Objective To qualitatively assess the barriers and facilitators to uptake of referral services amongst high-risk pregnant women in rural Rajasthan. Methods A purposive sample of pregnant women with high-risk conditions requiring referral follow-up care (severe hypertension, moderate anemia, and severe anemia) were considered for inclusion. In-depth individual interviews were conducted in the local dialect, Mewari. Interviews were transcribed, coded, and organized for thematic generation as per the analytical framework described in the socio-ecological model. Results 19 high risk pregnant women of low socioeconomic backgrounds across 15 villages were interviewed. Barriers to referral care included lack of transportation, household responsibilities, and limited awareness, education, and social support. The most prominent barrier was lack of accompaniment to the referral center by a family member or health worker. Facilitators included available husbands, engaged heath workers, supportive neighbors, and other female family members who shared past experiences. Conclusions Social support at the interpersonal and community level was key to overcoming referral care barriers faced by high-risk pregnant women in rural Rajasthan. Interventions that enhance social support may improve uptake of referral care services by high-risk pregnant women.

Nearly 80% of advanced cancer patients are afflicted with cachexia, a debilitating syndrome characterized by extensive loss of muscle mass and function. Cachectic cancer patients have a reduced tolerance to antineoplastic therapies and often succumb to premature death from the wasting of respiratory and cardiac muscles. Since there are no available treatments for cachexia, it is imperative to understand the mechanisms that drive cachexia in order to devise effective strategies to treat it. Although 25% of metastatic breast cancer patients develop symptoms of muscle wasting, mechanistic studies of breast cancer cachexia have been hampered by a lack of experimental models. Using tumor cells deficient for BARD1, a subunit of the BRCA1/BARD1 tumor suppressor complex, we have developed a new orthotopic model of triple‐negative breast cancer that spontaneously metastasizes to the lung and leads to systemic muscle deterioration. We show that expression of the metal‐ion transporter, Zip14, is markedly upregulated in cachectic muscles from these mice and is associated with elevated intramuscular zinc and iron levels. Aberrant Zip14 expression and altered metal‐ion homeostasis could therefore represent an underlying mechanism of cachexia development in human patients with triple‐negative breast cancer. Our study provides a unique model for studying breast cancer cachexia and identifies a potential therapeutic target for its treatment.

Objective If Rajasthan, India was a country, it would rank 148th out of 192 for maternal mortality. Early identification of high-risk pregnant women, timely referral care, early intervention and delivery planning are key factors in reducing maternal mortality. To our knowledge, this is the first study to qualitatively assess the barriers and facilitators to uptake of referral services amongst high-risk pregnant women in rural Rajasthan. Methods Active pregnant women tracked digitally through the Khushi Baby platform in Udaipur, Rajasthan were considered from the sample frame. Pregnant women who had either severe hypertension or moderate/severe anemia were considered for inclusion. A purposive sample was approached to ensure a diversity of perspectives. In-depth individual interviews were conducted in the local dialect, Mewari. Interviews were transcribed, coded, and used for thematic generation, and organized as per the analytical framework described in the socio-ecological model. Results 19 high risk pregnant women of low socioeconomic backgrounds across 15 villages were interviewed. Barriers to referral care included lack of transportation, household responsibilities, and limited awareness, education, and social support. The most prominent barrier was lack of accompaniment to the referral center by a family member or health worker. Facilitators included available husbands, engaged heath workers, supportive neighbors, and other female family members who shared past experiences. Social support through accompaniment was noted to have the ability to overcome barriers. Conclusions Social support at the interpersonal and community level is key to overcoming referral care barriers faced by high-risk pregnant women in rural Rajasthan. Completion of antenatal referral care visits is essential to improvement in maternal and child health outcomes. A multi-faceted approach is needed to improve referral care completion for maternal health in rural Rajasthan. The following interventions are likely to be effective: a) targeted awareness campaigns for ambulance availability for high-risk conditions; b) digital tools to improve planning and coordination among health workers; c) inclusion of screening indicators for social isolation as a risk factor; and d) incentivization of beneficiaries for referral completion. We are in the process of sharing these findings with the district and state government of Rajasthan.