Editorial 1 : Education ‘remains the most effective contraceptive’
Context
Last year, India overtook China as the world’s most populous country. According to United Nations estimates, India’s population which is currently 1.4 billion, will peak at 1.7 billion or so in 2064 before settling at 1.53 billion in 2100.
Growth is slowing
- But even though these numbers are staggering, data indicates that population growth is slowing —the total fertility rate has dipped below the replacement level of 2.1 and is projected to dip further.
- With World Population Day (July 11) around the corner, experts say India’s thrust should be on ensuring the sexual and reproductive health of its young people.
- A study that referenced the National Family Health Surveys (NFHS) concluded that there is a significant association between years of schooling and total unmet needs for family planning and unmet needs for spacing.
- According to a study, The demand for unmet needs for spacing and limiting was the highest among the women in the age categories 15–19 (17.8%) and 20–24 (17.3%).
The factors
- This is primarily due to two factors: women who get married very young are usually from backward regions and not very educated, and therefore, their agency to negotiate or even talk about family planning is limited.
- This is a social norm: even if the young woman does talk to a healthcare worker, the thinking is that once they are married, they must prove their fertility with children before family planning, and therefore there is no room for access to contraception.
- The other issue is that the country is increasingly seeing teenage pregnancies both among married and unmarried women, and yet, families are unwilling to accept that their unmarried children may be sexually active.
- This is compounded by the lack of sex education. Globally, evidence has shown that where sex education is given, the sexual debut of a young person is postponed.
- It also helps eradicate misconceptions. In India, for a young person to even access condoms or any other form of contraception is culturally and socially against norms.
The need of the hour
- There is an urgent need to focus on young people, both men and women, and on their sexual and reproductive health through culturally sensitive behaviour change communication, and by offering them a basket of contraceptive options to meet their needs.
- Women’s education continues to be the most effective contraception.
- Even abortion, is a qualified right. Abortion is largely criminal in India except under the Medical Termination of Pregnancy (MTP) Act, the person must qualify for the service as per the conditions of the act. Any abortion outside of the Act is criminalised. This makes access to safe and legal abortions difficult for a large section of pregnant people in India.
Conclusion
Both education and access are essential components in addressing reproductive health challenges and promoting well-being globally. By prioritizing both aspects, societies can better support individuals in making choices that align with their health needs and life aspirations.
Editorial 2 : Radiationbiodosimetry: the ABCs of responding to a radiological event
Context
After a large-scale radiological event, such as an Improvised Nuclear Device or reactor accident, it is important to identify those individuals who have received a significant dose of radiation and would benefit from one of the drugs that have been recently approved to treat radiation sickness.
What is biodosimetry?
- Biodosimetry allows one to determine the amount of radiation to which an individual was exposed based on changes in blood, urine, or hair.
- It would be particularly useful in a radiological event where the exposed individuals do not carry any personal radiation monitoring devices.
- The gold standardbiodosimetryassay is measurement of chromosome aberrations, in white blood cells.
- When irradiated, DNA in the blood cells gets broken and is repaired within a few hours.
- In some cases, there is an incorrect repair, joining fragments from different chromosomes, forming a ‘DicentricChromosome (DC)’ – a chromosome with two centromeres.
- Because a DC can only be formed by radiation, measuring these chromosomes is a specific and sensitive indicator of past radiation exposure.
- In order to measure DC, lymphocyte from the exposed individuals is cultured to begin division and then the chromosomes are spread on a slide and stained.
- The DC are then counted either while looking down a microscope directly or in images captured at high magnification.
- Due to the need for culturing the cells followed by the analysis of few hundred metaphases, the overall time taken to produce a result is about 2-3 days.
- Over the past decades, theDicentricChromosome Assay (DCA) has been successfully employed in many radiation accidents, where the number of exposed people is small.
- However, as implemented in a clinical cytogenetic lab, the DCA is too labour intensive to be practically applied in a larger event, with a throughput of a few tens of samples per day.
- A second, slightly simpler, assay is the Cytokinesis Block Micronucleus Assay (CBMN), where the white blood cells are made to divide, but arrested before division is complete.
- This forms a cell with two nuclei. Following radiation exposure some DNA will be ejected during division forming a “micronucleus”. This assay is slightly simpler to perform and score but overall time to answer is longer (~3 days), as it requires longer culturing of the cells.
- Measurement on the phosphorylated form of specific histone protein, an inherent component of chromosomes known as the “gamma-H2AX’ assay, has the potential to segregate the exposed from that of unexposed and those exposed to low dose versus high dose without culturing cells, within 6-8 hours of time.
- This assay needs to be performed within 24 hours owing to the kinetics of histone phosphorylation.
Increasing throughput
- The traditional approach to increasing the throughput of biodosimetry assays is to implement a lab network, where samples are shared between a dozen or more labs around the world, however this does not provide a sufficient increase in throughput to cope with a large radiological event.
- Over the last 20 years the Center for Radiological Research at Columbia University has developed automatable versions of the majorbiodosimetryassays, performed in 96-well plates.
- The first iteration of the Rapid AutomatedBiodosimetryTool (RABiT) used custom robotics to perform the CBMN assay with a target throughput of 6000 samples per day per machine.
- More recently we have implemented both the CBMN and DCA assays on several commercial High Throughput Screening (HTS) platforms, dubbed “RABiT-II”.
- HTS systems use robotics, liquid handling devices and automated microscopes to quickly conduct millions of chemicals, genetic, or pharmacological tests.
- In the pharmaceutical industry, these systems leverage automation to quickly assay the biochemical activity of many drug-like compounds.
- In academia, the same systems are increasingly used to arrive at fundamental biological insights rather than drug candidates.
Benefits
- The broad deployment of HTS platforms would allow significantly increased throughput for performing biodosimetry, with each machine capable, in principle, of analyzing thousands of samples per day. A second major advantage is reliability.
- A commercial system with such diverse deployment capabilities undergoes rigorous quality control during development, manufacture and most importantly maintenance.
- Because these systems are in continuous operation, they also have a broad base of trained users and maintenance personnel ensuring successful operation during a-crisis.
- This would obviously not be the case with a custom robotic system which would likely be in storage for years or decades before use.
Conclusion
- In conclusion, high throughput automatedbiodosimetryoffers the opportunity to perform dose assessment on a large number of people in the event of a large-scale radiological or nuclear incident.
- It fits well with the current operation concept, as a 2nd-tier triage separating exposed individuals into treatment categories and later for long-term epidemiological follow-up.
