Pub Date : 2025-08-26DOI: 10.1016/j.dialog.2025.100235
Arn Migowski , Ruffo Freitas-Junior , Jose Bines , Angela Marie Jansen , Angélica Nogueira-Rodrigues , Maria del Pilar Estevez-Diz , Mariana Rico-Restrepo , Gayatri Sanku , André Mattar
Breast cancer (BC) remains a significant health concern in Brazil, particularly within its public healthcare system, the Unified Health System, known by its Portuguese acronym “SUS”, with early detection being one of the main challenges. A review of literature and policy documents was conducted to evaluate the performance and challenges of BC screening and early diagnosis in SUS. Brazilian experts in BC early detection attended a three-day meeting to discuss the challenges of SUS's existing early detection program and provide recommendations for surmounting them. The study identified that Brazil's current opportunistic BC screening model perpetuates issues with access to screening and regional disparities, while also generating low effectiveness and inefficiency. It also highlights several causes of delays in early diagnosis and treatment. The conclusions suggest an urgent need for an organized national BC screening program, in addition to the implementation of early diagnosis strategies, with multifaceted interventions, including urgent referral guidelines for suspected cases, training of key health professionals, patient navigation, and one-stop breast clinics. Implementing these changes could alleviate the economic strain on the healthcare system while improving patient outcomes.
{"title":"Cracking the code: Pioneering early detection and management of breast cancer in the Brazilian public healthcare system","authors":"Arn Migowski , Ruffo Freitas-Junior , Jose Bines , Angela Marie Jansen , Angélica Nogueira-Rodrigues , Maria del Pilar Estevez-Diz , Mariana Rico-Restrepo , Gayatri Sanku , André Mattar","doi":"10.1016/j.dialog.2025.100235","DOIUrl":"10.1016/j.dialog.2025.100235","url":null,"abstract":"<div><div>Breast cancer (BC) remains a significant health concern in Brazil, particularly within its public healthcare system, the Unified Health System, known by its Portuguese acronym “SUS”, with early detection being one of the main challenges. A review of literature and policy documents was conducted to evaluate the performance and challenges of BC screening and early diagnosis in SUS. Brazilian experts in BC early detection attended a three-day meeting to discuss the challenges of SUS's existing early detection program and provide recommendations for surmounting them. The study identified that Brazil's current opportunistic BC screening model perpetuates issues with access to screening and regional disparities, while also generating low effectiveness and inefficiency. It also highlights several causes of delays in early diagnosis and treatment. The conclusions suggest an urgent need for an organized national BC screening program, in addition to the implementation of early diagnosis strategies, with multifaceted interventions, including urgent referral guidelines for suspected cases, training of key health professionals, patient navigation, and one-stop breast clinics. Implementing these changes could alleviate the economic strain on the healthcare system while improving patient outcomes.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"7 ","pages":"Article 100235"},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144987926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This short communication explores how identity erosion among Particularly Vulnerable Tribal Groups (PVTGs) in the Nilgiris district of Tamil Nadu, India, impacts their wellness and ecological stewardship. It aims to highlight culturally specific disruptions across generations and recommend policy responses that are identity-affirming and context-sensitive.
Methods
This exploratory qualitative study used an epistemological approach to understand tribal perceptions through in-depth interviews and focus group discussions with elders and youth from select members of the PVTGs in the Nilgiris. A semi-structured interview guide covering six wellness domains was developed through deductive and inductive methods. Data were collected over four months, transcribed, translated, and thematically analyzed using manual coding. Institutional ethical clearance was obtained, and informed consent was secured from all participants and community leaders.
Results
The study found that well-intentioned mainstream developmental interventions, such as non-contextual education and biomedical health models, have disrupted cultural transmission, resulting in identity erosion and loss of sacred landscapes. Many participants expressed concern over mental health issues, substance use, climate vulnerability, and inadequate community representation in governance. Mobile technologies and media consumption have contributed to cultural disorientation among tribal youth.
Conclusion
Preserving tribal identity is essential to ensuring community wellness and conserving the Nilgiri Biosphere Reserve. Policy efforts must shift from generalized welfare to culturally grounded, participatory frameworks that integrate traditional knowledge systems and support Indigenous autonomy.
