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Background: Disaster and mental health preparedness are inseparable domains highlighted during all the major disasters in India. To build Disaster-Mental health Preparedness (Disaster MHP), one has to understand the existing strategies, systemic efforts, and ground-level implementation. In this scoping review, we have analyzed the mental health preparedness efforts during major disasters in India. Methodology: We followed the Peters MDJ et al framework for scoping review named ‘Guidance for conducting systematic scoping reviews. This included the searching relevant articles on PubMed and google Scholar, and concept-context of the review. Results: The review identified major efforts taken during ten disasters in past 40 years and mapping of the potential areas for development of sustainable efforts towards Disaster MHP. Conclusion: This is the first systematic scoping review from India that provides insight into strength and sustainability of disaster mental health preparedness in India. The mapping of the review focuses on the models emerged from Bhopal, Odisha, Tamilnadu and NIMHANS for the future infrastructure, capacity building, and environment required for Disaster-MHP in India.

Context: Competitive exams conducted for undergraduate and postgraduate medical courses in India are tough. The undergraduate course is additionally taxing to the students' health. Lack of physical activity, the stress of studies, and universal adoption of different gadgets make the undergraduate medical students prone to develop musculoskeletal pain-related issues. Aims: This study aimed to evaluate the prevalence of neck pain and the associated factors including gadget use among undergraduate medical students of a premier medical college in central India. Settings and Design: All undergraduate medical students including the interns of our institute were enrolled for this cross-sectional study. Methods and Materials: A self-explanatory internet-based questionnaire prepared using Kobo Toolbox was circulated via WhatsApp and email by the class representative of each batch of students. The responses obtained were analyzed using Statistical Package for the Social Sciences (SPSS). Statistical Analysis Used: Proportions and means were calculated. Chi-square test and univariable logistic regression analysis were used. Results: Three hundred thirty-one valid responses out of 423 responses were analyzed. In total, 58.3% of 331 students suffered from neck pain within the last one year. Students in the 3rd and 4th year had 2.9 times higher odds of current neck pain in comparison to 1st-year students. History of neck pain before joining the course was associated with a higher risk of having current neck pain. Self-perceived aggravation of pain from gadget use had significantly higher odds of contributing to the current episode of neck pain. Conclusions: Neck pain is not uncommon among undergraduate medical students. History of previous neck pain including that during schooling makes a student prone for the current episode of pain. Academic stress, smartphone and laptop use tend to aggravate the pain in those who have neck pain.

BackgroundExcessive consumption of Sugar Sweetened Beverages (SSBs) in adolescents has become a global issue. As its link to obesity and non-communicable diseases is clear, it is imperative to understand SSB consumption behaviours in the future healthcare professionals.ObjectiveTo document the prevalence, patterns and clinic-social and behavioural factors predicting high intake of SSBs among medical students.MethodsThis cross-sectional study was conducted using a self-reported, web-based, questionnaire. All the students and interns who were part of a publicly funded premiere teaching hospital during October and November 2019 were included. The semi-structured questionnaire enquired regarding socio-demographic, clinical details, amount, behavioural patterns and money spent in connection with SSB consumption. Data were analysed using IBM SPSS version 24.ResultsThe mean (SD) age of participants was 19.3 (1.6) years, 71.7% being males. The current prevalence of SSB consumption was 90.5 %. Also, 49.9% and 29.1% participants preferred soft drinks and sweetened fruit juice respectively. Multivariable analysis showed that male gender (aOR 1.83, 95% CI 1.03-3.25), current alcohol consumption (aOR 4.09, 95% CI 1.25-13.42), and recent (last week) consumption of a SSB predicted high intake of SSBs (aOR 7.36, 95% CI 3.41-15.87) whereas, preference of energy/sports category of drinks predicted low intake of SSBs (aOR 0.10, 95% CI 0.02-0.47).ConclusionThe consumption of SSBs among medical students was high. Targeted health education and behaviour change interventions should be provided to males, alcohol users and frequent consumers.

