED] [Full text] 45.Raina SK, Chander V, Raina S, Kumar D. Feasibility of using everyday abilities scale of India as alternative to mental state examination as a screen in two-phase survey estimating the prevalence of dementia in largely illiterate Indian population.

Indian J Psychiatry 2016;58:459-61. [PUBMED] [Full text] 46.Diwan R. Mental health of tribal male-female factory workers in Jharkhand. IJAIR 2012;2278:234-42. 47.Banerjee T, Mukherjee SP, Nandi DN, Banerjee G, Mukherjee A, Sen B, et al.

Psychiatric morbidity in an urbanized tribal (Santal) community - A field survey. Indian J Psychiatry 1986;28:243-8. [PUBMED] [Full text] 48.Leske S, Harris MG, Charlson FJ, Ferrari AJ, Baxter AJ, Logan JM, et al. Systematic review of interventions for Indigenous adults with mental and substance use disorders in Australia, Canada, New Zealand and the United States. Aust N Z J Psychiatry 2016;50:1040-54.

49.Pollock NJ, Naicker K, Loro A, Mulay S, Colman I. Global incidence of suicide among Indigenous peoples. A systematic review. BMC Med 2018;16:145. 50.Silburn K, et al.

Evaluation of the Cooperative Research Centre for Aboriginal Health (Australian institute for primary care, trans.). Melbourne. LaTrobe University. 2010. 51.

Correspondence Address:S V. Siddhardh Kumar DevarapalliGeorge Institute for Global Health, Plot No. 57, Second Floor, Corporation Bank Building, Nagarjuna Circle, Punjagutta, Hyderabad - 500 082, Telangana IndiaSource of Support. None, Conflict of Interest. NoneDOI.

10.4103/psychiatry.IndianJPsychiatry_136_19 Figures [Figure 1] Tables [Table 1], [Table 2].

How to purchase zithromax cite this article:Singh OP. Psychiatry research in India. Closing the purchase zithromax research gap. Indian J Psychiatry 2020;62:615-6Research is an important aspect of the growth and development of medical science. Research in India purchase zithromax in general and medical research in particular is always being criticized for lack of innovation and originality required for the delivery of health services suitable to Indian conditions.

Even the Indian Council of Medical Research (ICMR) which is a centrally funded frontier organization for conducting medical research couldn't avert criticism. It has been criticized heavily for not producing quality research papers which are pioneering, ground breaking, or pragmatic solutions for health issues plaguing India. In the words of a leading daily, The ICMR could not even list one practical application of its hundreds of research papers published in various national and international research journals which helped cure any disease, or diagnose it with better accuracy or in less time, or purchase zithromax even one new basic, applied or clinical research or innovation that opened a new frontier of scientific knowledge.[1]This clearly indicates that the health research output of ICMR is not up to the mark and is not commensurate with the magnitude of the disease burden in India. According to the 12th Plan Report, the country contributes to a fifth of the world's share of diseases. The research conducted elsewhere may not be generalized to the Indian population owing to purchase zithromax differences in biology, health-care systems, health practices, culture, and socioeconomic standards.

Questions which are pertinent and specific to the Indian context may not be answered and will remain understudied. One of the vital elements in improving this situation is the need for relevant research base that would equip policymakers to take informed health policy decisions.The Parliamentary Standing Committee on Health and Family Welfare in the 100th report on Demand for Grants (2017–2018) of the Department of Health Research observed that “the biomedical research output needs to be augmented substantially to cater to the health challenges faced by the country.”[1]Among the various reasons, lack of fund, infrastructure, and resources is the prime cause which is glaringly evident from the inadequate budget allocation for biomedical research. While ICMR purchase zithromax has a budget of 232 million dollars per year on health research, it is zilch in comparison to the annual budget expenditure of the National Institute of Health, USA, on biomedical research which is 32 billion dollars.The lacuna of quality research is not merely due to lack of funds. There are other important issues which need to be considered and sorted out to end the status quo. Some of the factors which need our immediate attention are:Lack of research training and teachingImproper allocation of research facilitiesLack of information about research work happening globallyLack of promotion, motivation, commitment, and passion in the field of researchClinicians being overburdened with patientsLack of collaboration between medical colleges and established research institutesLack of continuity of research in successive batches of postgraduate (PG) students, leading to wastage of previous research and resourcesDifficulty in the application of basic biomedical research into pragmatic intervention purchase zithromax solutions due to lack of interdisciplinary technological support/collaboration between basic scientists, clinicians, and technological experts.Majority of the biomedical research in India are conducted in medical institutions.

The majority of these are done as thesis submission for fulfillment of the requirement of PG degree. From 2015 onward, publication of papers had been made an obligatory requirement for promotion of faculty purchase zithromax to higher posts. Although it offered a unique opportunity for training of residents and stimulus for research, it failed to translate into production of quality research work as thesis was limited by time and it had to be done with other clinical and academic duties.While the top four medical colleges, namely AIIMS, New Delhi. PGIMER, Chandigarh. CMC, Vellore purchase zithromax.

And SGIMS, Lucknow are among the top ten medical institutions in terms of publication in peer-reviewed journals, around 332 (57.3%) medical colleges have no research paper published in a decade between 2004 and 2014.[2]The research in psychiatry is realistically dominated by major research institutes which are doing commendable work, but there is a substantial lack of contemporary research originating from other centers. Dr. Chittaranjan Andrade (NIMHANS, Bengaluru) and Dr. K Jacob (CMC, Vellore) recently figured in the list of top 2% psychiatry researchers in the world from India in psychiatry.[3] Most of the research conducted in the field of psychiatry are limited to caregivers' burden, pathways of care, and other topics which can be done in limited resources available to psychiatry departments. While all these areas of work are important in providing proper care and treatment, there is overabundance of research in these areas.The Government of India is aggressively looking forward to enhancing the quality of research and is embarking on an ambitious project of purchasing all major journals and providing free access to universities across the country.

The India Genome Project started in January, 2020, is a good example of collaboration. While all these actions are laudable, a lot more needs to be done. Following are some measures which will reduce the gap:Research proposals at the level of protocol can be guided and mentored by institutes. Academic committees of different zones and journals can help in this endeavorBreaking the cubicles by establishing a collaboration between medical colleges and various institutes. While there is a lack of resources available in individual departments, there are universities and institutes with excellent infrastructure.

They are not aware of the requirements of the field of psychiatry and research questions. Creation of an alliance will enhance the quality of research work. Some of such institutes include Centre for Neuroscience, Indian Institute of Science, Bengaluru. CSIR-Institute of Genomics and Integrative Biology, New Delhi. And National Institute of Biomedical Genomics, KalyaniInitiation and establishment of interactive and stable relationships between basic scientists and clinical and technological experts will enhance the quality of research work and will lead to translation of basic biomedical research into real-time applications.

For example, work on artificial intelligence for mental health. Development of Apps by IITs. Genome India Project by the Government of India, genomic institutes, and social science and economic institutes working in the field of various aspects of mental healthUtilization of underutilized, well-equipped biotechnological labs of nonmedical colleges for furthering biomedical researchMedical colleges should collaborate with various universities which have labs providing testing facilities such as spectroscopy, fluoroscopy, gamma camera, scintigraphy, positron emission tomography, single photon emission computed tomography, and photoacoustic imagingCreating an interactive, interdepartmental, intradepartmental, and interinstitutional partnershipBy developing a healthy and ethical partnership with industries for research and development of new drugs and interventions.Walking the talk – the psychiatric fraternity needs to be proactive and rather than lamenting about the lack of resource, we should rise to the occasion and come out with innovative and original research proposals. With the implementation of collaborative approach, we can not only enhance and improve the quality of our research but to an extent also mitigate the effects of resource crunch and come up as a leader in the field of biomedical research. References 1.2.Nagoba B, Davane M.