{"title":"Preserving the tribal identity: A policy imperative for indigenous well-being and conservation of the Nilgiri Biosphere Reserve in South India","authors":"Geetha Veliah , Padma Venkatasubramanian , Irene Sambath","doi":"10.1016/j.dialog.2025.100234","DOIUrl":"10.1016/j.dialog.2025.100234","url":null,"abstract":"<div><h3>Purpose</h3><div>This short communication explores how identity erosion among Particularly Vulnerable Tribal Groups (PVTGs) in the Nilgiris district of Tamil Nadu, India, impacts their wellness and ecological stewardship. It aims to highlight culturally specific disruptions across generations and recommend policy responses that are identity-affirming and context-sensitive.</div></div><div><h3>Methods</h3><div>This exploratory qualitative study used an epistemological approach to understand tribal perceptions through in-depth interviews and focus group discussions with elders and youth from select members of the PVTGs in the Nilgiris. A semi-structured interview guide covering six wellness domains was developed through deductive and inductive methods. Data were collected over four months, transcribed, translated, and thematically analyzed using manual coding. Institutional ethical clearance was obtained, and informed consent was secured from all participants and community leaders.</div></div><div><h3>Results</h3><div>The study found that well-intentioned mainstream developmental interventions, such as non-contextual education and biomedical health models, have disrupted cultural transmission, resulting in identity erosion and loss of sacred landscapes. Many participants expressed concern over mental health issues, substance use, climate vulnerability, and inadequate community representation in governance. Mobile technologies and media consumption have contributed to cultural disorientation among tribal youth.</div></div><div><h3>Conclusion</h3><div>Preserving tribal identity is essential to ensuring community wellness and conserving the Nilgiri Biosphere Reserve. Policy efforts must shift from generalized welfare to culturally grounded, participatory frameworks that integrate traditional knowledge systems and support Indigenous autonomy.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"7 ","pages":"Article 100234"},"PeriodicalIF":0.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-21DOI: 10.1016/j.dialog.2025.100233
David Owiredu , Hanna Chidwick , Betty Kwagala , Deborah Mensah , Lydia Osei , Lydia Kapiriri
Introduction
Access to water, sanitation, and hygiene (WASH) is critical for public health but remains inadequate in marginalized areas, particularly in sub-Saharan Africa's artisanal and small-scale mining (ASM) communities. Adolescent girls and young women (AGYW) in these settings face unique challenges that impact their health and wellbeing.
Objective
This study aimed to assess WASH access among adolescent girls and young women (aged 10–24) in last-mile ASM communities in Ghana and Uganda, identifying disparities and factors influencing access.
Methods
A cross-sectional, mixed-methods design was employed between March and May 2022 in selected ASM communities in Ghana and Uganda. The quantitative component included a sample of 1618 AGYW (808 in Ghana, 810 in Uganda) recruited through random household selection. Data were collected using interviewer-administered questionnaires adapted from validated sources, covering socio-demographics, water sources, sanitation, and hygiene practices. Descriptive statistics, chi-square tests, and logistic regression were conducted, stratified by country, to examine associations between WASH access and sociodemographic factors. For the qualitative component, AGYW, community leaders, district officers, policymakers, and global experts were purposively selected. Data was collected through focus group discussions and in-depth/key informant interviews conducted in local languages. Thematic analysis was performed using NVivo 12, with illustrative participant quotes.
Results
Quantitative findings showed that 86.2 % reported access to improved water sources, but only 10.1 % had access to improved toilet facilities. In Ghana, 83 % lacked any toilet facility; in Uganda, 65 % used unimproved latrines. Water access was associated with religion and education in Ghana, and toilet access was linked to residence and wealth in both countries. Qualitative findings revealed concerns about water quality, reliability, distance to water points, and major sanitation challenges, especially for women and girls. Cultural norms and mining-related environmental impacts further exacerbated WASH vulnerabilities.
Conclusion
Significant disparities in WASH persist in ASM communities, particularly for sanitation. Context-specific, community-engaged interventions are urgently needed to address these gaps and promote health equity for AGYW in rural mining settings.
