Public Health – Dr. Soumyadeep Bhaumik

Transitioning medical education towards trans-disciplinarity

Community medicine training consists of a bit of family medicine and a bit of public health- with no advanced competencies on either. Family medicine is now an established discipline with its own scholarly niche, a clear generalist approach towards clinical care rooted in the philosophy of primary care. Public health developed outside medical universities, and global scholarly work has meant it has a strong but continually evolving philosophical basis. Both family medicine and public health have some commonalities – they do not shy away from integrating concepts from various disciplines; are collaborative in nature; and its post-graduates are job-ready. Community medicine on the other end has been not able to move away from the clinical lens and has no clear philosophical leanings.[⁵] Surely teaching medical students alone cannot be an enough justification for continued investment on community medicine.

The full article in Journal of Family Medicine & Primary Care is available open access here .

Facilitators and barriers of life jacket use for drowning prevention: qualitative evidence synthesis

Drowning is a public health problem globally, with over 90% of deaths occurring in low- and middle-income countries . Unintentional drowning was estimated to cause about 295,210 deaths in 2017worldwide. The true burden of drowning is expected to be much higher owing to challenges in classification, reporting and data collection. The World Health Organization has identified several interventions to prevent deaths due to unintentional drowning, including the use of life jacket in high-risk recreational and occupational settings.

Despite substantial evidence on the effectiveness of life jackets and the subsequent adoption of laws in several countries, the use of life jackets has largely remained low, including in high-income countries.However, there has been no qualitative synthesis of evidence to understand the context and internal perceptions and experiences that may influence life-jacket use. The study, published in Journal of Safety Research this week filled this important knowledge gap and found :

Life jacket use was shaped through complex interactions between lived experience and cultural norms which influenced the risk-perception of life jacket utility in preventing deaths.
The high cost of life jackets was almost always a barrier for its usage
Adoption of laws and its subsequent enforcement was perceived to be an important facilitator for life jacket use.
Design issues around comfort, fashion-sense, and shelf life influenced usage of life-jackets

Read the full study here .

Photo by Nikita Belokhonov on Pexels.com

Need for transdisciplinary systems thinking to address snakebite

Snakebite, a major public health issue but a hugely neglected problem continues to affect millions of people with death and disability worldwide. In 2018, the first ever International Snakebite Awareness Day was celebrated on September 19, to emphasize on awareness and actions needed to tackle the burden of snakebite. The George Institute for Global Health (TGI), will be organizing a seminar on the topic ‘Need for transdisciplinary approach for addressing snakebite burden’ on this day. The deliberations of the seminar aim to expand the lens from the current clinically dominant approach to address snakebite to include learnings from other disciplines and enable systems thinking to solve the issue.

Mark your calendars for 19th September 2021, Sunday, 14:00 -15:00 hours IST

Key Focus & Our Speakers

Introduction to event: Snakebite – an issue like no other
- Ms Deepti Beri, The George Institute for Global Health, India
Talk 1: Why ‘Neglected Tropical Disease’? The politics of ‘Otherization’ of snakebite in India
- Dr Rahul Bhaumik, Department of History, Women’s College, University of Calcutta, West Bengal, India,
Talk 2: Snakebite & climate change: preparedness for the imminent crisis
- Dr Soumyadeep Bhaumik, Injury Division, The George Institute for Global Health, India; Meta-research and Evidence Synthesis Unit, The George Institute for Global Health
Talk 3: Using snake rescue data to develop snakebite mitigation strategies
- Mr. Vishal Santra, Society for Nature Conservation, Research and Community Engagement, West Bengal, India; Captive and Field Herpetology, Wales, United Kingdom
Fireside Chat with audience interaction: Transdisciplinary systems approach for snakebite – challenges and way forward
- Professor Anthony Zwi, Global Health and Development, School of Social Sciences, UNSW, Australia
- Dr. Jagnoor Jagnoor, Injury Division, The George Institute for Global Health, India

The session concludes with a Q&A session where the audience can engage with the panelists.

More information here . Register here .

Maternal Mortality in Afghanistan: a critical review to understand strategic priorities

Afghanistan, a landlocked mountainous nation, situated strategically between Central and South Asia, has been in conflict since the Saur Revolution in 1978 when the socialist People’s Democratic Party (PDP) of Afghanistan seized power from the then secular government (Gascoigne, 2015; BBC, 2015) . This led to a civil war between PDP, supported by the Soviet Union, and the Mujahidin, supported by the United States vide Pakistan. The vicious cycle of conflicts continued till November 2001 when the Taliban (a radical offshoot of Mujahidin) was routed out, ironically by military action of United States(BBC, 2015) .