Current status of medical research in India. Where are we?. Walawalkar Int Med J 2017;4:66-71. 3.Ioannidis JP, Boyack KW, Baas J. Updated science-wide author databases of standardized citation indicators.

PLoS Biol 2020;18:e3000918. Correspondence Address:Dr. Om Prakash SinghAA 304, Ashabari Apartments, O/31, Baishnabghata, Patuli Township, Kolkata - 700 094, West Bengal IndiaSource of Support. None, Conflict of Interest. NoneDOI.

10.4103/indianjpsychiatry.indianjpsychiatry_1362_2Abstract Background. The burden of mental illness among the scheduled tribe (ST) population in India is not known clearly.Aim. The aim was to identify and appraise mental health research studies on ST population in India and collate such data to inform future research.Materials and Methods. Studies published between January 1980 and December 2018 on STs by following exclusion and inclusion criteria were selected for analysis. PubMed, PsychINFO, Embase, Sociofile, Cinhal, and Google Scholar were systematically searched to identify relevant studies.

Quality of the included studies was assessed using an appraisal tool to assess the quality of cross-sectional studies and Critical Appraisal Checklist developed by Critical Appraisal Skills Programme. Studies were summarized and reported descriptively.Results. Thirty-two relevant studies were found and included in the review. Studies were categorized into the following three thematic areas. Alcohol and substance use disorders, common mental disorders and sociocultural aspects, and access to mental health-care services.

Sociocultural factors play a major role in understanding and determining mental disorders.Conclusion. This study is the first of its kind to review research on mental health among the STs. Mental health research conducted among STs in India is limited and is mostly of low-to-moderate quality. Determinants of poor mental health and interventions for addressing them need to be studied on an urgent basis.Keywords. India, mental health, scheduled tribesHow to cite this article:Devarapalli S V, Kallakuri S, Salam A, Maulik PK.

Mental health research on scheduled tribes in India. Indian J Psychiatry 2020;62:617-30 Introduction Mental health is a highly neglected area particularly in low and middle-income countries (LMIC). Data from community-based studies showed that about 10% of people suffer from common mental disorders (CMDs) such as depression, anxiety, and somatic complaints.[1] A systematic review of epidemiological studies between 1960 and 2009 in India reported that about 20% of the adult population in the community are affected by psychiatric disorders in the community, ranging from 9.5 to 103/1000 population, with differences in case definitions, and methods of data collection, accounting for most of the variation in estimates.[2]The scheduled tribes (ST) population is a marginalized community and live in relative social isolation with poorer health indices compared to similar nontribal populations.[3] There are an estimated 90 million STs or Adivasis in India.[4] They constitute 8.6% of the total Indian population. The distribution varies across the states and union territories of India, with the highest percentage in Lakshadweep (94.8%) followed by Mizoram (94.4%). In northeastern states, they constitute 65% or more of the total population.[5] The ST communities are identified as culturally or ethnographically unique by the Indian Constitution.

They are populations with poorer health indicators and fewer health-care facilities compared to non-ST rural populations, even when within the same state, and often live in demarcated geographical areas known as ST areas.[4]As per the National Family Health Survey, 2015–2016, the health indicators such as infant mortality rate (IMR) is 44.4, under five mortality rate (U5MR) is 57.2, and anemia in women is 59.8 for STs – one of the most disadvantaged socioeconomic groups in India, which are worse compared to other populations where IMR is 40.7, U5MR is 49.7, and anemia in women among others is 53.0 in the same areas.[6] Little research is available on the health of ST population. Tribal mental health is an ignored and neglected area in the field of health-care services. Further, little data are available about the burden of mental disorders among the tribal communities. Health research on tribal populations is poor, globally.[7] Irrespective of the data available, it is clear that they have worse health indicators and less access to health facilities.[8] Even less is known about the burden of mental disorders in ST population. It is also found that the traditional livelihood system of the STs came into conflict with the forces of modernization, resulting not only in the loss of customary rights over the livelihood resources but also in subordination and further, developing low self-esteem, causing great psychological stress.[4] This community has poor health infrastructure and even less mental health resources, and the situation is worse when compared to other communities living in similar areas.[9],[10]Only 15%–25% of those affected with mental disorders in LMICs receive any treatment for their mental illness,[11] resulting in a large “treatment gap.”[12] Treatment gaps are more in rural populations,[13] especially in ST communities in India, which have particularly poor infrastructure and resources for health-care delivery in general, and almost no capacity for providing mental health care.[14]The aim of this systematic review was to explore the extent and nature of mental health research on ST population in India and to identify gaps and inform future research.

Materials and Methods Search strategyWe searched major databases (PubMed, PsychINFO, Embase, Sociofile, Cinhal, and Google Scholar) and made hand searches from January 1980 to December 2018 to identify relevant literature. Hand search refers to searching through medical journals which are not indexed in the major electronic databases such as Embase, for instance, searching for Indian journals in IndMed database as most of these journals are not available in major databases. Physical search refers to searching the journals that were not available online or were not available online during the study years. We used relevant Medical Subject Heading and key terms in our search strategy, as follows. €œMental health,” “Mental disorders,” “Mental illness,” “Psychiatry,” “Scheduled Tribe” OR “Tribe” OR “Tribal Population” OR “Indigenous population,” “India,” “Psych*” (Psychiatric, psychological, psychosis).Inclusion criteriaStudies published between January 1980 and December 2018 were included.

Studies on mental disorders were included only when they focused on ST population. Both qualitative and quantitative studies on mental disorders of ST population only were included in the analysis.Exclusion criteriaStudies without any primary data and which are merely overviews and commentaries and those not focused on ST population were excluded from the analysis.Data management and analysisTwo researchers (SD and SK) initially screened the title and abstract of each record to identify relevant papers and subsequently screened full text of those relevant papers. Any disagreements between the researchers were resolved by discussion or by consulting with an adjudicator (PKM). From each study, data were extracted on objectives, study design, study population, study duration, interventions (if applicable), outcomes, and results. Quality of the included studies was assessed, independently by three researchers (SD, SK, and AS), using Critical Appraisal Checklist developed by Critical Appraisal Skills Programme (CASP).[15] After a thorough qualitative assessment, all quantitative data were generated and tabulated.

A narrative description of the studies is provided in [Table 1] using some broad categories. Results Search resultsOur search retrieved 2306 records (which included hand-searched articles), of which after removing duplicates, title and abstracts of 2278 records were screened. Of these, 178 studies were deemed as potentially relevant and were reviewed in detail. Finally, we excluded 146 irrelevant studies and 32 studies were included in the review [Figure 1].Quality of the included studiesSummary of quality assessment of the included studies is reported in [Table 2]. Overall, nine studies were of poor quality, twenty were of moderate quality, and three studies were of high quality.

The CASP shows that out of the 32 studies, the sample size of 21 studies was not representative, sample size of 7 studies was not justified, risk factors were not identified in 28 studies, methods used were not sufficiently described to repeat them in 24 studies, and nonresponse reasons were not addressed in 24 studies. The most common reasons for studies to be of poor-quality included sample size not justified. Sample is not representative. Nonresponse not addressed. Risk factors not measured correctly.

And methods used were not sufficiently described to repeat them. Studies under the moderate quality did not have a representative sample. Non-responders categories was not addressed. Risk factors were not measured correctly. And methods used were not sufficiently described to allow the study to be replicated by other researchers.The included studies covered three broad categories.