{"title":"Water, sanitation, and hygiene challenges in last-mile artisanal mining communities in Ghana and Uganda","authors":"David Owiredu , Hanna Chidwick , Betty Kwagala , Deborah Mensah , Lydia Osei , Lydia Kapiriri","doi":"10.1016/j.dialog.2025.100233","DOIUrl":"10.1016/j.dialog.2025.100233","url":null,"abstract":"<div><h3>Introduction</h3><div>Access to water, sanitation, and hygiene (WASH) is critical for public health but remains inadequate in marginalized areas, particularly in sub-Saharan Africa's artisanal and small-scale mining (ASM) communities. Adolescent girls and young women (AGYW) in these settings face unique challenges that impact their health and wellbeing.</div></div><div><h3>Objective</h3><div>This study aimed to assess WASH access among adolescent girls and young women (aged 10–24) in last-mile ASM communities in Ghana and Uganda, identifying disparities and factors influencing access.</div></div><div><h3>Methods</h3><div>A cross-sectional, mixed-methods design was employed between March and May 2022 in selected ASM communities in Ghana and Uganda. The quantitative component included a sample of 1618 AGYW (808 in Ghana, 810 in Uganda) recruited through random household selection. Data were collected using interviewer-administered questionnaires adapted from validated sources, covering socio-demographics, water sources, sanitation, and hygiene practices. Descriptive statistics, chi-square tests, and logistic regression were conducted, stratified by country, to examine associations between WASH access and sociodemographic factors. For the qualitative component, AGYW, community leaders, district officers, policymakers, and global experts were purposively selected. Data was collected through focus group discussions and in-depth/key informant interviews conducted in local languages. Thematic analysis was performed using NVivo 12, with illustrative participant quotes.</div></div><div><h3>Results</h3><div>Quantitative findings showed that 86.2 % reported access to improved water sources, but only 10.1 % had access to improved toilet facilities. In Ghana, 83 % lacked any toilet facility; in Uganda, 65 % used unimproved latrines. Water access was associated with religion and education in Ghana, and toilet access was linked to residence and wealth in both countries. Qualitative findings revealed concerns about water quality, reliability, distance to water points, and major sanitation challenges, especially for women and girls. Cultural norms and mining-related environmental impacts further exacerbated WASH vulnerabilities.</div></div><div><h3>Conclusion</h3><div>Significant disparities in WASH persist in ASM communities, particularly for sanitation. Context-specific, community-engaged interventions are urgently needed to address these gaps and promote health equity for AGYW in rural mining settings.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"7 ","pages":"Article 100233"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Population ageing is a global trend, driven by increased life expectancy, which has led to a rise in chronic diseases and greater healthcare needs among older persons. Despite the implementation of national policies and initiatives such as the National Programme for Health Care of the Elderly (NPHCE), Ayushman Bharat and the National Health Policy 2017, older persons, particularly in rural areas, still face barriers to accessing healthcare, including cost, distance, and the quality of care. Socio-economic factors continue to play a key role in healthcare utilisation. This study examines the healthcare access and utilisation patterns and identifies associated determinants among older persons using nationally representative data.
Methods
This study analysed cross-sectional data from the Longitudinal Ageing Study in India (LASI) Wave I Survey (2017–18), which included 31,902 individuals aged 60 years and above. Data from the Individual Schedule was analysed, focusing on healthcare utilisation and related factors. Binary logistic regression was conducted to assess factors influencing outpatient (OPD) and inpatient (IPD) service use. Adjusted odds ratios (aORs) with 95 % confidence intervals (CIs) were reported, and a p value of <0.05 was considered statistically significant.
Findings
Lack of health insurance reduced OPD use (aOR: 0.869, p = 0.006). Females were less likely to use IPD services (aOR: 0.818, p < 0.001), while individuals aged >90 years had higher odds (aOR: 1.470, p < 0.001). Religion, socioeconomic status, and literacy significantly influenced utilisation. Christians and Buddhists had higher IPD use; Muslims and Sikhs had lower odds. Richer groups were less likely to use both services. Limited literacy was linked to reduced OPD use. The North-East reported the highest OPD expenses and travel distances.
Interpretations
There is a pressing need to address healthcare access gaps among older persons through targeted policies and improved outreach. Expanding affordable health insurance can reduce out-of-pocket costs and improve health outcomes in India's ageing population, addressing key Sustainable Development Goals (SDGs), particularly SDG 1,3,10 and 11.
