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Background: Healthcare professionals, students, and workers are vital change agents in the global battle against tobacco. Yet, it’s important to note a concerning trend: there’s a high prevalence of tobacco use among them in India, although data on this is limited. Objective: This study aimed to assess tobacco use prevalence, awareness of related laws, and attitudes among healthcare professionals, students, and staff in Bihar and Jharkhand, India. Methodology: In July and August 2023, we conducted an extensive cross sectional, online survey across 24 tertiary healthcare institutions. Participants included a diverse group of medical, dental, and nursing students, faculty, resident physicians, nursing professionals, and support staff. The survey covered sociodemographic factors, tobacco use, awareness of laws (26 items) [a: 0.924), compliance practices (9 items) (a: 0.929), and perceptions of tobacco control (10 items) (a: 0.728). Results: Our research revealed a significant prevalence of tobacco use: 15.9% reported current use, with 9.6% as daily users. Notably, awareness levels differed noticeably between users and non-users, with non-users displaying deeper knowledge of tobacco-related laws in 61.5% of cases. Our multifactor logistic regression models for current (R2: 0.184, PAR: 84.1%) and daily tobacco use (R2: 0.203, PAR: 90.4%) highlighted various associated factors, including age, gender, marital status, occupation, family income, and native state. Importantly, insufficient awareness emerged as a key factor, correlating with higher chances of current and daily tobacco use. Regional differences were evident, with lower prevalence in southern states. A majority of faculty (90.0%) and students (93.6%) expressed the need for increased emphasis on tobacco control in healthcare curricula. Conclusion: Our research highlights disparities in healthcare tobacco use, influenced by age, gender, marital status, occupation, income, and location. Awareness plays a crucial role, emphasizing the need for integrating tobacco education into curricula and sustaining awareness campaigns to address this issue effectively

Background: Loss to follow up of tuberculosis patient during diagnosis is an important barrier to achieve elimination of TB by 2025 in India. This study estimated the burden and trend of loss to follow up of TB patient during diagnosis, explored tuberculosis patient’s perspective for becoming Loss To Follow Up during diagnostic period (LTFU) and stakeholders’ initiatives and suggested solutions for the same. Methods: Mixed Method study was used - Quantitative (Record based cohort study) and Qualitative (In – depth interview with LTFU patients on their challenges faced and barriers for not giving 2nd sputum sample and free list with stakeholders). Data were extracted from RNTCP Laboratory Register for the cohort of patients registered between January 2014 and December 2018 in a DMC of tertiary care teaching hospital. Qualitative interviews were carried out using interview guide. Results: Of the total 1678 positive cases, 90 (5.3%) were LTFU. On adjusted analysis distance >75km from medical college (Relative risk 2.3; 95%CI: 1.2-4.3) and year of diagnosis were identified as significant risk factors. In Manual content analysis showed five categories of challenges faced by LTFU cases namely 1) lack of awareness; 2) addictions; 3) stigma; 4) Employment related barriers and 5) perception on drug side effects. Free listing conducted between staffs of hospital and from stakeholders the main suggested solutions identified were 1) context-based counselling; 2) friendly patient tracking; and 3) proactive in-service. Conclusion: There was significantly decreasing trend in LTFU patients over the years (in 2014 – 6% to 0.5% in 2018). Co-ordinated context-specific pro-active interventions are required to achieve End TB strategy of the nation

Background. Reflective practice is an integral component of continuing professional development. However, assessing the written narration is complex and difficult. Rubric is a potential tool that can overcome this difficulty. We aimed to develop, validate and estimate inter-rater reliability of an analytical rubric used for assessing reflective narration. Methods. A triangulation type of mixed-methods design (Qual-Nominal group Technique, Quan-Analytical followup design and Qual-Open-ended response) was adopted to achieve the study objectives. Faculties involved in the active surveillance of Covid-19 participated in the process of development of assessment rubrics. The reflective narrations of medical interns were assessed by postgraduates with and without the rubric. Steps recommended by the assessment committee of the University of Hawaii were followed to develop rubrics. Content validity index and inter-rater reliability measures were estimated. Results. An analytical rubric with eight criteria and four mastery levels yielding a maximum score of 40 was developed. There was a significant difference in the mean score obtained by interns when rated without and with the developed rubrics. Kendall's coefficient of concordance, which is a measure of concordance of scorers among more than two scorers, was higher after using rubrics. Conclusion. Our attempt to develop an analytical rubric for assessing reflective narration was successful in terms of the high content validity index and better inter-rater concordance. The same process can be replicated to develop any such analytical rubric in the future. [ABSTRACT FROM AUTHOR]

Byline: Suguna. Elayaperumal, Vinayagamoorthy. Venugopal, Amol. Dongre Background: As a part of initiating community-based palliative care program in the field practice areas of Urban Health Training Centre (UHTC), Villupuram, it [...]