Public health care facilities in Sonipat District, Haryana State, India.To assess 1) the proportion of tuberculosis (TB) patients screened for diabetes mellitus (DM) and vice versa, 2) factors associated with screening, and 3) the enablers, barriers and solutions related to screening.A mixed-methods study with quantitative (cohort study involving record reviews of patients registered between November 2016 and April 2017) and qualitative (interviews of patients, health care providers [HCPs] and key district-level staff) components.Screening for TB among DM patients was not implemented, despite documents indicating that it had been. Of 562 TB patients, only 137 (24%) were screened for DM. TB patients registered at tertiary and secondary health centres were more likely to be screened than primary health centres. Low patient awareness, poor knowledge of guidelines among HCPs, lack of staff and inadequate training were barriers to screening. Enablers were the positive attitude of HCPs and programme staff. The key solutions suggested were to improve awareness of HCPs and patients regarding the need for screening, training of HCPs and wider availability of DM testing facilities.The implementation of bidirectional screening was poor. Adequate staffing, regular training, continuous laboratory supplies for DM diagnosis and widespread publicity should be ensured.Structures de santé publiques du district de Sonipat, état d’Haryana, Inde.1) Evaluer la proportion de patients avec la tuberculose (TB) ayant eu une recherche de diabète (DM) et vice-versa, 2) les facteurs associés à ce dépistage ; et 3) les facilitateurs, les contraintes et les solutions relatifs au dépistage.Une étude à méthodes mixtes comportant des composants quantitatifs (étude de cohorte basée sur une revue des dossiers des patients enregistrés entre novembre 2016 et avril 2017) et qualitatifs (entretiens avec des patients, des prestataires de soins de santé [HCP] et du personnel clé du district).Le dépistage de la TB parmi les patients DM n’a pas été mis en œuvre, malgré les documents indiquant qu’il l’avait été. Sur 562 patients TB, seulement 137 (24%) ont été dépistés à la recherche de DM. Les patients TB enregistrés dans des centres de santé tertiaires et secondaires ont été plus susceptibles d’être dépistés, comparés à ceux des centres de santé primaires. La faible sensibilisation des patients, une connaissance médiocre des directives parmi les HCP, le manque de personnel et une formation insuffisante ont été les contraintes au dépistage. L’attitude positive des HCP et du personnel du programme a favorisé le dépistage. Les solutions principales suggérées ont été d’améliorer la sensibilisation des HCP et des patients en matière de nécessité du dépistage, de la formation des HCP et de la plus grande disponibilité des structures de recherche du DM.La mise en œuvre du dépistage bidirectionnel a été médiocre. Il faut assurer suffisamment de personnel, une formation régulière, des fournitures de laboratoire continues pour le diagnostic du DM ainsi qu’une vaste propagande.Establecimientos de atención de salud en el distrito Sonipat, del estado de Haryana en la India.1) Evaluar la proporción de pacientes con tuberculosis (TB) en quienes se practica el tamizaje de la diabetes (DM) y vice versa; 2) los factores asociados con la práctica del tamizaje; y 3) los factores facilitadores, los obstáculos y las soluciones en materia de detección sistemática.Fue este un estudio de métodos mixtos con componentes cuantitativos (estudio de cohortes a partir de las historias clínicas de los pacientes registrados de noviembre del 2016 a abril del 2017) y componentes cualitativos (entrevistas a los pacientes, los proveedores de atención de salud [HCP] y miembros clave del personal distrital).La detección sistemática de la TB en los pacientes con diagnóstico de DM no se practicaba, pese a los documentos que afirmaban lo contrario. De los 562 pacientes con TB, solo en 137 (24%) se practicó el tamizaje de la DM. La probabilidad de recibir el tamizaje fue mayor en los pacientes con TB registrados en los centros de atención terciaria y secundaria, que en los registrados en centros de atención primaria. Los obstáculos al tamizaje fueron la escasa sensibilización de los pacientes, el desconocimiento de las directrices por parte de los HCP, la escasez de personal y la capacitación deficiente. Los factores que facilitaron la práctica del tamizaje fueron la actitud positiva de los HCP y del personal del programa. Las principales soluciones propuestas fueron reforzar la sensibilización de los HCP y los pacientes con respecto a la necesidad del tamizaje, la capacitación de los HCP y una mayor disponibilidad de establecimientos que practiquen las pruebas de la DM.La ejecución de la detección sistemática recíproca era deficiente. Es necesario procurar una dotación adecuada de personal, realizar capacitaciones periódicas y velar por un abastecimiento continuo de suministros de laboratorio para el diagnóstico de la DM, además de realizar extensas campañas de comunicación.