人口老龄化是一种全球趋势，其驱动因素是预期寿命的延长，预期寿命的延长导致老年人慢性病的增加和更大的保健需求。尽管实施了《国家老年人保健方案》、《Ayushman Bharat》和《2017年国家卫生政策》等国家政策和举措，但老年人，特别是农村地区的老年人，在获得医疗保健方面仍然面临障碍，包括费用、距离和护理质量。社会经济因素继续在保健利用方面发挥关键作用。这项研究考察了医疗保健的获取和利用模式，并利用具有全国代表性的数据确定了老年人中相关的决定因素。方法本研究分析了印度纵向老龄化研究（LASI）第一波调查（2017-18）的横断面数据，其中包括31,902名60岁及以上的个体。分析了来自个人时间表的数据，重点关注医疗保健利用率和相关因素。采用二元logistic回归评估影响门诊（OPD）和住院（IPD）服务使用的因素。校正优势比（aORs）为95%可信区间（CIs）， p值为<；0.05认为具有统计学意义。发现健康保险的闲置减少了OPD的使用（aOR: 0.869, p = 0.006）。女性使用IPD服务的可能性较低（aOR: 0.818, p < 0.001），而90岁以上的个体使用IPD服务的可能性较高（aOR: 1.470, p < 0.001）。宗教、社会经济地位和识字率对使用率有显著影响。基督教徒和佛教徒使用IPD的比例更高；穆斯林和锡克教徒的几率较低。较富裕的群体不太可能同时使用这两种服务。识字率有限与OPD使用减少有关。东北部报告了最高的门诊费用和旅行距离。解释：迫切需要通过有针对性的政策和改进的外展来解决老年人获得医疗保健的差距。扩大负担得起的医疗保险可以减少印度老龄化人口的自付费用，改善健康结果，实现关键的可持续发展目标，特别是可持续发展目标1、3、10和11。
{"title":"Healthcare access and utilisation trends among the elderly in India: Evidence from the LASI Wave-1 survey","authors":"Dhruvendra Lal , Amrit Virk , Ashish Goel , Sonu Goel , Kavisha Kapoor Lal , Suneela Garg , Bhavneet Bharti","doi":"10.1016/j.dialog.2025.100232","DOIUrl":"10.1016/j.dialog.2025.100232","url":null,"abstract":"<div><h3>Background</h3><div>Population ageing is a global trend, driven by increased life expectancy, which has led to a rise in chronic diseases and greater healthcare needs among older persons. Despite the implementation of national policies and initiatives such as the National Programme for Health Care of the Elderly (NPHCE), Ayushman Bharat and the National Health Policy 2017, older persons, particularly in rural areas, still face barriers to accessing healthcare, including cost, distance, and the quality of care. Socio-economic factors continue to play a key role in healthcare utilisation. This study examines the healthcare access and utilisation patterns and identifies associated determinants among older persons using nationally representative data.</div></div><div><h3>Methods</h3><div>This study analysed cross-sectional data from the Longitudinal Ageing Study in India (LASI) Wave I Survey (2017–18), which included 31,902 individuals aged 60 years and above. Data from the Individual Schedule was analysed, focusing on healthcare utilisation and related factors. Binary logistic regression was conducted to assess factors influencing outpatient (OPD) and inpatient (IPD) service use. Adjusted odds ratios (aORs) with 95 % confidence intervals (CIs) were reported, and a <em>p</em> value of <0.05 was considered statistically significant.</div></div><div><h3>Findings</h3><div>Lack of health insurance reduced OPD use (aOR: 0.869, <em>p</em> = 0.006). Females were less likely to use IPD services (aOR: 0.818, <em>p</em> < 0.001), while individuals aged >90 years had higher odds (aOR: 1.470, p < 0.001). Religion, socioeconomic status, and literacy significantly influenced utilisation. Christians and Buddhists had higher IPD use; Muslims and Sikhs had lower odds. Richer groups were less likely to use both services. Limited literacy was linked to reduced OPD use. The North-East reported the highest OPD expenses and travel distances.</div></div><div><h3>Interpretations</h3><div>There is a pressing need to address healthcare access gaps among older persons through targeted policies and improved outreach. Expanding affordable health insurance can reduce out-of-pocket costs and improve health outcomes in India's ageing population, addressing key Sustainable Development Goals (SDGs), particularly SDG 1,3,10 and 11.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"7 ","pages":"Article 100232"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Effective diabetes management relies on medical treatment and self-care practices, yet many individuals face challenges in adhering to prescribed routines. With the rise of mobile health (mHealth), there is potential to enhance self-management through regular reminders, guidance, and support. This qualitative study explores patient practices in managing diabetes and the role of mHealth in influencing their behaviours and outcomes.