Introduction: Assessment is a critical step in learning process. Postgraduate theory examination ideally should assess higher levels of cognition. In order to maintain high standard of public health the postgraduates of the specialty should be certified properly using the appropriate assessment methods. Since the assessment drives learning, ideally it should be aimed at judging a learner's attainment of curriculum outcomes. Aim: To evaluate the postgraduate theory exam question papers from 2014 to 2018 in Community Medicine (CM) of various South Indian Universities and to measure the actual content coverage as stated in National Medical Commission (NMC) curriculum and cognitive domain coverage as per Bloom's taxonomy. Materials and Methods: The present retrospective analytical study was conducted from April 2019 to July 2019 to asses the question papers from 2014-2018 in community medicine. Sixty theory exam question papers (20 per University) of last 5 years of three South Indian Universities namely Pondicherry (PU), Tamil Nadu (TN), and Kerala (KR) of CM subject were analysed for content coverage and to categorise the level of knowledge assessed as per Bloom's taxonomy. The significance of difference between the data of various years was tested using Chi-square test. Results: Questions testing higher cognitive domain was found only in 15%, 3.75% and 2.5% of PU, TN and KR universities, respectively. Epidemiology of communicable and noncommunicable diseases was the content that received maximum coverage of total marks, 25%, 21.25% and 18.5% in PU, TN and KR universities respectively. Certain topics were not covered in many papers. There was no statistical difference in distribution of marks among various Universities in South India. Conclusion: Findings of this study may be used to redefine the distribution of contents and cognitive domain tested across universities ensuring the validity and reliability of the assessment. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic status (SES) is a key determinant of health. However, ascertaining the SES in developing countries is really challenging. Hence, we decided to develop an asset-based simple and rational SES tool for urban population of Puducherry and compare it with Modified Kuppuswamy's (MK) scale. Materials and Methods: Sequential mixed methods design was used. The list of local household assets to determine SES was created based on group interviews with stakeholders and review of literature. Then, survey was carried out among 500 urban households by trained medical interns after obtaining informed consent. EpiCollect-5, mobile-based software, was used to capture data. Principal component analysis (PCA) was carried out to construct a wealth index using SPSS version 24. The assets included in the final PCA were ranked based on their contribution to the index by linear regression. Results: The eigenvalue for the first principal component was 6.7 accounting for 33.6% of the variance in the original data. Finally, reduced 10-item-based SES scale was created and scoring system was formulated based on regression coefficient. The weighted kappa statistics and correlation coefficient measure of reliability between household quintiles on 20-item and 10-item reduced SES tool were 0.77 and 0.95, respectively. There was a moderate correlation between SES obtained from MK scale and newly constructed scale. Conclusions: The newly devised SES scale is context specific, reliable, easy to administer, and quick to ascertain the SES and thus can be used for a similar context in future health research. [ABSTRACT FROM AUTHOR]

Introduction: Injury morbidity and mortality have been steadily increasing in both developed and developing countries including India. The current study tried to assess the incidence of injury and identify the risk factors associated with injuries during the festival month in a selected urban area in Puducherry. Methods: It is a community-based cross-sectional survey conducted among the residents in the urban field practice area of a medical college in Puducherry. Participants were interviewed using a pretested questionnaire. Information on the incidence of injury and its associated factors were collected. Data were entered in EpiData and analyzed using Stata. Generalized linear models with Poisson distribution were used to identify the risk factors associated with the injuries. Results: Overall, 1380 participants from two selected clusters were interviewed. The incidence rate of injuries was 5.2% (95% CI: 4.0–6.4). In adjusted analysis male (RR 1.96, 95% CI: 1.15–3.37) and student (RR 2.91, 95% CI: 1.13–7.54) were independently associated with having an injury. Most of the injuries were unintentional and accidental. Conclusion: The reported incidence of at least one injury was 52 per 1000 population per month and the majority were accidental in nature. It was higher during the festival week. Public health strategies at the primary healthcare level targeting adult males and school children will be effective in the reduction and prevention of injury. [ABSTRACT FROM AUTHOR]

