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IntroductionDietary modification, particularly low-carbohydrate diet, and diabetes self-management education (DSME) have shown promise in improving glycaemic control among persons with type 2 diabetes mellitus (T2DM). However, real-world evidence from India is limited. This protocol describes the methods of a cluster randomised trial to determine the effectiveness and feasibility of adopting a low-carbohydrate diet among persons with T2DM.Methods and analysisOur cluster-randomised trial with a mixed-method process evaluation will use computer-generated block randomisation sequence to randomise Urban Primary Health Centres (UPHCs) (n=16) to either continue delivering the usual guideline-based care under the National Programme for Prevention and Control of Non-Communicable Diseases (NPNCD) or our study intervention. The study intervention will comprise a personalised nutrition counselling focusing on (i) low-carbohydrate diet (<130 g/day) (ii) diabetes self-management principles. A primary care nurse will deliver the intervention at baseline, 3, 6, 9 and 12 months.We will include persons with T2DM, over the age of 30 years and above, irrespective of comorbidities, registered in the selected UPHC under care for diabetes for at least a month and with an glycated haemoglobin (HbA1c) level ≥6.5% during the screening test. We will collect data electronically using semistructured questionnaires and measure HbA1c, blood pressure, lipid profile, serum creatinine and body weight at baseline, 3, 6, 9 and 12 months after enrolment. We will use a difference in difference analysis, adjusted for clustering, to compare the change in HbA1c at the follow-up visits compared with baseline across the two study arms. We will conduct both intention-to-treat and per-protocol analysis, exploring reasons for differences in effect size.Ethics and disseminationThe study protocol was reviewed and approved by the Scientific Advisory Committee/Institutional Human Ethics Committee of the research institution (NIE/IHEC/202302-03). The findings of this study will be disseminated through publication in peer-reviewed journals.Trial registration numberClinical Trials Registry-India (CTRI/2024/02/062202).

Microplastics are the newly emerged contaminants with a presence in almost every part of the globe. Despite being small in size, microplastic particles have proved to be harmful for plants, animals, humans, and for the ecosystem in general. Water is one of the most important routes through which microplastics transfer from one place to another. Moreover, water is also an important route for the ingestion of microplastics in human, which results in various health issues, such as cancer, mutagenic and teratogenic abnormalities. Thus, microplastics in water is an emerging public health issue which needs attention and, hence, it is important to investigate removal techniques for microplastics in wastewater. Although, there are some biological, chemical/electrochemical, and physical techniques to remove microplastics, their wide scale applicability and cost–effectiveness is an issue. In this review, we have discussed the existing and upcoming treatment technologies for the removal of microplastics from wastewater and also tried to present an overview for the future approaches.

Microplastics are one of the emerging contaminants that have received attention in recent decades due to their adverse effects on human health and the environment. Though microplastics are primarily found in abundance in oceans, freshwater sources and drinking water are not unaffected. Nevertheless, it is not only the microplastics that are harmful; rather their ability to transport contaminants is another serious issue of concern. The contaminant transport ability is affected by various environmental and physico-chemical parameters of microplastics. Lack of effective and targeted water treatment technologies have led intake of microplastics by humans resulting in a variety of health issues. Even though a few regulatory attempts have been made in the direction of curtailing the production and use of microplastics, there is still a long way to go. This paper focuses on various aspects of microplastics’ presence in drinking water, focusing on their contaminant transport ability, human health risks, removal technologies, and the global scenario of concern.