Methodology
The study employed semi-structured, in-depth interviews with 14 individuals living with diabetes who had received SMS reminders and utilized the feedback application services as part of their diabetes management. Participants got education regarding self-care routines, including medication adherence, diet, exercise, and blood glucose monitoring. Thematic analysis was conducted to identify patterns related to diabetes management practices, patient challenges, and the role of mHealth.
Results
Participants expressed positive feedback on the SMS and app-based services, which promote medication adherence and provide valuable health information. Challenges in diabetes management include physical limitations, social pressures leading to dietary lapses, time constraints, and concerns about receiving spam or misleading information via SMS. However, they recommended improvements, such as guidance on treatment, dietary advice, and the inclusion of interactive features like sugar level tracking.
Conclusion
mHealth has the potential to enhance diabetes self-management significantly, and patient feedback suggests a need for more personalised, interactive, and comprehensive support. Addressing these recommendations alongside patients' physical, social, and financial challenges could improve health outcomes and foster more effective diabetes management.
{"title":"Empowering diabetes care: Patient practices and the role of mobile health – A qualitative exploration","authors":"Jayvardhan Singh , Ramesh Kumar Sangwan , Shiv Kumar Mudgal , Ramesh Kumar Huda","doi":"10.1016/j.dialog.2025.100231","DOIUrl":"10.1016/j.dialog.2025.100231","url":null,"abstract":"<div><h3>Introduction</h3><div>Effective diabetes management relies on medical treatment and self-care practices, yet many individuals face challenges in adhering to prescribed routines. With the rise of mobile health (mHealth), there is potential to enhance self-management through regular reminders, guidance, and support. This qualitative study explores patient practices in managing diabetes and the role of mHealth in influencing their behaviours and outcomes.</div></div><div><h3>Methodology</h3><div>The study employed semi-structured, in-depth interviews with 14 individuals living with diabetes who had received SMS reminders and utilized the feedback application services as part of their diabetes management. Participants got education regarding self-care routines, including medication adherence, diet, exercise, and blood glucose monitoring. Thematic analysis was conducted to identify patterns related to diabetes management practices, patient challenges, and the role of mHealth.</div></div><div><h3>Results</h3><div>Participants expressed positive feedback on the SMS and app-based services, which promote medication adherence and provide valuable health information. Challenges in diabetes management include physical limitations, social pressures leading to dietary lapses, time constraints, and concerns about receiving spam or misleading information via SMS. However, they recommended improvements, such as guidance on treatment, dietary advice, and the inclusion of interactive features like sugar level tracking.</div></div><div><h3>Conclusion</h3><div>mHealth has the potential to enhance diabetes self-management significantly, and patient feedback suggests a need for more personalised, interactive, and comprehensive support. Addressing these recommendations alongside patients' physical, social, and financial challenges could improve health outcomes and foster more effective diabetes management.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"7 ","pages":"Article 100231"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144665481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-14DOI: 10.1016/j.dialog.2025.100230
Khuman Bhagirath Jetubhai
This paper examines the nature of Indian digital news reporting on suicides and suicide attempts within the LGBTQ+ community. The objective is to analyse how these incidents are framed by the media by identifying the dominant narratives, demographic characteristics highlighted, and attributed causes presented in news coverage. Following PRISMA guidelines, this study identified and analysed 164 unique digital news reports published between 2001 and 2022. The analysis reveals that news coverage most frequently focuses on individuals identified as trans women or lesbians, who are in the 19–24 and 25–44 age brackets, and are reported to be in a relationship. The most common narratives constructed in these reports attribute the suicides to family non-acceptance of their relationship or identity and partner separation. Furthermore, hanging and drug/poison ingestion are the most frequently reported methods of suicide, and joint/couple suicides are a significant feature of the media coverage. These findings demonstrate that the portrayal of LGBTQ+ suicide in Indian digital media is a curated narrative, likely shaped by journalistic news values rather than being a direct reflection of population-level trends. This research provides critical insights into the construction of media discourse on a sensitive public health issue and its implications for public perception and policy.