Background: Previously, we had a course in epidemiology for medical undergraduates that was based on traditional lecture methods with no formal formative assessment (FA). We found poor uptake of our course in terms of learning and attendance by students. Objective: The objective was to assess the effect of improved course (interactive lectures and formal FA) in epidemiology on student learning and attendance. Materials and Methods: It was a triangulation type of mixed-methods program evaluation, where both quantitative (quasi-experimental design) and qualitative (open-ended responses) analysis was done. This study was carried out in the department of community medicine in a tertiary care teaching hospital, Puducherry. We improved the quality of the course material, interaction in lectures and included formal structured FA in the last course. Kirkpatrick's framework was used for the course evaluation. We compared the performance of three batches to check the effect of our revisions on students' learning and their attendance. Results: Student's learning outcome was measured using end-of-course assessment scores (Level-2). The percentage of students successfully completing the course improved from 39% to 81% and attendance status of ≥90% improved from 50% to 57%. Learner's immediate reactions (Level-1) were captured using open-ended questions, and content analysis was done. Students appreciated the course material, FAs, and in-class activity. Conclusions: Little improvement in a traditional epidemiology course for undergraduates in the form of interactive lectures and formative feedback and providing the student with course material led to significant gains in students' knowledge and attendance. [ABSTRACT FROM AUTHOR]

Background: Hair dyes are commonly used for the concealment of grey hair in India. The pigmentary alterations produced by hair dyes on the face and neck have not received sufficient attention. Aims: To study the pigmentary alterations on the face and neck in hair dye users, and identify possible risk factors associated with the face and neck hyperpigmentation. Methods: A hospital-based descriptive cross-sectional study was done on consecutive hair dye users. A detailed history was taken, and a clinical examination was done to record the pigmentary alterations. The patterns, areas affected, the intensity of hyperpigmentation, percentage of the area involved and risk factors were noted. Results: One hundred and twenty patients were included in the study. Around 118 (98.3%) patients had hyperpigmentation over face and/or neck: 16 (13.3%) barely perceivable, 40 (33.3%) mild, 44 (36.7%) moderate, and 18 (15%) severe pigmentation. The lateral forehead (106, 88.3%), the helix of the ear (106, 88.3%), central forehead (97, 80.8%), and zygomatic area (92, 76.7%) were the most frequently affected areas in our study. Fourteen patients (11.7%) had depigmented macules on the scalp and/or lips. Conclusion: Pigmentary alterations, particularly hyperpigmentation over the upper face and ears are common with the use of hair dyes. The skin type may play a role in the intensity of hyperpigmentation. [ABSTRACT FROM AUTHOR]

Background: Burden of metabolic syndrome (MS) is rising. There were many previous studies conducted in India on MS, yet it is less studied in Puducherry which has embraced modern culture and lifestyle. Hence, we aimed to study the prevalence and predictors of MS. Materials and Methods: A cross-sectional study was undertaken on a representative sample of 489 adults of age 30 years and above over the period of 18 months. MS was defined according to the International Diabetes Federation (IDF) criteria. Data on sociodemography, lifestyle characteristics, and biochemical parameters were collected by a well-trained health professional using standard methods. Generalized linear models with Poisson distribution and log link function were used to calculate the adjusted prevalence ratio (PR). Results: The prevalence of MS was 39.7% (95% confidence interval [CI]: 35.3-44.1) among the study participants. The most commonly deranged component of MS was central obesity (63.6%). Increasing age, upper socioeconomic status, low fruit intake, physical inactivity, use of refined sunflower oil (PR: 1.40, 95% CI: 1.07-1.83) for cooking, and high perceived stress (PR: 1.77, 95% CI: 1.32-2.37) were found to be associated with MS. Conclusion: The prevalence of MS in Puducherry was high as per the IDF criteria. Usage of refined sunflower oil for cooking and perceived stress was independently associated with an increased risk of MS along with other routinely studied risk factors. [ABSTRACT FROM AUTHOR]