Alcohol and substance use disorders, CMD (depression, anxiety, stress, and suicide risk), socio-cultural aspects, and access to mental health services.Alcohol and substance use disordersFive studies reviewed the consumption of alcohol and opioid. In an ethnographic study conducted in three western districts in Rajasthan, 200 opium users were interviewed. Opium consumption was common among both younger and older males during nonharvest seasons. The common causes for using opium were relief of anxiety related to crop failure due to drought, stress, to get a high, be part of peers, and for increased sexual performance.[16]In a study conducted in Arunachal Pradesh involving a population of more than 5000 individuals, alcohol use was present in 30% and opium use in about 5% adults.[17] Contrary to that study, in Rajasthan, the prevalence of opium use was more in women and socioeconomic factors such as occupation, education, and marital status were associated with opium use.[16] The prevalence of opium use increased with age in both sexes, decreased with increasing education level, and increased with employment. It was observed that wages were used to buy opium.

In the entire region of Chamlang district of Arunachal Pradesh, female substance users were almost half of the males among ST population.[17] Types of substance used were tobacco, alcohol, and opium. Among tobacco users, oral tobacco use was higher than smoking. The prevalence of tobacco use was higher among males, but the prevalence of alcohol use was higher in females, probably due to increased access to homemade rice brew generally prepared by women. This study is unique in terms of finding a strong association with religion and culture with substance use.[18]Alcohol consumption among Paniyas of Wayanad district in Kerala is perceived as a male activity, with many younger people consuming it than earlier. A study concluded that alcohol consumption among them was less of a “choice” than a result of their conditions operating through different mechanisms.

In the past, drinking was traditionally common among elderly males, however the consumption pattern has changed as a significant number of younger men are now drinking. Drinking was clustered within families as fathers and sons drank together. Alcohol is easily accessible as government itself provides opportunities. Some employers would provide alcohol as an incentive to attract Paniya men to work for them.[19]In a study from Jharkhand, several ST community members cited reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement, as a reason for consuming alcohol. Societal acceptance of drinking alcohol and peer pressure, as well as high emotional problems, appeared to be the major etiology leading to higher prevalence of substance dependence in tribal communities.[20] Another study found high life time alcohol use prevalence, and the reasons mentioned were increased poverty, illiteracy, increased stress, and peer pressure.[21] A household survey from Chamlang district of Arunachal Pradesh revealed that there was a strong association between opium use and age, occupation, marital status, religion, and ethnicity among both the sexes of STs, particularly among Singhpho and Khamti.[15] The average age of onset of tobacco use was found to be 16.4 years for smoked and 17.5 years for smokeless forms in one study.[22]Common mental disorders and socio-cultural aspectsSuicide was more common among Idu Mishmi in Roing and Anini districts of Arunachal Pradesh state (14.2%) compared to the urban population in general (0.4%–4.2%).

Suicides were associated with depression, anxiety, alcoholism, and eating disorders. Of all the factors, depression was significantly high in people who attempted suicide.[24] About 5% out of 5007 people from thirty villages comprising ST suffered from CMDs in a study from West Godavari district in rural Andhra Pradesh. CMDs were defined as moderate/severe depression and/or anxiety, stress, and increased suicidal risk. Women had a higher prevalence of depression, but this may be due to the cultural norms, as men are less likely to express symptoms of depression or anxiety, which leads to underreporting. Marital status, education, and age were prominently associated with CMD.[14] In another study, gender, illiteracy, infant mortality in the household, having <3 adults living in the household, large family size with >four children, morbidity, and having two or more life events in the last year were associated with increased prevalence of CMD.[24] Urban and rural ST from the same community of Bhutias of Sikkim were examined, and it was found that the urban population experienced higher perceived stress compared to their rural counterparts.[25] Age, current use of alcohol, poor educational status, marital status, social groups, and comorbidities were the main determinants of tobacco use and nicotine dependence in a study from the Andaman and Nicobar Islands.[22] A study conducted among adolescents in the schools of rural areas of Ranchi district in Jharkhand revealed that about 5% children from the ST communities had emotional symptoms, 9.6% children had conduct problems, 4.2% had hyperactivity, and 1.4% had significant peer problems.[27] A study conducted among the female school teachers in Jharkhand examined the effects of stress, marital status, and ethnicity upon the mental health of school teachers.

The study found that among the three factors namely stress, marital status, and ethnicity, ethnicity was found to affect mental health of the school teachers most. It found a positive relationship between mental health and socioeconomic status, with an inverse relationship showing that as income increased, the prevalence of depression decreased.[28] A study among Ao-Nagas in Nagaland found that 74.6% of the population attributed mental health problems to psycho-social factors and a considerable proportion chose a psychiatrist or psychologist to overcome the problem. However, 15.4% attributed mental disorders to evil spirits. About 47% preferred to seek treatment with a psychiatrist and 25% preferred prayers. Nearly 10.6% wanted to seek the help of both the psychiatrist and prayer group and 4.4% preferred traditional healers.[28],[29] The prevalence of Down syndrome among the ST in Chikhalia in Barwani district of Madhya Pradesh was higher than that reported in overall India.

Three-fourth of the children were the first-born child. None of the parents of children with Down syndrome had consanguineous marriage or a history of Down syndrome, intellectual disability, or any other neurological disorder such as cerebral palsy and epilepsy in preceding generations. It is known that tribal population is highly impoverished and disadvantaged in several ways and suffer proportionately higher burden of nutritional and genetic disorders, which are potential factors for Down syndrome.[30]Access to mental health-care servicesIn a study in Ranchi district of Jharkhand, it was found that most people consulted faith healers rather than qualified medical practitioners. There are few mental health services in the regions.[31] Among ST population, there was less reliance and belief in modern medicine, and it was also not easily accessible, thus the health-care systems must be more holistic and take care of cultural and local health practices.[32]The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health project was implemented in thirty ST villages in West Godavari District of Andhra Pradesh. The key objectives were to use task sharing, training of primary health workers, implementing evidence-based clinical decision support tools on a mobile platform, and providing mental health services to rural population.

The study included 238 adults suffering from CMD. During the intervention period, 12.6% visited the primary health-care doctors compared to only 0.8% who had sought any care for their mental disorders prior to the intervention. The study also found a significant reduction in the depression and anxiety scores at the end of intervention and improvements in stigma perceptions related to mental health.[14] A study in Gudalur and Pandalur Taluks of Nilgiri district from Tamil Nadu used low cost task shifting by providing community education and identifying and referring individuals with psychiatric problems as effective strategies for treating mental disorders in ST communities. Through the program, the health workers established a network within the village, which in turn helped the patients to interact with them freely. Consenting patients volunteered at the educational sessions to discuss their experience about the effectiveness of their treatment.

Community awareness programs altered knowledge and attitudes toward mental illness in the community.[33] A study in Nilgiri district, Tamil Nadu, found that the community had been taking responsibility of the patients with the system by providing treatment closer to home without people having to travel long distances to access care. Expenses were reduced by subsidizing the costs of medicine and ensuring free hospital admissions and referrals to the people.[34] A study on the impact of gender, socioeconomic status, and age on mental health of female factory workers in Jharkhand found that the ST women were more likely to face stress and hardship in life due to diverse economic and household responsibilities, which, in turn, severely affected their mental health.[35] Prevalence of mental health morbidity in a study from the Sunderbans delta found a positive relation with psycho-social stressors and poor quality of life. The health system in that remote area was largely managed by “quack doctors” and faith healers. Poverty, illiteracy, and detachment from the larger community helped reinforce superstitious beliefs and made them seek both mental and physical health care from faith healers.[36] In a study among students, it was found that children had difficulties in adjusting to both ethnic and mainstream culture.[27] Low family income, inadequate housing, poor sanitation, and unhealthy and unhygienic living conditions were some environmental factors contributing to poor physical and mental growth of children. It was observed that children who did not have such risk factors maintained more intimate relations with the family members.