Background: Consumption of excessive sugar sweetened beverages (SSBs) has been linked to non-communicable diseases. It is imperative to understand the perceptions regarding taxation and health warnings amongst the medical students, since they are important stakeholders and as there is some evidence that the government may introduce these soon. Objective was to document the awareness and perceptions about taxation and health warnings on SSBs and the predictors of decreasing consumption of SSBs with regards to their future implementation.Methods: This cross-sectional study was conducted among all the undergraduate medical students of a premier teaching hospital of central India during October and November 2019. A web-based self-administered semi-structured questionnaire was used for data collection using Kobo toolbox. Data were analysed using the SPSS software version 24 (IBM SPSS).Results: About three fourths of the study participants were not aware of any taxes on SSBs and had never seen any health warning on SSB packaging. Multivariable logistic regression analysis showed that those aged ≥ 20 were not in favour of decreasing SSB consumption if health warning is present. Participants who were females, whose fathers were professionals, had consumed SSB in the previous seven days, were aware of taxes and those with inadequate sleep were not in favour of decreasing SSB consumption if taxes are increased.Conclusions: There is a need to include health education regarding the harmful effects of consumption of SSBs and to make aware of the benefits of the taxes and warning labels beginning from school days and continued during medical schools.

Background and Aims: There is paucity of data regarding some of the lesser known contextual and epidemiological factors with respect to road traffic injuries (RTIs). The objective was to study the epidemiological profile of RTI victims attending an emergency department of a tertiary care trauma center. Methods: The present study was a hospital-based cross-sectional study conducted in the emergency department of a tertiary care trauma center in New Delhi. All patients of RTI attending the emergency department during the designated data collection days were included in the study. Patients brought dead were excluded from the study. A semi-structured interview schedule was developed for collecting data on various domains such as sociodemographic characteristics, vehicle-related factors, accident site-related factors, personal protection measures, contextual factors, and prehospital care-related factors. Results: A total of 984 patients and informants were approached and finally data of 900 participants were analyzed after excluding those who refused participation and those for whom incomplete data were available. Out of 900 RTI victims, 756 were male (84.0*) and 144 (16.0*) were female. Mean age of the victims was 32.7 years. Most of the victims, i.e., 377 out of 900 (41.9*) were occupants rather than drivers. Majority of victim's vehicle meeting accidents were motorized two-wheelers (53.4*), and majority of the colliding vehicle was a four-wheeler (39.3*). Helmet use was found to be low (63.3*), but seat belt use was particularly low (32.4*). Most accidents (28*) happened between midnight and 6 A.M. More than half of the victims were in a hurry on the day of the accident. An ambulance was used to transport the victims in only 14.6* cases. Conclusion: In road traffic accidents some lesser known epidemiological data were generated that may be useful in defining preventive measures.