{"title":"Portrayals of suicide and suicide attempts among LGBTQ+ individuals in Indian digital news","authors":"Khuman Bhagirath Jetubhai","doi":"10.1016/j.dialog.2025.100230","DOIUrl":"10.1016/j.dialog.2025.100230","url":null,"abstract":"<div><div>This paper examines the nature of Indian digital news reporting on suicides and suicide attempts within the LGBTQ+ community. The objective is to analyse how these incidents are framed by the media by identifying the dominant narratives, demographic characteristics highlighted, and attributed causes presented in news coverage. Following PRISMA guidelines, this study identified and analysed 164 unique digital news reports published between 2001 and 2022. The analysis reveals that news coverage most frequently focuses on individuals identified as trans women or lesbians, who are in the 19–24 and 25–44 age brackets, and are reported to be in a relationship. The most common narratives constructed in these reports attribute the suicides to family non-acceptance of their relationship or identity and partner separation. Furthermore, hanging and drug/poison ingestion are the most frequently reported methods of suicide, and joint/couple suicides are a significant feature of the media coverage. These findings demonstrate that the portrayal of LGBTQ+ suicide in Indian digital media is a curated narrative, likely shaped by journalistic news values rather than being a direct reflection of population-level trends. This research provides critical insights into the construction of media discourse on a sensitive public health issue and its implications for public perception and policy.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"7 ","pages":"Article 100230"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-05DOI: 10.1016/j.dialog.2025.100228
Norman Tafirenyika Nhede, Adrino Mazenda, Dymon Gondwe
This study examines the impact of Child Support Grants (CSGs) on access to medical care and contraception use in South Africa, investigating whether social assistance can enhance healthcare access beyond its primary aim of alleviating poverty. While previous research highlights CSGs' poverty reduction and welfare enhancement effects, little is known about their effects on healthcare and reproductive healthcare access, especially given South Africa's healthcare disparities. Using data from the first wave of the 2020 National Income Dynamics Study—Coronavirus Rapid Mobile Survey (NIDS-CRAM), this study employs mediation analysis to analyse the effects of CSG receipt on healthcare and contraception access while controlling for socio-economic factors. The findings indicate a complex relationship. CSGs have a positive but insignificant indirect effect on healthcare and contraception access and a significant negative direct effect, suggesting that the current grant structure may not adequately address existing barriers. The results highlight the need for policy changes, indicating that while CSGs are vital as a social safety net, their effectiveness in improving healthcare access could be enhanced through increased grant amounts and targeted interventions to address healthcare costs and structural barriers.
{"title":"Beyond poverty alleviation: The impact of child support grants on healthcare access and contraception use in South Africa","authors":"Norman Tafirenyika Nhede, Adrino Mazenda, Dymon Gondwe","doi":"10.1016/j.dialog.2025.100228","DOIUrl":"10.1016/j.dialog.2025.100228","url":null,"abstract":"<div><div>This study examines the impact of Child Support Grants (CSGs) on access to medical care and contraception use in South Africa, investigating whether social assistance can enhance healthcare access beyond its primary aim of alleviating poverty. While previous research highlights CSGs' poverty reduction and welfare enhancement effects, little is known about their effects on healthcare and reproductive healthcare access, especially given South Africa's healthcare disparities. Using data from the first wave of the 2020 National Income Dynamics Study—Coronavirus Rapid Mobile Survey (NIDS-CRAM), this study employs mediation analysis to analyse the effects of CSG receipt on healthcare and contraception access while controlling for socio-economic factors. The findings indicate a complex relationship. CSGs have a positive but insignificant indirect effect on healthcare and contraception access and a significant negative direct effect, suggesting that the current grant structure may not adequately address existing barriers. The results highlight the need for policy changes, indicating that while CSGs are vital as a social safety net, their effectiveness in improving healthcare access could be enhanced through increased grant amounts and targeted interventions to address healthcare costs and structural barriers.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"7 ","pages":"Article 100228"},"PeriodicalIF":0.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cancer epidemiology and care services in low- and middle-income countries, has traditionally overlooked the specific needs of the lesbian, gay, bisexual, transgender, queer, intersex, and asexual community, including people who identify with diverse gender identities and sexual orientations (LGBTQIA+). This narrative review examines the intersection of LGBTQIA+ individual's health and oncology cases in Nepal, highlighting disparities in cancer risk factors, delayed diagnosis, limited screening access and the compounding effects of social stigma and discrimination. Drawing from regional data and global insights, we identify systemic barriersincluding heteronormative healthcare environments, lack of provider training in LGBTQIA+-inclusive oncology, and policy gaps that hinder equitable cancer care access. We also outline targeted strategies to improve cancer outcomes for LGBTQIA+ individuals, including stakeholder engagement, culturally competent oncology training for healthcare providers and students, and community-led education and advocacy. This review underscores the urgent need to integrate LGBTQIA+-specific priorities into Nepal's national cancer strategies to advance equity in oncology care delivery.