Children belonging to the disadvantaged environment expressed their verbal, emotional need, blame, and harm avoidances more freely than their counterparts belonging to less disadvantaged backgrounds. Although disadvantaged children had poor interfamilial interaction, they had better relations with the members outside family, such as peers, friends, and neighbors.[37] Another study in Jharkhand found that epilepsy was higher among ST patients compared to non-ST patients.[31] Most patients among the ST are irregular and dropout rates are higher among them than the non-ST patients. Urbanization per se exerted no adverse influence on the mental health of a tribal community, provided it allowed preservation of ethnic and cultural practices. Women in the ST communities were less vulnerable to mental illness than men. This might be a reflection of their increased responsibilities and enhanced gender roles that are characteristic of women in many ST communities.[38] Data obtained using culturally relevant scales revealed that relocated Sahariya suffer a lot of mental health problems, which are partially explained by livelihood and poverty-related factors.

The loss of homes and displacement compromise mental health, especially the positive emotional well-being related to happiness, life satisfaction, optimism for future, and spiritual contentment. These are often not overcome even with good relocation programs focused on material compensation and livelihood re-establishment.[39] Discussion This systematic review is to our knowledge the first on mental health of ST population in India. Few studies on the mental health of ST were available. All attempts including hand searching were made to recover both published peer-reviewed papers and reports available on the website. Though we searched gray literature, it may be possible that it does not capture all articles.

Given the heterogeneity of the papers, it was not possible to do a meta-analysis, so a narrative review was done.The quality of the studies was assessed by CASP. The assessment shows that the research conducted on mental health of STs needs to be carried out more effectively. The above mentioned gaps need to be filled in future research by considering the resources effectively while conducting the studies. Mental and substance use disorders contribute majorly to the health disparities. To address this, one needs to deliver evidence-based treatments, but it is important to understand how far these interventions for the indigenous populations can incorporate cultural practices, which are essential for the development of mental health services.[30] Evidence has shown a disproportionate burden of suicide among indigenous populations in national and regional studies, and a global and systematic investigation of this topic has not been undertaken to date.

Previous reviews of suicide epidemiology among indigenous populations have tended to be less comprehensive or not systematic, and have often focused on subpopulations such as youth, high-income countries, or regions such as Oceania or the Arctic.[46] The only studies in our review which provided data on suicide were in Idu Mishmi, an isolated tribal population of North-East India, and tribal communities from Sunderban delta.[24],[37] Some reasons for suicide in these populations could be the poor identification of existing mental disorders, increased alcohol use, extreme poverty leading to increased debt and hopelessness, and lack of stable employment opportunities.[24],[37] The traditional consumption pattern of alcohol has changed due to the reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement.[19],[20]Faith healers play a dominant role in treating mental disorders. There is less awareness about mental health and available mental health services and even if such knowledge is available, access is limited due to remoteness of many of these villages, and often it involves high out-of-pocket expenditure.[35] Practitioners of modern medicine can play a vital role in not only increasing awareness about mental health in the community, but also engaging with faith healers and traditional medicine practitioners to help increase their capacity to identify and manage CMDs that do not need medications and can be managed through simple “talk therapy.” Knowledge on symptoms of severe mental disorders can also help such faith healers and traditional medicine practitioners to refer cases to primary care doctors or mental health professionals.Remote settlements make it difficult for ST communities to seek mental health care. Access needs to be increased by using solutions that use training of primary health workers and nonphysician health workers, task sharing, and technology-enabled clinical decision support tools.[3] The SMART Mental Health project was delivered in the tribal areas of Andhra Pradesh using those principles and was found to be beneficial by all stakeholders.[14]Given the lack of knowledge about mental health problems among these communities, the government and nongovernmental organizations should collect and disseminate data on mental disorders among the ST communities. More research funding needs to be provided and key stakeholders should be involved in creating awareness both in the community and among policy makers to develop more projects for ST communities around mental health. Two recent meetings on tribal mental health – Round Table Meeting on Mental Health of ST Populations organized by the George Institute for Global Health, India, in 2017,[51] and the First National Conference on Tribal Mental Health organized by the Indian Psychiatric Society in Bhubaneswar in 2018 – have identified some key areas of research priority for mental health in ST communities.

A national-level policy on mental health of tribal communities or population is advocated which should be developed in consultation with key stakeholders. The Indian Psychiatric Society can play a role in coordinating research activities with support of the government which can ensure regular monitoring and dissemination of the research impact to the tribal communities. There is a need to understand how mental health symptoms are perceived in different ST communities and investigate the healing practices associated with distress/disaster/death/loss/disease. This could be done in the form of cross-sectional or cohort studies to generate proper evidence which could also include the information on prevalence, mental health morbidity, and any specific patterns associated with a specific disorder. Future research should estimate the prevalence of mental disorders in different age groups and gender, risk factors, and the influence of modernization.

Studies should develop a theoretical model to understand mental disorders and promote positive mental health within ST communities. Studies should also look at different ST communities as cultural differences exist across them, and there are also differences in socioeconomic status which impact on ability to access care.Research has shown that the impact and the benefits are amplified when research is driven by priorities that are identified by indigenous communities and involve their active participation. Their knowledge and perspectives are incorporated in processes and findings. Reporting of findings is meaningful to the communities. And indigenous groups and other key stakeholders are engaged from the outset.[47] Future research in India on ST communities should also adhere to these broad principles to ensure relevant and beneficial research, which have direct impact on the mental health of the ST communities.There is also a need to update literature related to mental health of ST population continuously.

Develop culturally appropriate validated instruments to measure mental morbidity relevant to ST population. And use qualitative research to investigate the perceptions and barriers for help-seeking behavior.[48] Conclusion The current review helps not only to collate the existing literature on the mental health of ST communities but also identify gaps in knowledge and provide some indications about the type of research that should be funded in future.Financial support and sponsorshipNil.Conflicts of interestThere are no conflicts of interest. References 1.Gururaj G, Girish N, Isaac MK. Mental. Neurological and Substance abuse disorders.

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Indian J Psychiatry 2010;52:S95-103. 3.Tewari A, Kallakuri S, Devarapalli S, Jha V, Patel A, Maulik PK. Process evaluation of the systematic medical appraisal, referral and treatment (SMART) mental health project in rural India. BMC Psychiatry 2017;17:385. 4.Ministry of Tribal Affairs, Government of India.

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Global pattern of experienced and anticipated discrimination against people with schizophrenia. A cross-sectional survey. Lancet 2009;373:408-15. 13.Armstrong G, Kermode M, Raja S, Suja S, Chandra P, Jorm AF. A mental health training program for community health workers in India.

Impact on knowledge and attitudes. Int J Ment Health Syst 2011;5:17. 14.Maulik PK, Kallakuri S, Devarapalli S, Vadlamani VS, Jha V, Patel A. Increasing use of mental health services in remote areas using mobile technology. A pre-post evaluation of the SMART Mental Health project in rural India.

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Prevalence and dependancy of tobacco use in an indigenous population of Kerala, India. Oral Hygiene and Health 2016;4:1 23.Manimunda SP, Benegal V, Sugunan AP, Jeemon P, Balakrishna N, Thennarusu K, et al. Tobacco use and nicotine dependency in a cross-sectional representative sample of 18,018 individuals in Andaman and Nicobar Islands, India. BMC Public Health 2012;12:515. 24.Singh PK, Singh RK, Biswas A, Rao VR.

High rate of suicide attempt and associated psychological traits in an isolated tribal population of North-East India. J Affect Dis 2013;151:673-8. 25.Sushila J. Perception of Illness and Health Care among Bhils. A Study of Udaipur District in Southern Rajasthan.

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27.Ali A, Eqbal S. Mental Health status of tribal school going adolescents. A study from rural community of Ranchi, Jharkhand. Telangana J Psychiatry 2016;2:38-41. 28.Diwan R.

Stress and mental health of tribal and non tribal female school teachers in Jharkhand, India. Int J Sci Res Publicat 2012;2:2250-3153. 29.Longkumer I, Borooah PI. Knowledge about attitudes toward mental disorders among Nagas in North East India. IOSR J Humanities Soc Sci 2013;15:41-7.

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Effect of a participatory intervention with women's groups on birth outcomes and maternal depression in Jharkhand and Orissa, India. A cluster-randomised controlled trial. Lancet 2010;375:1182-92. 36.Aparajita C, Anita KM, Arundhati R, Chetana P. Assessing Social-support network among the socio culturally disadvantaged children in India.

Early Child Develop Care 1996;121:37-47. 37.Chowdhury AN, Mondal R, Brahma A, Biswas MK. Eco-psychiatry and environmental conservation. Study from Sundarban Delta, India. Environ Health Insights 2008;2:61-76.

38.Jeffery GS, Chakrapani U. Eco-psychiatry and Environmental Conservation. Study from Sundarban Delta, India. Working Paper- Research Gate.net. September, 2016.

39.Ozer S, Acculturation, adaptation, and mental health among Ladakhi College Students a mixed methods study of an indigenous population. J Cross Cultl Psychol 2015;46:435-53. 40.Giri DK, Chaudhary S, Govinda M, Banerjee A, Mahto AK, Chakravorty PK. Utilization of psychiatric services by tribal population of Jharkhand through community outreach programme of RINPAS. Eastern J Psychiatry 2007;10:25-9.

41.Nandi DN, Banerjee G, Chowdhury AN, Banerjee T, Boral GC, Sen B. Urbanization and mental morbidity in certain tribal communities in West Bengal. Indian J Psychiatry 1992;34:334-9. [PUBMED] [Full text] 42.Hackett RJ, Sagdeo D, Creed FH. The physical and social associations of common mental disorder in a tribal population in South India.

Soc Psychiatry Psychiatr Epidemiol 2007;42:712-5. 43.Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A. Development of a cognitive screening instrument for tribal elderly population of Himalayan region in northern India. J Neurosci Rural Pract 2013;4:147-53. [PUBMED] [Full text] 44.Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A.

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Psychiatric morbidity in an urbanized tribal (Santal) community - A field survey. Indian J Psychiatry 1986;28:243-8. [PUBMED] [Full text] 48.Leske S, Harris MG, Charlson FJ, Ferrari AJ, Baxter AJ, Logan JM, et al. Systematic review of interventions for Indigenous adults with mental and substance use disorders in Australia, Canada, New Zealand and the United States. Aust N Z J Psychiatry 2016;50:1040-54.

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Evaluation of the Cooperative Research Centre for Aboriginal Health (Australian institute for primary care, trans.). Melbourne. LaTrobe University. 2010. 51.

Correspondence Address:S V. Siddhardh Kumar DevarapalliGeorge Institute for Global Health, Plot No. 57, Second Floor, Corporation Bank Building, Nagarjuna Circle, Punjagutta, Hyderabad - 500 082, Telangana IndiaSource of Support. None, Conflict of Interest. NoneDOI.

10.4103/psychiatry.IndianJPsychiatry_136_19 Figures [Figure 1] Tables [Table 1], [Table 2].

Zithromax dosage for gonorrhea

Epinephrine dose and flush volumeEvidence for the efficacy and optimal administration zithromax dosage for gonorrhea of epinephrine during neonatal resuscitation http://ptandpilates.com/cialis-internet-purchase is hard to come by. Deepika Sankaran and colleagues performed a randomised study to model the use of epinephrine in a complex resuscitation situation that was based on the NRP algorithm. They studied newborn lambs that had been asphyxiated to the point of cardiac arrest by umbilical cord zithromax dosage for gonorrhea clamping before delivery. Five minutes after cardiac arrest positive pressure ventilation was provided and 1 min later chest compressions were provided and the FiO2 was increased to 1.0.

Epinephrine was administered into an umbilical venous catheter 5 min after the onset of resuscitation. Epinephrine doses of 0.01 mg/kg and 0.03 mg/kg were compared and flush volumes of 1 mL or 3 mL were compared in randomised groups zithromax dosage for gonorrhea. Epinephrine was repeated at the same dose every 3 min until return of spontaneous circulation. The higher dose of epinephrine was more effective than the zithromax dosage for gonorrhea lower dose and, with either dose, the response was better after the higher flush volume.

The higher flush volume may be more effective at ensuring that the drug gets as far as the right atrium. See page F578Thermal management immediately after birth with and without servo-controlFrancesco Cavallin and colleagues performed a randomised controlled study in 15 Italian tertiary hospitals. They studied infants with estimated birthweight <1500 g or gestation zithromax dosage for gonorrhea <30+6 weeks. In one group manually adjusted thermal control was provided during initial stabilisation, with the heater set on full.

In the other group servo control was used. There were 450 infants in the zithromax dosage for gonorrhea study. There was no difference in the rate of normothermia (temperature 36.5–37.5 C) at the time of neonatal unit admission. All infants zithromax dosage for gonorrhea were placed in plastic bags.

Normothermia rates were relatively low in both groups (39.6% and 42.2%), with hypothermia being more frequent. Very few infants were hyperthermic. Servo control zithromax dosage for gonorrhea of temperature during initial stabilisation offered no advantage. Low normothermia rates show that initial thermal care is a complex dynamic process challenge that is not solved simply by choice of equipment.

See page F572Osteopathic manipulative treatment to improve breast feedingIt is unusual for the Fetal and Neonatal Edition to receive a trial of a complimentary therapy. Osteopathic manipulative treatment (OMT) has been used to treat various health issues, including zithromax dosage for gonorrhea breastfeeding difficulties. Marie Danielo Jouhier and colleagues performed a double blinded randomised controlled trial. Mother baby dyads were eligible if there was suboptimal breastfeeding behaviour, maternal cracked nipples or maternal pain zithromax dosage for gonorrhea.

The intervention consisted of two sessions of early OMT. To preserve blinding the manipulations were performed behind a screen. The primary zithromax dosage for gonorrhea outcome was the exclusive breastfeeding rate at 1 month. There was no significant difference in the primary outcome, OMT 31/59 (53%), control 39/59 (66%).

The trial does not support the use of OMT for zithromax dosage for gonorrhea this indication. See page F591Time to desaturation during endotracheal intubationRadhika Kothari and colleagues measured the time from the last application of positive pressure until desaturation <90% SpO2 in preterm infants<32 weeks’ gestation who were being electively intubated in the neonatal unit with pre-medication. There were 78 infants in the study and 73/78 desaturated to below 90% in a median of 22 s. The infants who desaturated to below 80% took a median 35 s to zithromax dosage for gonorrhea do so.

As these were planned intubations in the neonatal unit, the times taken to desaturate may be longer than they would be for delivery room intubations, where the unrecruited lungs would not provide a reservoir of oxygen pending intubation success. The information may assist with the generation of guidelines. See page F603Parenteral lipid emulsions in the preterm infantLauren Frazer and Camilla Martin review current the current evidence and physiological considerations around how to use parenteral lipid emulsions as zithromax dosage for gonorrhea part of parenteral nutrition for preterm infants. As with so many areas of current practice, the evidence is weak in many areas.

It is useful to learn more about the hypothetical risks and benefits of newer preparations and to have knowledge gaps and research priorities identified zithromax dosage for gonorrhea so clearly. See page F676Treatment thresholds in extremely preterm infants in the UKFollowing the publication in 2019 by the British Association of Perinatal Medicine of professional guidance for the perinatal management of birth before 27 weeks of gestation, Lydia Mietta Di Stefano and colleagues surveyed UK health professionals to determine the lowest gestation at which they would now be willing to offer active treatment to an extremely preterm infant at parental request and the highest gestation at which they would agree to withhold treatment. The majority of respondents were willing to offer active treatment from 22+0 weeks. The highest gestation at which respondents would offer palliative care at parental request was 23+6/24+0 weeks zithromax dosage for gonorrhea for 59% of those surveyed (n=172).

The survey data indicate that there has been a shift in practice in relation to both thresholds since the publication of the guidance. See page F596Ethics statementsPatient consent for publicationNot applicable..

Epinephrine dose and flush volumeEvidence for the efficacy and optimal administration of read this epinephrine during purchase zithromax neonatal resuscitation is hard to come by. Deepika Sankaran and colleagues performed a randomised study to model the use of epinephrine in a complex resuscitation situation that was based on the NRP algorithm. They studied newborn lambs that purchase zithromax had been asphyxiated to the point of cardiac arrest by umbilical cord clamping before delivery.

Five minutes after cardiac arrest positive pressure ventilation was provided and 1 min later chest compressions were provided and the FiO2 was increased to 1.0. Epinephrine was administered into an umbilical venous catheter 5 min after the onset of resuscitation. Epinephrine doses of 0.01 mg/kg purchase zithromax and 0.03 mg/kg were compared and flush volumes of 1 mL or 3 mL were compared in randomised groups.

Epinephrine was repeated at the same dose every 3 min until return of spontaneous circulation. The higher dose of epinephrine purchase zithromax was more effective than the lower dose and, with either dose, the response was better after the higher flush volume. The higher flush volume may be more effective at ensuring that the drug gets as far as the right atrium.

See page F578Thermal management immediately after birth with and without servo-controlFrancesco Cavallin and colleagues performed a randomised controlled study in 15 Italian tertiary hospitals. They studied infants with estimated birthweight <1500 g or gestation <30+6 weeks purchase zithromax. In one group manually adjusted thermal control was provided during initial stabilisation, with the heater set on full.

In the other group servo control was used. There were 450 infants in the study purchase zithromax. There was no difference in the rate of normothermia (temperature 36.5–37.5 C) at the time of neonatal unit admission.

All infants were placed in purchase zithromax plastic bags. Normothermia rates were relatively low in both groups (39.6% and 42.2%), with hypothermia being more frequent. Very few infants were hyperthermic.

Servo control purchase zithromax of temperature during initial stabilisation offered no advantage. Low normothermia rates show that initial thermal care is a complex dynamic process challenge that is not solved simply by choice of equipment. See page F572Osteopathic manipulative treatment to improve breast feedingIt is unusual for the Fetal and Neonatal Edition to receive a trial of a complimentary therapy.

Osteopathic manipulative treatment (OMT) has been used to treat various health purchase zithromax issues, including breastfeeding difficulties. Marie Danielo Jouhier and colleagues performed a double blinded randomised controlled trial. Mother baby dyads were eligible if there was suboptimal breastfeeding purchase zithromax behaviour, maternal cracked nipples or maternal pain.

The intervention consisted of two sessions of early OMT. To preserve blinding the manipulations were performed behind a screen. The primary outcome was the purchase zithromax exclusive breastfeeding rate at 1 month.

There was no significant difference in the primary outcome, OMT 31/59 (53%), control 39/59 (66%). The trial does not support the use purchase zithromax of OMT for this indication. See page F591Time to desaturation during endotracheal intubationRadhika Kothari and colleagues measured the time from the last application of positive pressure until desaturation <90% SpO2 in preterm infants<32 weeks’ gestation who were being electively intubated in the neonatal unit with pre-medication.

There were 78 infants in the study and 73/78 desaturated to below 90% in a median of 22 s. The infants purchase zithromax who desaturated to below 80% took a median 35 s to do so. As these were planned intubations in the neonatal unit, the times taken to desaturate may be longer than they would be for delivery room intubations, where the unrecruited lungs would not provide a reservoir of oxygen pending intubation success.

The information may assist with the generation of guidelines. See page F603Parenteral lipid emulsions in the preterm infantLauren Frazer purchase zithromax and Camilla Martin review current the current evidence and physiological considerations around how to use parenteral lipid emulsions as part of parenteral nutrition for preterm infants. As with so many areas of current practice, the evidence is weak in many areas.

It is useful to learn more about the hypothetical risks and purchase zithromax benefits of newer preparations and to have knowledge gaps and research priorities identified so clearly. See page F676Treatment thresholds in extremely preterm infants in the UKFollowing the publication in 2019 by the British Association of Perinatal Medicine of professional guidance for the perinatal management of birth before 27 weeks of gestation, Lydia Mietta Di Stefano and colleagues surveyed UK health professionals to determine the lowest gestation at which they would now be willing to offer active treatment to an extremely preterm infant at parental request and the highest gestation at which they would agree to withhold treatment. The majority of respondents were willing to offer active treatment from 22+0 weeks.

The highest gestation at which respondents would offer palliative care at parental request was 23+6/24+0 purchase zithromax weeks for 59% of those surveyed (n=172). The survey data indicate that there has been a shift in practice in relation to both thresholds since the publication of the guidance. See page F596Ethics statementsPatient consent for publicationNot applicable..

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Today, the World Health Organization (WHO) issued an emergency use listing (EUL) for COVAXIN® (developed by Bharat Biotech), adding to a growing portfolio of treatments validated by WHO for the prevention of buy antibiotics caused by antibiotics.WHO’s EUL procedure assesses the quality, safety zithromax side effects and efficacy of buy antibiotics treatments and is a prerequisite for COVAX treatment supply. It also allows countries to expedite their own regulatory approval to import and administer buy antibiotics treatments. €œThis emergency zithromax side effects use listing expands the availability of treatments, the most effective medical tools we have to end the zithromax,” said Dr Mariângela Simão, WHO Assistant-Director General for Access to Medicines and Health Products.

€˜But we must keep up the pressure to meet the needs of all populations, giving priority to the at-risk groups who are still waiting for their first dose, before we can start declaring victory.” COVAXIN® was assessed under the WHO EUL procedure based on the review of data on quality, safety, efficacy, a risk management plan and programmatic suitability. The Technical Advisory Group (TAG), convened by WHO and made up of regulatory experts from around the world, has determined that the treatment meets WHO standards for protection against buy antibiotics, that the benefit of the treatment far outweighs risks and the treatment can be used globally.The treatment is formulated from an inactivated antibiotics antigen and is presented in single dose vials and multidose vials of 5, 10 and 20 doses.COVAXIN® was also reviewed on 5 October by WHO’s Strategic Advisory Group of Experts on Immunization (SAGE), which formulates treatment specific policies and zithromax side effects recommendations for treatments’ use in populations (i.e. Recommended age groups, intervals between doses, specific groups such as pregnant and lactating women).

The SAGE recommended use of zithromax side effects the treatment in two doses, with a dose interval of four weeks, in all age groups 18 and above. COVAXIN® was found to have 78% efficacy against buy antibiotics of any severity, 14 or more days after the second dose, and is extremely suitable for low- and middle-income countries due to easy storage requirements. Available data from clinical trials on zithromax side effects vaccination of pregnant women are insufficient to assess treatment safety or efficacy in pregnancy.

However, initial studies were reassuring. The treatment has been given to over 120 000 pregnant women zithromax side effects in India, with no short-term adverse effects noted. Further studies in pregnant women are planned.

WHO emergency use listing The emergency use zithromax side effects listing (EUL) procedure assesses the suitability of novel health products during public health emergencies. The objective is to make medicines, treatments and diagnostics available as rapidly as possible to address the emergency while adhering to stringent criteria of safety, efficacy and quality. The assessment weighs the threat posed by the emergency as well as the benefit that would accrue from the use of the product against any potential risks.The EUL pathway involves a rigorous assessment of late phase II and phase III clinical trial data, as well zithromax side effects as substantial additional data on safety, efficacy, quality and a risk management plan.