Homeless people with mental illness (HPWMI) are an ultra-vulnerable population with unmet clinical and social needs. To address this, the Government of Tamil Nadu, India, launched the Emergency Care and Recovery Centres (ECRCs) in 2019 to rescue, treat, and reintegrate HPWMI with their families. We conducted this study to evaluate the clinical and social outcomes of individuals admitted to ECRCs. We conducted a descriptive analysis using case records for individuals admitted to 13 ECRCs between 1st January 2022 and 31st December 2022. Using simple random sampling, 250 records were selected from all admissions during this period. We retrospectively extracted social, demographic and clinical characteristics and treatment outcomes using data-extraction forms. The characteristics and outcome were summarized and reported as proportions. Ethical approval was obtained from the Institutional Human Ethics Committee of ICMR–NIE. A total of 1619 individuals were admitted during the study period. We retrieved 250 case records. The majority were male (59%, 148/250) and were aged 26–50 years (75%, 162/217). Schizophrenia spectrum disorders were the most common psychiatric diagnosis (57%, 137/242). Physical comorbidities were present in 20% (49/250), with anaemia being the most frequent. Majority (71%, 135/190) showed weight gain at discharge, and 46% (84/184, 95%CI: 38–53) were reintegrated with families. The ECRC program has the potential to improve clinical outcomes and social life of HPWMIs. Long-term care models are required for individuals who were not reintegrated with families after initial rehabilitation. •ECRC is a state-initiated, multicentric program to rescue, treat and reintegrate homeless people with mental illness (HPWMI).•This is the first study documenting the socio-demographic profile and the clinical and social outcomes of HPWMI admitted to multiple ECRCs across the state.•The study documents that the ECRC model improved clinical and social outcomes HPWMI evidenced by clinical improvement, family reintegration and access to social entitlements.•The model has the potential to be replicated in settings facing similar challenges.

Background Segregation of household waste at the source is an effective and sustainable strategy for management of municipal waste. However, household segregation levels remain insufficient as waste management approaches are mostly top down and lack local support. The realisation and recognition of effective, improved and adequate waste management may be one of the vital drivers for attaining environmental protection and improved health and well-being. The presence of a local level motivator may promote household waste segregation and ultimately pro-environmental behaviour. The present cluster randomized control trial aims to understand if volunteer based information on waste segregation (I-MISS) can effectively promote increased waste segregation practices at the household level when compared with existing routine waste segregation information in an urban Indian setting. Methods This paper describes the protocol of an 18 month two-group parallel,cluster randomised controlled trialin the urban setting of Ujjain, Madhya Pradesh, India. Randomization will be conducted at ward level, which is the last administrative unit of the municipality. The study will recruit 425 households in intervention and control groups. Assessments will be performed at baseline (0 months), midline (6 months), end line (12 months) and post intervention (18 months). The primary outcome will be the comparison of change in proportion of households practicing waste segregation and change in proportion of mis-sorted waste across the study period between the intervention and control groups as assessed by pick analysis. Intention to treat analysis will be conducted. Written informed consent will be obtained from all participants. Discussion The present study is designed to study whether an external motivator, a volunteer selected from the participating community and empowered with adequate training, could disseminate waste segregation information to their community, thus promoting household waste segregation and ultimately pro-environmental behaviour. The study envisages that the volunteers could link waste management service providers and the community, give a local perspective to waste management, and help to change community habits through information, constant communication and feedback. Trial registration The study is registered prospectively with Indian Council of Medical Research- Clinical Trial Registry of India ( CTRI/2020/03/024278 ).

Context: After the gas tragedy on the night of December 2/3, 1984, at Bhopal, the Indian Council of Medical Research (ICMR) started following up on four population cohorts with different levels of post-disaster mortality from December 3-6, 1984. Aims: The present study was undertaken to estimate the survival time of the cohort, and investigate the risk of mortality based on exposure, gender, and median age. Settings and Design: Survival analysis is generally used to evaluate factors associated with the time to an event of failure or death among any covered population. Methods and Materials: To know the cause of death and mortality rate, a retrospective cohort analysis was conducted on the outcomes of 92,320 individuals with an exposed and non-exposed group from 1985 to 2015 in Bhopal, India. Statistical Analysis Used: Basic survival analysis method, Kaplan-Meier method, and Cox proportional hazard regression model were used to analyze the mortality risk. Results: During the past 30 years, the survivability was 87.25%, and the mortality rate was 7.2% for the cohort population of Bhopal gas survivors. Cox regression analysis showed that exposed, males, and individuals above 21 years (at the time of the disaster) were at higher risk of mortality from 1985 to 2015. Conclusions: During the initial two phases, the mortality was higher in the exposed group, but over time, their survival turned out to be the same in both groups.