{"title":"Strengthening cancer care for the LGBTQIA+ population in Nepal: A narrative review to set priorities for equitable oncology services","authors":"Sunil Shrestha , Nabin Pathak , Simit Sapkota , Sudip Thapa , Subhas Pandit , Jeebana Bhandari , Pankaj Barman , Pratik Khanal , Kamal Ranabhat , Vibhu Paudyal , Deependra Singh","doi":"10.1016/j.dialog.2025.100229","DOIUrl":"10.1016/j.dialog.2025.100229","url":null,"abstract":"<div><div>Cancer epidemiology and care services in low- and middle-income countries, has traditionally overlooked the specific needs of the lesbian, gay, bisexual, transgender, queer, intersex, and asexual community, including people who identify with diverse gender identities and sexual orientations (LGBTQIA+). This narrative review examines the intersection of LGBTQIA+ individual's health and oncology cases in Nepal, highlighting disparities in cancer risk factors, delayed diagnosis, limited screening access and the compounding effects of social stigma and discrimination. Drawing from regional data and global insights, we identify systemic barriersincluding heteronormative healthcare environments, lack of provider training in LGBTQIA+-inclusive oncology, and policy gaps that hinder equitable cancer care access. We also outline targeted strategies to improve cancer outcomes for LGBTQIA+ individuals, including stakeholder engagement, culturally competent oncology training for healthcare providers and students, and community-led education and advocacy. This review underscores the urgent need to integrate LGBTQIA+-specific priorities into Nepal's national cancer strategies to advance equity in oncology care delivery.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"7 ","pages":"Article 100229"},"PeriodicalIF":0.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pharmacovigilance (PV) and adverse drug reaction (ADR) reporting are essential components of ensuring medication safety. However, many healthcare students have limited knowledge in these areas. This study evaluates the pharmacovigilance knowledge and ADR reporting skills among undergraduate medical and nursing students.
Methods
A cross-sectional study was conducted at the All India Institute of Medical Sciences (AIIMS), Deoghar, with 190 undergraduate healthcare students. Participants completed a validated structured questionnaire assessing their pharmacovigilance and ADR reporting knowledge. Data were analyzed using SPSS version 23.0, with descriptive statistics to present the results.
Results
The findings revealed that 35 % of students had limited knowledge of pharmacovigilance and ADR reporting, while 52 % demonstrated a moderate level of understanding. A majority were aware of the importance of pharmacovigilance and ADR reporting, although they faced challenges in completing ADR reports accurately.
Conclusions
Although students exhibited a basic understanding of pharmacovigilance, significant gaps were found in their ability to effectively report ADRs. These findings underscore the need for enhanced pharmacovigilance education within healthcare curricula, ensuring students are adequately prepared to apply their knowledge in clinical settings.
{"title":"Assessment of pharmacovigilance knowledge and ADR reporting skills in undergraduate medical students using the OSPA model","authors":"T.Y. Sree Sudha , Kusum Kumari , C. Vasantha Kalyani , Monika Kankarwal , K.S.B.S. Krishna Sasanka","doi":"10.1016/j.dialog.2025.100227","DOIUrl":"10.1016/j.dialog.2025.100227","url":null,"abstract":"<div><h3>Background</h3><div>Pharmacovigilance (PV) and adverse drug reaction (ADR) reporting are essential components of ensuring medication safety. However, many healthcare students have limited knowledge in these areas. This study evaluates the pharmacovigilance knowledge and ADR reporting skills among undergraduate medical and nursing students.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted at the All India Institute of Medical Sciences (AIIMS), Deoghar, with 190 undergraduate healthcare students. Participants completed a validated structured questionnaire assessing their pharmacovigilance and ADR reporting knowledge. Data were analyzed using SPSS version 23.0, with descriptive statistics to present the results.</div></div><div><h3>Results</h3><div>The findings revealed that 35 % of students had limited knowledge of pharmacovigilance and ADR reporting, while 52 % demonstrated a moderate level of understanding. A majority were aware of the importance of pharmacovigilance and ADR reporting, although they faced challenges in completing ADR reports accurately.</div></div><div><h3>Conclusions</h3><div>Although students exhibited a basic understanding of pharmacovigilance, significant gaps were found in their ability to effectively report ADRs. These findings underscore the need for enhanced pharmacovigilance education within healthcare curricula, ensuring students are adequately prepared to apply their knowledge in clinical settings.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"7 ","pages":"Article 100227"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Continuum of care (CoC) emphasizes the importance of establishing connections between maternal healthcare service provided at various stages throughout pregnancy, labour, and the postpartum period. The objective of this study was to investigate the CoC for maternal health, focusing on recent utilization and dropout pattern and to examine the underlying wealth inequality and its association with the dimensions of women's empowerment.