These data are reviewed by independent experts and WHO teams who consider the current body of evidence on the treatment under consideration, the plans for monitoring its use, and plans for further studies.As part of the EUL process, the company producing the treatment must commit to continue to generate data to enable full licensure and WHO prequalification of the treatment. The WHO prequalification process will assess additional clinical data generated from treatment trials and deployment on a rolling basis to ensure the treatment meets the necessary standards of quality, safety and efficacy for broader zithromax side effects availability.See all EUL listingsSAGESAGE is the principal advisory group to WHO for treatments and immunization. It is charged with advising WHO on overall global policies and strategies, ranging from treatments and immunization technology, research and development, to delivery of immunization and its linkages with other health interventions.

SAGE is concerned not just with childhood treatments and immunization, but all treatment-preventable diseases.SAGE assesses evidence on safety, efficacy, effectiveness, impact and zithromax side effects programmatic suitability, considering both individual and public health impact. SAGE Interim recommendations for EUL products provide guidance for national vaccination policy makers. These recommendations are updated as additional evidence becomes available and as there are changes to the epidemiology of disease and the availability of additional treatments and other disease control interventions.See Sage interim recommendations.

Today, the purchase zithromax World Health Organization (WHO) issued an emergency use listing (EUL) for COVAXIN® (developed by Bharat Biotech), adding to a growing portfolio of treatments validated by WHO for the prevention of buy antibiotics caused by antibiotics.WHO’s EUL procedure assesses the quality, safety and efficacy of buy antibiotics treatments and is a prerequisite for COVAX treatment supply. It also allows countries to expedite their own regulatory approval to import and administer buy antibiotics treatments. €œThis emergency use listing expands the availability of treatments, the most effective medical tools we have to end the zithromax,” said Dr Mariângela Simão, WHO purchase zithromax Assistant-Director General for Access to Medicines and Health Products.

€˜But we must keep up the pressure to meet the needs of all populations, giving priority to the at-risk groups who are still waiting for their first dose, before we can start declaring victory.” COVAXIN® was assessed under the WHO EUL procedure based on the review of data on quality, safety, efficacy, a risk management plan and programmatic suitability. The Technical Advisory Group (TAG), convened by WHO and made up of regulatory experts from around the world, has determined that the treatment meets WHO standards for protection purchase zithromax against buy antibiotics, that the benefit of the treatment far outweighs risks and the treatment can be used globally.The treatment is formulated from an inactivated antibiotics antigen and is presented in single dose vials and multidose vials of 5, 10 and 20 doses.COVAXIN® was also reviewed on 5 October by WHO’s Strategic Advisory Group of Experts on Immunization (SAGE), which formulates treatment specific policies and recommendations for treatments’ use in populations (i.e. Recommended age groups, intervals between doses, specific groups such as pregnant and lactating women).

The SAGE recommended use of the treatment in two doses, with a dose interval of four weeks, purchase zithromax in all age groups 18 and above. COVAXIN® was found to have 78% efficacy against buy antibiotics of any severity, 14 or more days after the second dose, and is extremely suitable for low- and middle-income countries due to easy storage requirements. Available data from clinical trials on vaccination of pregnant women are insufficient to assess treatment safety or efficacy in pregnancy purchase zithromax.

However, initial studies were reassuring. The treatment has been given purchase zithromax to over 120 000 pregnant women in India, with no short-term adverse effects noted. Further studies in pregnant women are planned.

WHO emergency use listing The emergency use listing (EUL) procedure assesses the suitability of purchase zithromax novel health products during public health emergencies. The objective is to make medicines, treatments and diagnostics available as rapidly as possible to address the emergency while adhering to stringent criteria of safety, efficacy and quality. The assessment weighs the threat posed purchase zithromax by the emergency as well as the benefit that would accrue from the use of the product against any potential risks.The EUL pathway involves a rigorous assessment of late phase II and phase III clinical trial data, as well as substantial additional data on safety, efficacy, quality and a risk management plan.

These data are reviewed by independent experts and WHO teams who consider the current body of evidence on the treatment under consideration, the plans for monitoring its use, and plans for further studies.As part of the EUL process, the company producing the treatment must commit to continue to generate data to enable full licensure and WHO prequalification of the treatment. The WHO prequalification process will assess additional clinical data generated from treatment trials and deployment on a rolling basis purchase zithromax to ensure the treatment meets the necessary standards of quality, safety and efficacy for broader availability.See all EUL listingsSAGESAGE is the principal advisory group to WHO for treatments and immunization. It is charged with advising WHO on overall global policies and strategies, ranging from treatments and immunization technology, research and development, to delivery of immunization and its linkages with other health interventions.

SAGE is concerned not just with childhood treatments and immunization, but purchase zithromax all treatment-preventable diseases.SAGE assesses evidence on safety, efficacy, effectiveness, impact and programmatic suitability, considering both individual and public health impact. SAGE Interim recommendations for EUL products provide guidance for national vaccination policy makers. These recommendations are updated as additional evidence becomes available and as there are changes to the epidemiology of disease and the availability of additional treatments and other disease control interventions.See Sage interim recommendations.

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Cancer Institute The CRUK and generic zithromax for chlamydia UCL Cancer Trials Centre (CTC) is a Research Department in the Cancer Institute at UCL http://www.ec-louis-cazeaux-soufflenheim.site.ac-strasbourg.fr/wp/?page_id=51. The CTC is responsible for the development, design and conduct of clinical trials to evaluate new approaches to the treatment or early detection of cancer. It is one of the largest cancer trials centres in the UK, conducting predominantly generic zithromax for chlamydia multicentre phase II and III trials.

As well as large-scale cancer screening studies, and observational studies. There is an expanding portfolio of generic zithromax for chlamydia phase I, II and feasibility studies, some with biological endpoints, and most trials now include a translational research component. The CTC is conducting over 110 national/international trials (ongoing/in set-up) with over 100 staff, involving the recruitment of several thousand patients.

The CTC Director is Jonathan Ledermann, Professor of Medical Oncology generic zithromax for chlamydia at UCL. The CTC portfolio is divided into 4 trial groups, each led by a Trials Group Lead (TGL). Haematological/Brain.

Gastrointestinal, Head generic zithromax for chlamydia &. Neck, Prostate and Sarcoma. Gynaecological/Lung.

And Advanced Therapies. These groups reflect the type of work currently undertaken, however, as the CTC works flexibly these groups and divisions may evolve over time. We are looking to appoint a Senior Trials Coordinator (STC) for the Advanced Therapies group to manage our increasing number of trials.

The STC is responsible for managing a portfolio of trials. Ensuring that they are conducted according to the protocol, GCP and relevant regulations, and to planned timelines. The STC has line management responsibility for Trial Coordinators and Data Managers and is expected to ensure that members of his/her team are appropriately trained and supported to carry out their roles effectively.

The STC works closely with the TGL to develop new trials, deal with issues in ongoing trials, manage the workload of the team, and assess working practices of the team to inform changes to improve communication, efficiency and quality. This is a high-level post, and candidates should have considerable experience in conducting and managing clinical interventional trials. The majority of studies at the CTC involve evaluating investigational medicinal products, therefore the postholder will have sufficient knowledge and experience in these particular studies.

The post is funded for one year in the first instance. The postholder will have a medical, nursing or life-sciences degree, and preferably a relevant post-graduate degree. They should also have considerable experience of conducting clinical trials, including developing protocols and other trial-related documents, site set-up, monitoring trial progress, preparing databases for analysis, and trial close down.