Background: Declining child sex ratio in India even after enactment of PCPNDT Act is a major concern from public health point of view. Objectives: 1) To find out the perceived reasons and preference for the gender of the prospective child 2) to find out practices related to ultrasound (USG) scanning during pregnancy and abortion and 3) to find out the child sex ratio in the selected urban field practice areas of JIPMER, Pondicherry. Methods: A community-based explorative study was conducted during the months of June and July 2013. A pre-tested semi-structured questionnaire was used to collect information on the socio-demographic details, sex preference for the prospective child, and practices related to USG scanning during pregnancy and abortion among 270 households in the study area of urban Puducherry. One Focus Group Discussion (FGD) was organized to explore and understand the qualitative aspect of gender preference in the study area. Results: Among the respondents who had not completed their families (67), majority (60%, 40/67) didn’t have any gender preference. Out of the rest 27, 16 respondents (60%) preferred their prospective child to be male. The common reasons for male preference were 1 st child being female, dowry and other financial reasons. Majority (62%) of the USG during pregnancy were done in private set up. Nearly three fourth of the abortions took place either in private set up or at home. Nearly 37 % of respondents felt that proportion of females was less in their area as compared to males. Nearly 6% (16/270) of the respondents were aware of existence of practice of sex determination and female foeticide in their area. The child sex ratio was found to be 1012 per 1000 males. Conclusions: Male preference in the backdrop of higher proportion of practice of abortion in the private set up, along with participants’ awareness of existence of sex determination practices points towards plausible female foeticide. There is a need to generate stronger evidence to confirm these suspected links.

In the recent years, outbreaks of blood-borne infections have been reported from assisted living facilities, which were traced back to improper blood glucose monitoring practices. Needle-stick injuries have been implicated in many such cases. This directly raises concerns over sharp disposal practices of diabetic patients self-managing their condition in home care settings. With India being home to a huge diabetic population, this issue, if neglected, can cause substantial damage to the health of the population and a marked economic loss. This article discusses the sharp disposal practices prevalent among diabetes patients, the importance of proper sharp disposal, barriers to safe disposal of sharps, and the options available for doing the same. For adopting an environmentally safe wholesome approach, disposal of plastics generated as a result of diabetes self-care at home is important as well. The article also looks at the possible long-term solutions to these issues that are sustainable in an Indian context.

Health-related quality of life is an important, yet neglected aspect of chronic kidney disease (CKD) care. We evaluated the quality of life and its determinants across CKD 3 to 5D using a kidney disease specific tool (Kidney Disease Quality of Life-SF™) in an underprivileged, predominantly rural population with high rates of illiteracy and unemployment. The scores of individual domains were summarized to three composite scores - physical composite summary (PCS), mental composite summary (MCS), and kidney disease component summary score (KDCS). A total number of 204 participants were recruited from nephrology outpatient clinics. About 68.1% of participants were males. The mean age of the study population was 49.14 ± 13.63 years. There was a high proportion of illiteracy (36.3%) and unemployment (80.9%). KDCS showed a significant decline (P = 0.01) from CKD 3 to CKD 5D whereas MCS and PCS showed a nonsignificant decrease. There was no difference in KDCS, PCS, or MCS scores between patients treated by hemodialysis and CAPD. Illiteracy and unemployment were associated with significantly lower KDCS, PCS, and MCS scores. Age ≥50 years was associated with poor PCS (29.49 ± 8.20 vs. 34.17 ± 9.99; P < 0.001). Hemoglobin

Background: One key barrier to proper management of common cardio-metabolic conditions such as diabetes and hypertension in primary care is inadequate adherence to treatment, which, in many cases, results from inadequate follow-up at scheduled appointments. In addition to provider and health system level factors, individual patient level factors are also associated with attendance at follow-up appointments. Objective: To document the association of diabetic, hypertensive diabetic, and hypertensive patient's demographic and clinical factors with showing up inadequately at scheduled appointments. Methods: A record-based retrospective follow-up study was conducted in an urban primary health center of Puducherry from January to March 2015. Registered diabetic, hypertensive diabetic, and hypertensive patients who made at least one visit between July and December 2014 were included. Data on demographic factors, clinical factors, and dates of visits to the clinic were collected from case records of patients and were entered in EpiData entry version 3.1. Analysis was performed using R statistical package. Results: Out of 366 patients, 79% were females and 70.2% were aged >50 years. It was found that 183 (50%) were diabetic, 266 (72.7%) were hypertensive, and 115 (31.4%) were hypertensive diabetic. Out of 366 patients, all the five follow-up visits were attended by 185 (50.6%) patients, and “adequate follow-up” was found in 123 (33.6%) patients. Young, underweight, and obese patients were more likely to have inadequate follow-up. Conclusion: Family physicians should give special attention to these groups in their routine practice along with providing targeted health education and implementing full proof mechanisms to track them.