Material and methods
For our analysis, we focused on mothers who had given birth within the five years preceding the National family health survey (NFHS)-5 survey. Outcome variable, the CoC for maternal health was assessed at three distinct levels: CoC until 4+ antenatal care (ANC), CoC until skilled birth attendance (SBA), CoC until postnatal care (PNC) or complete CoC. Binary logistic regression, concentration curve and index were utilized to address the objectives of the study.
Results
Our study found that 93.8 % of women initiated maternal healthcare with at least one ANC visit, but only 63.1 % completed the recommended 4+ visits. Among them, 94.6 % received SBA, yet only 62 % continued to PNC. A concerning dropout pattern was observed across all states, with even prosperous states like Chandigarh, West Bengal, Goa, Kerala, New Delhi, and Gujarat showing higher dropout rates before PNC than the national average of 38 %. Concentration curves revealed pro-rich inequality in CoC. Women's social independence positively influenced CoC adherence, along with parity, pregnancy intention, wealth index, and region of residence as key determinants.
Conclusion
Our findings reveal significant gaps in the continuum of maternal healthcare, including high dropout rates before postnatal care and persistent wealth-based disparities. Addressing these issues requires targeted policies, greater women's empowerment, and equitable healthcare access. Future research should conduct a comprehensive analysis to understand why dropout rates remain high, even in relatively prosperous states, by examining health system inefficiencies, sociocultural barriers, and policy gaps.
{"title":"Pregnancy to postpartum: Analyzing dropouts and socioeconomic predictors of continuum of maternal healthcare in India","authors":"Pooja Singh , Sanjiv Singh , Kaushalendra Kumar Singh","doi":"10.1016/j.dialog.2025.100226","DOIUrl":"10.1016/j.dialog.2025.100226","url":null,"abstract":"<div><h3>Background</h3><div>Continuum of care (CoC) emphasizes the importance of establishing connections between maternal healthcare service provided at various stages throughout pregnancy, labour, and the postpartum period. The objective of this study was to investigate the CoC for maternal health, focusing on recent utilization and dropout pattern and to examine the underlying wealth inequality and its association with the dimensions of women's empowerment.</div></div><div><h3>Material and methods</h3><div>For our analysis, we focused on mothers who had given birth within the five years preceding the National family health survey (NFHS)-5 survey. Outcome variable, the CoC for maternal health was assessed at three distinct levels: CoC until 4+ antenatal care (ANC), CoC until skilled birth attendance (SBA), CoC until postnatal care (PNC) or complete CoC. Binary logistic regression, concentration curve and index were utilized to address the objectives of the study.</div></div><div><h3>Results</h3><div>Our study found that 93.8 % of women initiated maternal healthcare with at least one ANC visit, but only 63.1 % completed the recommended 4+ visits. Among them, 94.6 % received SBA, yet only 62 % continued to PNC. A concerning dropout pattern was observed across all states, with even prosperous states like Chandigarh, West Bengal, Goa, Kerala, New Delhi, and Gujarat showing higher dropout rates before PNC than the national average of 38 %. Concentration curves revealed pro-rich inequality in CoC. Women's social independence positively influenced CoC adherence, along with parity, pregnancy intention, wealth index, and region of residence as key determinants.</div></div><div><h3>Conclusion</h3><div>Our findings reveal significant gaps in the continuum of maternal healthcare, including high dropout rates before postnatal care and persistent wealth-based disparities. Addressing these issues requires targeted policies, greater women's empowerment, and equitable healthcare access. Future research should conduct a comprehensive analysis to understand why dropout rates remain high, even in relatively prosperous states, by examining health system inefficiencies, sociocultural barriers, and policy gaps.</div></div>","PeriodicalId":72803,"journal":{"name":"Dialogues in health","volume":"7 ","pages":"Article 100226"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144580251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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