Experience of conducting CTIMPs (and ideally ATIMPs), preparing trial-related contracts and submissions to MHRA, REC and R&D is essential. The postholder will also have experience of supervising staff (including staff motivation, monitoring performance, staff appraisals and recruitment). Previous experience of working in an academic Clinical Trials Unit would be advantageous.

Applicants should apply online. To access further details about the position and how to apply please click on the ‘Apply’ button above. For queries regarding the application process, contact Louise Rusha, ctc.hr@ucl.ac.uk.

For informal enquiries about the post, contact Laura Clifton-Hadley, l.clifton-hadley@ucl.ac.uk. The UCL Ways of Working for professional services supports colleagues to be successful and happy at UCL through sharing expectations around how we work – please see www.ucl.ac.uk/ways-of-working to find out more. We particularly welcome applications from black and minority ethnic candidates as they are under-represented within UCL at this level.

Our department holds an Athena SWAN Silver award, in recognition of our commitment and demonstrable impact in advancing gender equality.Student Support, Student WellbeingFixed term for 18 monthsThe Sheffield Hallam University Student Wellbeing service is a large multidisciplinary team with a wide-ranging portfolio offering specialist support to students who are experiencing one or several situations that can impact on their success at University. We enable students to develop strategies for University life and beyond so that they can become resilient and independent learners.We are looking to recruit an experienced lead practitioner to manage and deliver the Service strand for case-management and mental health support. This is a key role in the service that offers an exciting opportunity to make a difference to the experience of students and provides line-management to a dedicated and committed staff team of Senior Wellbeing Practitioners.We are looking for someone with extensive knowledge and experience of working within mental health services to support people experiencing emotional distress and complex needs.

You will have excellent leadership and communication skills with significant experience of providing line-management support to staff in a multi-disciplinary service.We welcome applications from experienced managers in disciplines such as social work, occupational therapy, clinical psychology, psychiatry, psychiatric nursing, or voluntary sector mental health services. Candidates must be accredited or actively working towards accreditation by a professional body (such as SWE, BABCP, UKCP) in order to maintain the standards reflected by the leadership group within the service.If you are offered this post you will be subject to an enhanced with barred lists check by the Disclosure and Barring Service. A criminal record will not necessarily prevent you from working at Sheffield Hallam University but its relevance to the duties of the post will need to be assessed before the appointment is confirmed.Sheffield Hallam welcomes applications from all candidates irrespective of age, pregnancy and maternity, disability, gender, gender identity, sexual orientation, race, religion or belief, or marital or civil partnership status.We particularly welcome applicants from underrepresented groups.Please quote job number.

061244Closing date. 1st November 2020 at 23.30pmTo find out more about working at Sheffield Hallam University please visit www.shu.ac.uk/jobsWe welcome applications for job-share, part-time and flexible working arrangementsTo apply, or get more information about this post, please click on the apply button above..

Cancer Institute The CRUK and UCL Cancer Trials Centre (CTC) is a purchase zithromax Research Department in the Cancer Institute at UCL. The CTC is responsible for the development, design and conduct of clinical trials to evaluate new approaches to the treatment or early detection of cancer. It is one of the largest cancer trials centres in the UK, conducting predominantly multicentre phase II and III purchase zithromax trials. As well as large-scale cancer screening studies, and observational studies. There is an expanding portfolio of phase I, II and feasibility studies, some purchase zithromax with biological endpoints, and most trials now include a translational research component.

The CTC is conducting over 110 national/international trials (ongoing/in set-up) with over 100 staff, involving the recruitment of several thousand patients. The CTC Director is Jonathan Ledermann, Professor of Medical Oncology at purchase zithromax UCL. The CTC portfolio is divided into 4 trial groups, each led by a Trials Group Lead (TGL). Haematological/Brain. Gastrointestinal, Head purchase zithromax &.

Neck, Prostate and Sarcoma. Gynaecological/Lung. And Advanced Therapies. These groups reflect the type of work currently undertaken, however, as the CTC works flexibly these groups and divisions may evolve over time. We are looking to appoint a Senior Trials Coordinator (STC) for the Advanced Therapies group to manage our increasing number of trials.

The STC is responsible for managing a portfolio of trials. Ensuring that they are conducted according to the protocol, GCP and relevant regulations, and to planned timelines. The STC has line management responsibility for Trial Coordinators and Data Managers and is expected to ensure that members of his/her team are appropriately trained and supported to carry out their roles effectively. The STC works closely with the TGL to develop new trials, deal with issues in ongoing trials, manage the workload of the team, and assess working practices of the team to inform changes to improve communication, efficiency and quality. This is a high-level post, and candidates should have considerable experience in conducting and managing clinical interventional trials.

The majority of studies at the CTC involve evaluating investigational medicinal products, therefore the postholder will have sufficient knowledge and experience in these particular studies. The post is funded for one year in the first instance. The postholder will have a medical, nursing or life-sciences degree, and preferably a relevant post-graduate degree. They should also have considerable experience of conducting clinical trials, including developing protocols and other trial-related documents, site set-up, monitoring trial progress, preparing databases for analysis, and trial close down. Experience of conducting CTIMPs (and ideally ATIMPs), preparing trial-related contracts and submissions to MHRA, REC and R&D is essential.

The postholder will also have experience of supervising staff (including staff motivation, monitoring performance, staff appraisals and recruitment). Previous experience of working in an academic Clinical Trials Unit would be advantageous. Applicants should apply online. To access further details about the position and how to apply please click on the ‘Apply’ button above. For queries regarding the application process, contact Louise Rusha, ctc.hr@ucl.ac.uk.

For informal enquiries about the post, contact Laura Clifton-Hadley, l.clifton-hadley@ucl.ac.uk. The UCL Ways of Working for professional services supports colleagues to be successful and happy at UCL through sharing expectations around how we work – please see www.ucl.ac.uk/ways-of-working to find out more. We particularly welcome applications from black and minority ethnic candidates as they are under-represented within UCL at this level. Our department holds an Athena SWAN Silver award, in recognition of our commitment and demonstrable impact in advancing gender equality.Student Support, Student WellbeingFixed term for 18 monthsThe Sheffield Hallam University Student Wellbeing service is a large multidisciplinary team with a wide-ranging portfolio offering specialist support to students who are experiencing one or several situations that can impact on their success at University. We enable students to develop strategies for University life and beyond so that they can become resilient and independent learners.We are looking to recruit an experienced lead practitioner to manage and deliver the Service strand for case-management and mental health support.

This is a key role in the service that offers an exciting opportunity to make a difference to the experience of students and provides line-management to a dedicated and committed staff team of Senior Wellbeing Practitioners.We are looking for someone with extensive knowledge and experience of working within mental health services to support people experiencing emotional distress and complex needs. You will have excellent leadership and communication skills with significant experience of providing line-management support to staff in a multi-disciplinary service.We welcome applications from experienced managers in disciplines such as social work, occupational therapy, clinical psychology, psychiatry, psychiatric nursing, or voluntary sector mental health services. Candidates must be accredited or actively working towards accreditation by a professional body (such as SWE, BABCP, UKCP) in order to maintain the standards reflected by the leadership group within the service.If you are offered this post you will be subject to an enhanced with barred lists check by the Disclosure and Barring Service. A criminal record will not necessarily prevent you from working at Sheffield Hallam University but its relevance to the duties of the post will need to be assessed before the appointment is confirmed.Sheffield Hallam welcomes applications from all candidates irrespective of age, pregnancy and maternity, disability, gender, gender identity, sexual orientation, race, religion or belief, or marital or civil partnership status.We particularly welcome applicants from underrepresented groups.Please quote job number. 061244Closing date.

1st November 2020 at 23.30pmTo find out more about working at Sheffield Hallam University please visit www.shu.ac.uk/jobsWe welcome applications for job-share, part-time and flexible working arrangementsTo apply, or get more information about this post, please click on the apply button above..