In 2001, as multi-pronged reconstruction efforts started, it brought hopes that conflict, social upheaval, and food shortages would end(Castillo, 2013), and Afghanistan would march towards the Millennium Development Goals (MDG), along with the 191 other countries that had adopted it . Among the eight ambitious MDG’s , adopted was the goal to “reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio (MMR)”(United Nations, 2015) . Afghanistan however was accorded the unfortunate title of being the “riskiest place on earth for health of mothers” a few years back (Save The Children, 2010) .

The report aims to critically analyse maternal mortality in Afghanistan from the year 2000 to 2015. – a period roughly corresponding to the era of US-led reconstruction action (Castillo, 2013).

The report written for an academic purpose to analyze a post-conflict state is being released publicly on 31^st August 2021 as Afghanistan potentially faces conflict again. The report, it is hoped, serves as a reminder to democratic nations that : Peace is the most important determinant of health. There is no health without human rights.

Maternal Mortality in Afghanistan: a critical review to understand strategic priorities Download

Health and beyond…strategies for a better India: using the “prison window” to reach disadvantaged groups in primary care

…Politicians, policy makers and the general public in India are prejudiced by the traditional notion that “sinners deserve neither mercy nor money.” Owing to this mind-set policy makers tend to allocate the resources “as per law” rather than “as per needs.” Even this is provided only after significant lobbying by pressure groups like human/prison rights activists. Sadly the media too presents prison health as a human rights issue and not an issue of public health concern. The very fact that almost all prisoners return back to the community makes it imperative to link prison health with the public health system and bring them under the coverage of primary health care. Policy makers as well as the general public need to understand that the prison and the community are at continuum. The much needed overhaul of the prison health system by linking it with public health cannot be achieved without a sustained campaign aimed at changing these dogmas. Historical data from nations which have separate health systems for prisons clearly indicate very poor quality of services. …Read the full article published at Journal of Family Medicine & Primary Care here.(Click: Open Access)

Developing evidence based health policy in resource limited settings—lessons from Nepal

Few would argue against the benefits of evidence informed public health and health policies. However, efforts to inform health policy in resource limited settings face particularly daunting challenges—often specific to the political complexity and resource limitations experienced uniquely in low and middle income countries (LMICs).

The Nepal Health Research Council (NHRC), a Government of Nepal body, has a long held mandate to support informed decision making by health policymakers in Nepal—an exciting but daunting role to operationalise. Informing health policy assumes that there is a base of information to communicate: in Nepal, this often isn’t available.

Read the full article by Dr Sangeeta R, Dr. Soumyadeep B and Dr. Krishna A at the British Medical Journal Blogs (Open Access)

Perspective of different stakeholders in research priority setting for a public health problem in low and middle income nation

The 22nd Cochrane Colloquium in Hyderabad saw a special session on “Setting research agendas: balancing public health and patient level priorities” on 25th September 2014, . The session organised by the Cochrane Agenda and Priority Setting Methods Group (CAPSMG) had the following format :

Session Co-Chairs Roberto D’Amico & Damian Francis

Rebecca Armstrong: Priority setting: the CPHG experience

Robert Dellavalle & Chante Karimkhani :On the Global Burden of Disease project and how it can help set priorities vis-a-vis public health and patient level priorities

Soumyadeep Bhaumik : Perspective of different stakeholders in a research priority setting of a public health problem in LMIC

Kevin Pottie: Priority Setting for Guidelines and Interventions

Vivian Welch: Cochrane Agenda and Priority Setting Methods Group (CAPSMG)

Discussion Session : ROLE PLAY where participants took roles as policy makers, clinicians and members of the public for deciding priority for Ebola and Sin taxes for Sugar Sweetened Beverages.

Dr. Soumyadeep B presentation at the session is attached and free to use under CC-BB-NY-SA (Click)

Perspective of different stakeholders in a research priority setting of a public health problem in LMIC

Visit https://capsmg.cochrane.org/ For more details

Participants in Role Play at the Session

Notes from the GRADE and SoF #CochraneMethods Workshop at #CochraneHYD

Interpreting results of Cochrane reviews and Summary of Findings Tables: GRADE and SoF Workshop Magnitude of effect and confidence on effect are important parameters in quality of evidence

The Cochrane Colloquium 2014 is keeping up with its trend of providing high quality training for doing systematic reviews. The workshop today focused on the very useful issue of interpreting reviews and summary of findings. The event was done by the McMaster University , Canada faculty.

Here are some useful notes from the workshop .

Important parameters assessed in GRADE are
risk of bias
inconsistency
indirectness
imprecision
publication bias
dose response ,
size of effect ,
confounding

The conclusion about the effect of studies should provide the following information.
1.results of section
2.no of studeies
3.magnitude of effect
4.converting it to numbers which stakeholders understand (example : how many fractures were prevented after intervention : use confidence interval to report )
5. GRADE quality of evidence and brief on rational behind it.