Increasing amount of municipal solid waste is a growing global concern harming the health of the humans and animals and affecting the sustainability of the environment. While citizens are expected to take responsibility for waste sorting and segregation, limited engagement, lack of awareness, and dependency on others often hinder effective waste management at the source. This study aims to understand participants’ perceptions of waste segregation and management using a photovoice-based crowdsourcing approach. Through qualitative analysis of photographs and accompanying narratives submitted in a national contest, we explored how individuals interpret waste-related challenges, their motivations or barriers to action, and developed a conceptual framework. While many participants demonstrated awareness of the consequences of poor waste management and advocated for the principles of reduce, reuse, and recycle, a key theme that emerged was the lack of community participation and engagement. The conceptual framework was mapped against the Theory of Planned Behaviour and the Motivation-Opportunity-Ability-Behaviour model to contextualize and highlight the interaction of attitudes, perceived norms, and abilities. This study highlights the utility of participatory, photovoice-driven methods in shaping effective and inclusive waste management strategies. Graphical abstract Highlights Present insights and perceptions of the community members using photovoice method of data collection. Explores challenges, opportunities, and community-driven suggestions in managing waste from all of India. Applied MOAB model and TPB theory to highlight the central role of behaviour and attitude in shaping waste management practices. Community involvement and engagement enhances waste segregation and its appropriate disposal. Behaviour change can be promoted by aligning individuals’ motivations, opportunities, and abilities with desired behavioural outcomes.

Improper disposal of household waste adversely affects both the environment and human health. Effective household waste segregation relies on the collaboration of program managers, service providers, and household members. This study focused on service providers’ and program managers’ perspectives on household waste segregation in India. We conducted 25 semi-structured interviews with 13 program managers and 12 service providers in Ujjain, Madhya Pradesh, India. Interviews were digitally recorded, transcribed, translated and analyzed through thematic analysis. Three key themes emerged: 1) Optimizing household waste segregation—observations from service providers and program managers, 2) Navigating the current landscape of household waste segregation, and 3) Unveiling the driving forces behind household waste segregation. Participants emphasized the need for a comprehensive strategy integrating incentives, community education, and engagement, along with the development of adequate infrastructure. Building provider-resident trust, equipping facilities, and ensuring timely waste collection were identified as crucial for public compliance. Program managers and service providers also stressed the importance of targeted educational interventions to enhance waste segregation skills through proactive community engagement.

Background: The traditional teaching learning methods involve a one way process of transmission of knowledge leaving the students lacking behind in creative abilities. Medical schools need to change their teaching strategies to keep the interest of students and empower them for future self- learning and critical thinking. Objective: To assess the impact of mind mapping technique in information retrieval among medical college students in Puducherry. Methods: A pilot study was conducted using experimental study design among sixth semester MBBS students (n = 64) at a medical college in Puducherry, India. One group (n = 32) followed the text reading method and another group (n = 32) followed the mind mapping technique to learn the same passage given to them. The knowledge about the topic was assessed using a pre designed questionnaire at baseline, day 0 and day 7. The knowledge gain is the primary outcome variable and is compared between two groups. The feedback regarding the teaching methods was obtained from the participants. Results: Mean knowledge score in the text group was lesser than the mind map group at baseline (2.6 Vs 3.5; p = 0.08). On Day 0, the mean score in text group was slightly lesser than the mind map group (8.7 Vs 9.0; p = 0.26). On Day 7, the mean score in mind map group is significantly more than the text group (8.9 Vs 8.5; p = 0.03). Conclusion: The mind mapping technique is an innovative and effective method in remembering things better than the routine way of reading texts.

Occurrence of microplastics in various environmental matrices is a global reality. Considering the significance of this fact, scientists are trying to identify and characterize this emerging contaminant in a variety of abiotic as well as biotic matrices, so that effective preventive measures may be adopted. Increasing plastic usage in agricultural practices in the form of packaging, mulching etc. have introduced this contaminant in agricultural soil as well. Therefore, present study was carried out in agricultural soil of Bhopal, Central India. Microplastics in agricultural soil were identified and characterized using FTIR spectroscopy, and further assessed for possible ecological risks. An amount of 307.5 ± 9.19 and 69.5 ± 4.95 particles were found in the 10 soil samples collected from each of the Bhauri and Kokta agricultural areas of Bhopal, respectively. Polyethylene and polypropylene were the most abundant microplastic polymers. Presence of these particles resulted in ‘very-low’ to ‘low’ hazard to the soil. Presence of plastic particles in agricultural soil of Bhopal was attributed to the littering of plastic packaging materials of various agrochemicals, and atmospheric deposition. Presence of microplastics may pose considerable risk to the agricultural soil, crop health, and subsequently to human health. Therefore, control measures to minimize plastic pollution need to be adopted.