Recent National Mental Health Survey (2015-16) reported a prevalence of 13.7% for any mental disorders excluding tobacco use disorders in India. Translating it into real numbers, nearly 150 million people need active mental health interventions, disproportionately more in rural areas. Major challenges in delivering comprehensive mental health services in rural India are: a) lack of a well-defined strategy; and b) lack of trained mental health manpower. To fill this gap, the global mental health community has increasingly realized the importance of Community Health Workers (CHWs) and role of stepped care approach in mental health service delivery. We propose a model of stepped care approach to fulfil the need of rural India, utilizing the existing health system components for improving mental health knowledge, reducing social stigma for mental disorders, screening for priority mental disorders at community level, ensuring compliance to treatment, timely follow-up, and community-based rehabilitation by mobilising community support for diagnosed cases. This stepped care approach will integrate mental health into Ayushman Bharat’s Health and Wellness Centres (HWCs) for the provision of comprehensive primary health care. Integration of new age technologies such as telepsychiatry, e-health, and mHealth into the proposed model will make it feasible and cost-efficient for inaccessible parts of the country.

Introduction: The incidence of Acute respiratory infections (ARI) is high among under-five children, especially in developing countries. However, the data on ARI from rural and urban areas in India are scarce. Objective: To estimate the prevalence of ARI and selected associated factors among under-five children. Materials and Methods: A community-based cross-sectional study was conducted in urban and rural areas of Puducherry, India. Data were collected from 509 parents of under-five children regarding ARI incidence along with socio-demographic and selected associated factors. Results: Overall prevalence of ARI was observed to be 59.1%, with prevalence in urban and rural areas being 63.7% and 53.7%, respectively. Bivariate analysis indicated that overcrowding, place of residence, and mother's education were significantly associated with ARI. Multiple logistic regression analysis suggested that presence of overcrowding (adjusted odds ratio [AOR] = 1.492), urban residence (AOR = 2.329), and second birth order (AOR = 0.371) were significant predictors of ARI. Conclusion: The prevalence of ARI is high, particularly in urban areas. Improvement of living conditions may help in reduction of burden of ARI in the community.

BACKGROUND: Limited information exists in India about the awareness and perception of the people regarding pictorial health warnings (PHWs) and text warnings on tobacco products, more so from rural areas. Objectives were to report the awareness of these warnings, factors predicting awareness and perceived effectiveness of PHWs, and understanding of their content in a rural population. MATERIALS AND METHODS: A community-based cross-sectional study was conducted in two villages (chosen randomly out of total four) in the rural field practice area of a tertiary care teaching hospital in Puducherry. Households were selected by systematic random sampling. All persons ≥18 years and residing in the area for at least 6 months were included. Data regarding awareness and perception of participants was collected through a semi-structured interview schedule. RESULTS: A total of 428 participants were recruited; 197 (46%) were male, and 231 (54%) were female. The mean age of the participants was 38.9 (standard deviation 15.0) years. Awareness of PHWs and text warnings was 39.5% (169/428) and 21% (90/428), respectively. Only 11.2% participants perceived PHWs as effective. Most (45%) of the participants had a vague understanding of the content of PHWs. On multivariate logistic regression, male gender, current tobacco use, and better education emerged as predictors of greater awareness of PHWs. Extended family predicted greater perceived effectiveness of PHWs, whereas, high socioeconomic class and middle school completion predicted lower perceived effectiveness of PHWs. CONCLUSION: Awareness and perceived effectiveness of adults in rural Puducherry regarding PHWs were low. There is a need to create awareness through education and using meaningful, larger pictures.

Background: Quality of Life (QOL) among elderly is a neglected issue especially in developing countries including India. Aim: To assess the QOL and its associated factors among elderly population. Materials and Methods: A community based cross-sectional study was conducted among 300 elderly subjects in urban Puducherry, India. Data on QOL was assessed by World Health Organization Quality of Life BREF (WHOQOL-BREF) and Activities of Daily Living (ADLs) by Katz ADL scale. Socio-demographic factors and chronic morbid conditions were recorded by using structured questionnaire. Statistical Analysis: Independent sample test and multiple linear regression analysis. Results: Majority (64%, 192) were in the (60-69) years’ age-group. Overall mean Standard Deviation (SD) score of QOL was 49.74 (10.21). QOL was significantly low among those with no schooling, nuclear family, not receiving pension, not with partner, having musculoskeletal disorder, low vision and impaired ADL groups in univariate analysis. Multiple linear regression analysis revealed that older age (p=0.014), no schooling (p=0.004), without spouse (p=

Background: More than half of cases with diabetes mellitus in India remain undiagnosed. Considering factors on yield and availability of resources, population-based screening is not recommended in low- and middle-income countries. Evidences on feasibility of opportunistic screening for diabetes mellitus and follow-up in rural settings are scarce. Objective: To estimate the proportion of undiagnosed diabetes mellitus among individuals aged 30 years or more attending a primary health center, and to identify factors influencing yield of such an opportunistic screening. Materials and Methods: Individuals aged 30 years and above attending a rural health center were screened for diabetes mellitus (using random blood sugar test) and for noncommunicable diseases risk factors. People who had random blood sugar level 140 mg% or more were advised to come for the follow-up visit to confirm the diagnosis. Study participants with fasting blood sugar level of ≥126 mg/dL (7.0 mmol/L) and/or 2-h postprandial blood sugar level of ≥200 mg/dL (11.1 mmol/L) were diagnosed as having diabetes mellitus. Result: Of 400 eligible participants, 81 (21.3%) had a random blood sugar level of 140 mg% or more. A total of 18 participants (4.5%) were newly diagnosed with diabetes mellitus. Overall, the number needed to screen a case of diabetes mellitus was 22. The number needed to screen was least among males (12) and highest among females (43). Conclusion: In primary care settings where more than half of the cases were unidentified in the community, opportunistic screening can be a feasible strategy to find out missed cases.

Background: Women facing domestic violence are likely to seek medical care but are likely not to report the cause as domestic violence. Objective: To find out the yield of screening for domestic violence among ever-married adult women visiting an urban primary health-care center and to understand the health consequences and perception of women affected by domestic violence regarding selected aspects of the same. Materials and Methods: This hospital-based, cross-sectional study was conducted in an urban health center attached to a tertiary care institution in Puducherry during October and November 2014. All adult women who had married at least once in their lifetime, and visited the outpatient department of the urban health center during the study period, either as patients or as patients’ attenders, were included in the study. Anonymized data were collected using a pretested semi-structured questionnaire. Questions assessed whether participants had ever faced or currently facing any physical, emotional, or sexual violence after marriage. Results: Reportedly, 133 (57.3%) participants have experienced some form of domestic violence after marriage; of which, 68 (51.1%) had faced it in the last 1 year. Physical, emotional, and sexual violence was reported by 105 (45.3%), 110 (47.4%), and 26 (11.2%) participants, respectively. Both physical and emotional violence were faced by 89 (38%) women. Arguing with husband was perceived by most women as the most common cause of violence (about 43%). About 34.4% women cited the reason for not speaking about violence to someone else as not being helpful. Conclusion: Screening for domestic violence was feasible in urban health center, the yield being high.

Acute respiratory infections (ARIs) are the leading cause of death among children less than 5 years in India. Emergence of newer pathogenic organisms, reemergence of disease previously controlled, wide spread antibiotic resistance, and suboptimal immunization coverage even after many innovative efforts are major factors responsible for high incidence of ARI. Drastic reduction in the burden of ARI by low-cost interventions such as hand washing, breast feeding, availability of rapid and feasible array of diagnostics, and introduction of pentavalent vaccine under National Immunization Schedule which are ongoing are necessary for reduction of ARI.