New online version of grade software : GDT www.guidelinedevelopment.org

When using scales and reporting in meta-analysis figure or GRADE table it is always important to communicate direction of scale and what is it about.

Remember to adjust for the image scale in forest plot .

Reviewers often forgot the red, green and yellow dots they have created in the risk of bias during interpretation of results .

Funnel plot cannot be created when less than 10 studies
Consider search strategy comprehensiveness, foreign language missing . smaller studies , grey literature search if funnel plot appears skewed.

Also Look at funding of study and competing interests when looking at publication bias .

Look at the characteristics of study carefully when doing GRADE

Do not use terms like ” not statistically significant” .
It is Important to calculate the optimal information size when using GRADE for imprecision. quality

Imprecision is done on basis of following for dichotomous outcomes : 1. sample size and number of events 2, confidence intervals
Imprecision is done on basis of following for Continuos outcomes : at least 400 people providing outcome measures : if not GRADE for imprecision.

Rule of thumb is if CI includes 0.75 to 1.25 indicates null effect and appreciable benefit or harm

Distinction between serious and very serious is important : but the balance is to be done by the reviewers: the thinking behind the judgement should be reflected in the footnotes. Let people know the thinking behind the grade done

small sample size but large effect. : could be indicative of the obeservation being just due to chance. Therefore do not depend on confidence interval but on the number of events.

Their are multiple ways of choosing a baseline risk for GRADE process. It can be the average or the extremes or even baseline risk from observational study. However this has to be justified.

All presentations in the colloquium are available at http://cebgrade.mcmaster.ca/hyderabad/.

From the #CochraneMethods Symposium of the 22nd Cochrane Colloquium, India

The COCHRANE METHODS SYMPOSIUM 2014 held on Sunday 21st September 2014 at Hyderbad, India was themed “” “From concepts to evidence synthesis:Towards a research agenda for methods of public health systematic reviews ”

Here is a list of some key points, quotes and slides I found interesting :

Liz Waters : Question right and match to the right evidence… Focus on evidence landscaping and realistic and narrative (but transparent) synthesis for public health reviews.

Daniel Francis: Logic Models help multi-disciplinary review teams to come together and explain relationships and improve the entire process, identify intervention components , understand rationale behind subgroup analyses and surrogate outcomes- all in a graphical manner.

James Thomas : Mixed methods meta-analyses allow to empirically understand and explain variations observed- thus allowing contextualization .. Are complementary to traditional methods.

Rebecca Armstrong : Review Advisory groups have an important role and there is need to use them better. Time for Review Advisory Group 2.0 which would include critical friends and stress on web-based technologies and include training as well as link review authors with RAG members .

Ruth Turley : Capturing all relevant evidence with lease amount of noise is difficult in a public health systematic review. This is complicated by lack of standard terminology, reviews being not restricted to RCT, not indexation of studies and evidence being locked in select databases.

Jane Noyes : New CERQual tool: will become integrated into the summary of findings tables in Cochrane reviews

Hilary Thomson: Narrative synthesis of quantitative data the Cinderella of Systematic review

Elie Akl: The most positive thing about GRADE us that it is systematic transparent and explicit but there are concerns about choice of outcomes and outcome measurements and the fact that the process is solely dependent on epidemiological data and cannot be applied to narrative synthesis and does not discriminated between different types of observational studies.

The Cochrane Colloquium comes to India

Picture from Chowmahalla Palace,Hyderabad, royal seat of the Asaf Jahi dynasty where the Nizams entertained their official guests and royal visitors.

Cochrane, the global leader in evidence-informed health is for the first time in its more than 20 year history (the first Cochrane Centre opened in Oxford,UK in October 1992 ) is for the first time holding its annual colloquium in India, or for that matter in South Asia.

The 22nd Cochrane Colloquium takes place in Hyderabad, India from 21-26 September, 2014 with the theme ‘Evidence-informed public health: opportunities and challenges’. The event is landmark especially when seen in the background of the impending evidence based medicine as well as universal health coverage in South Asia.The event will see Professor Gordon Guyatt delivering the Annual Cochrane Lecture and plenaries conducted and chaired by global leaders on EBM,public health and policies with the following themes :
1. East meets West: Evidence-Informed Public Health; Concepts, Context, Opportunities, Challenges,
2.Public Health: the context, the vision, the opportunities
3.Capacity Development: Challenges and Innovations
4.Cochrane Reviews: Assuring Quality and Relevance
5.Advocating for Evidence: Improving Health Decision-Making through Advocacy, Partnerships and Better Communication

Five Special themed session which will highlight important issues on the following theme are also scnheduled and their are inumerable workshops held.There are about 88 oral presentations and more than hundred posters.

Keep looking at this page for daily on the spot updates on the event.
Link: https://colloquium.cochrane.org/

Share this:

Like this:

Share this:

Like this:

Key Focus & Our Speakers

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this: